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This is VAERS ID 1111924

History of Changes from the VAERS Wayback Machine

First Appeared on 3/19/2021

VAERS ID: 1111924
VAERS Form:2
Age:70.0
Sex:Female
Location:Montana
Vaccinated:2021-03-16
Onset:2021-03-17
Submitted:0000-00-00
Entered:2021-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003A21A / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-17
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: Prednisone 5mg QDay Folic Acid 1mg Q Day Colace Sodium 100mg BID Hydroxyzine 25mg 2 tabs TID Lactulose 40ml M, W, F Culturelle 1 capsule once daily Mircera 300mg IM once per month Prilosec 20mg once daily Gentamicin topical applied to cathe
Current Illness: ESRD HTN Dyslipidemia Skin Cancer Vitamin B12 Deficiency Osteoporosis
Preexisting Conditions: ESRD HTN Dyslipidemia Skin Cancer Vitamin B12 Deficiency Osteoporosis
Allergies: Scallops and clams, anaphylaxis
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient found demised at home on 3/17/2021

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1111924&WAYBACKHISTORY=ON


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