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This is VAERS ID 1088367

History of Changes from the VAERS Wayback Machine

First Appeared on 3/11/2021

VAERS ID: 1088367
VAERS Form:2
Age:98.0
Sex:Female
Location:Puerto Rico
Vaccinated:2021-02-04
Onset:2021-02-24
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Arteriosclerosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-24
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid, Prilosec, Imdur, ASA, Valium, Lipitor, Toprol, Vitamin d3 10,000 Units, Remeron, Restoril, Fosamax, Norvasc, Iron vitamin, Buspar, Seroquel
Current Illness:
Preexisting Conditions: Hypothyroidism, Diabetes, Osteoporosis, Chronic Ischemic Heart Disease, Bedridden
Allergies: None were reported
Diagnostic Lab Data:
CDC 'Split Type': PR-53-21

Write-up: Person of contact spent around 10 minutes in the room, spoke with the resident, left the room. When the caregiver came into the room with the resident lunch the resident was without vital signs. Dxn: Atherosclerotic Heart Diseases


Changed on 5/7/2021

VAERS ID: 1088367 Before After
VAERS Form:2
Age:98.0
Sex:Female
Location:Puerto Rico
Vaccinated:2021-02-04
Onset:2021-02-24
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Arteriosclerosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-24
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid, Prilosec, Imdur, ASA, Valium, Lipitor, Toprol, Vitamin d3 10,000 Units, Remeron, Restoril, Fosamax, Norvasc, Iron vitamin, Buspar, Seroquel
Current Illness:
Preexisting Conditions: Hypothyroidism, Diabetes, Osteoporosis, Chronic Ischemic Heart Disease, Bedridden
Allergies: None were reported reported
Diagnostic Lab Data:
CDC 'Split Type': PR-53-21

Write-up: Person of contact spent around 10 minutes in the room, spoke with the resident, left the room. When the caregiver came into the room with the resident lunch the resident was without vital signs. Dxn: Atherosclerotic Heart Diseases


Changed on 5/14/2021

VAERS ID: 1088367 Before After
VAERS Form:2
Age:98.0
Sex:Female
Location:Puerto Rico
Vaccinated:2021-02-04
Onset:2021-02-24
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Arteriosclerosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-24
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Synthroid, Prilosec, Imdur, ASA, Valium, Lipitor, Toprol, Vitamin d3 10,000 Units, Remeron, Restoril, Fosamax, Norvasc, Iron vitamin, Buspar, Seroquel
Current Illness:
Preexisting Conditions: Hypothyroidism, Diabetes, Osteoporosis, Chronic Ischemic Heart Disease, Bedridden
Allergies: None were reported reported
Diagnostic Lab Data:
CDC 'Split Type': PR-53-21

Write-up: Person of contact spent around 10 minutes in the room, spoke with the resident, left the room. When the caregiver came into the room with the resident lunch the resident was without vital signs. Dxn: Atherosclerotic Heart Diseases

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1088367&WAYBACKHISTORY=ON

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