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This is VAERS ID 1111645

History of Changes from the VAERS Wayback Machine

First Appeared on 3/19/2021

VAERS ID: 1111645
VAERS Form:2
Age:94.0
Sex:Female
Location:Illinois
Vaccinated:2021-02-10
Onset:2021-03-18
Submitted:0000-00-00
Entered:2021-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / 2 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Areflexia, Death, Dysphagia, Oxygen saturation decreased, Productive cough

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-18
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:
Current Illness: Hx: CAD, HTN, GERD, anxiety
Preexisting Conditions: Hx: CAD, HTN, GERD, anxiety
Allergies: NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was a resident on a LTC wing. Received Covid-19 vaccine on 1/13/21 & 2/10/21. Pt stated she felt phlegm in her throat 3/14/21. On 3/15/21 patient started having trouble swallowing, and started needing supplemental oxygen for low oxygen saturation and needing suctioned for c/o being unable to swallow.. ST eval showed no gag reflex and inability to swallow effectively or safely. Pt needed 5L/O2 and unable to hold saturations above 90%. Patient became ?comfort care?, and passed away 3/18/21.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1111645&WAYBACKHISTORY=ON


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