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This is VAERS ID 1102443

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/19/2021

VAERS ID: 1102443
VAERS Form:2
Age:90.0
Sex:Male
Location:Colorado
Vaccinated:2021-01-27
Onset:2021-02-18
Submitted:0000-00-00
Entered:2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood lactic acid normal, Cough, Death, Fibrin D dimer increased, Oxygen saturation decreased, Pyrexia, Vomiting, Brain natriuretic peptide increased, Computerised tomogram thorax, Urine analysis normal, Troponin normal, Lung opacity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-25
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Abilify Tablet 5 MG (ARIPiprazole), Donepezil 10 mg HCl Tablet, Finasteride 5 mg Tablet, Levothyroxine Sodium Tablet 75 MCG, Lidoderm Patch 5 % (Lidocaine), Loratadine Tablet 10 MG, MiraLax Powder (PolyethyleneGlycol 3350) 17 gram, Omeprazo
Current Illness: The resident had dementia and was requiring increase assistance. The resident had been experiencing weight loss over the past few months. The resident was medicated for chronic pain.
Preexisting Conditions: The resident was wheelchair bound and dependent on staff for care.
Allergies: Pregabalin
Diagnostic Lab Data: 2/18/2021- CTA-PE of Chest performed at the hospital. Results- no evidence of pulmonary embolism. Scattered centrilobular nodules and groundglass opacities in the right lower lobe, right middle lobe and left lower lobe. Appearance is concerning for endobronchial infectious/inflammatory process such as aspiration pneumonia. The appearance is not compatible with covid pneumonia. 2/18/2021- UA - negative 2/18/2021- D-Dimer 1.55 (High) 2/18/2021- BNP 862 (High) 2/18/2021- Troponin WNL, Lactic Acid WNL,
CDC 'Split Type':

Write-up: On 2/18/2021 the resident spiked a fever of 101.7 and had decrease oxygen saturation down to 86% with a cough. The resident was transferred to the ER for evaluation. Per Advanced Directives resident was not treated with antibiotics and returned to the Nursing Home on 2/19/2021. The resident had several episodes of emesis and was placed on comfort measures. He dised on 2/25/2021.


Changed on 5/7/2021

VAERS ID: 1102443 Before After
VAERS Form:2
Age:90.0
Sex:Male
Location:Colorado
Vaccinated:2021-01-27
Onset:2021-02-18
Submitted:0000-00-00
Entered:2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood lactic acid normal, Cough, Death, Fibrin D dimer increased, Oxygen saturation decreased, Pyrexia, Vomiting, Brain natriuretic peptide increased, Computerised tomogram thorax, Urine analysis normal, Troponin normal, Lung opacity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-25
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Abilify Tablet 5 MG (ARIPiprazole), Donepezil 10 mg HCl Tablet, Finasteride 5 mg Tablet, Levothyroxine Sodium Tablet 75 MCG, Lidoderm Patch 5 % (Lidocaine), Loratadine Tablet 10 MG, MiraLax Powder (PolyethyleneGlycol 3350) 17 gram, Omeprazo
Current Illness: The resident had dementia and was requiring increase assistance. The resident had been experiencing weight loss over the past few months. The resident was medicated for chronic pain.
Preexisting Conditions: The resident was wheelchair bound and dependent on staff for care.
Allergies: Pregabalin Pregabalin
Diagnostic Lab Data: 2/18/2021- CTA-PE of Chest performed at the hospital. Results- no evidence of pulmonary embolism. Scattered centrilobular nodules and groundglass opacities in the right lower lobe, right middle lobe and left lower lobe. Appearance is concerning for endobronchial infectious/inflammatory process such as aspiration pneumonia. The appearance is not compatible with covid pneumonia. 2/18/2021- UA - negative 2/18/2021- D-Dimer 1.55 (High) 2/18/2021- BNP 862 (High) 2/18/2021- Troponin WNL, Lactic Acid WNL,
CDC 'Split Type':

Write-up: On 2/18/2021 the resident spiked a fever of 101.7 and had decrease oxygen saturation down to 86% with a cough. The resident was transferred to the ER for evaluation. Per Advanced Directives resident was not treated with antibiotics and returned to the Nursing Home on 2/19/2021. The resident had several episodes of emesis and was placed on comfort measures. He dised on 2/25/2021.


Changed on 5/14/2021

VAERS ID: 1102443 Before After
VAERS Form:2
Age:90.0
Sex:Male
Location:Colorado
Vaccinated:2021-01-27
Onset:2021-02-18
Submitted:0000-00-00
Entered:2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood lactic acid normal, Cough, Death, Fibrin D dimer increased, Oxygen saturation decreased, Pyrexia, Vomiting, Brain natriuretic peptide increased, Computerised tomogram thorax, Urine analysis normal, Troponin normal, Lung opacity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-25
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Abilify Tablet 5 MG (ARIPiprazole), Donepezil 10 mg HCl Tablet, Finasteride 5 mg Tablet, Levothyroxine Sodium Tablet 75 MCG, Lidoderm Patch 5 % (Lidocaine), Loratadine Tablet 10 MG, MiraLax Powder (PolyethyleneGlycol 3350) 17 gram, Omeprazo
Current Illness: The resident had dementia and was requiring increase assistance. The resident had been experiencing weight loss over the past few months. The resident was medicated for chronic pain.
Preexisting Conditions: The resident was wheelchair bound and dependent on staff for care.
Allergies: Pregabalin Pregabalin
Diagnostic Lab Data: 2/18/2021- CTA-PE of Chest performed at the hospital. Results- no evidence of pulmonary embolism. Scattered centrilobular nodules and groundglass opacities in the right lower lobe, right middle lobe and left lower lobe. Appearance is concerning for endobronchial infectious/inflammatory process such as aspiration pneumonia. The appearance is not compatible with covid pneumonia. 2/18/2021- UA - negative 2/18/2021- D-Dimer 1.55 (High) 2/18/2021- BNP 862 (High) 2/18/2021- Troponin WNL, Lactic Acid WNL,
CDC 'Split Type':

Write-up: On 2/18/2021 the resident spiked a fever of 101.7 and had decrease oxygen saturation down to 86% with a cough. The resident was transferred to the ER for evaluation. Per Advanced Directives resident was not treated with antibiotics and returned to the Nursing Home on 2/19/2021. The resident had several episodes of emesis and was placed on comfort measures. He dised on 2/25/2021.

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