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This is VAERS ID 1125778

History of Changes from the VAERS Wayback Machine

First Appeared on 3/26/2021

VAERS ID: 1125778
VAERS Form:2
Age:64.0
Sex:Female
Location:Mississippi
Vaccinated:2021-03-19
Onset:2021-03-20
Submitted:0000-00-00
Entered:2021-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Abdominal distension, Albumin globulin ratio decreased, Anion gap decreased, Blood albumin decreased, Blood calcium decreased, Blood creatine increased, Blood glucose normal, Blood urea increased, Carbon dioxide increased, Death, Full blood count abnormal, Haematocrit decreased, Haemoglobin decreased, Hypopnoea, Mean cell haemoglobin concentration decreased, Mean cell haemoglobin decreased, Nausea, Protein total decreased, Pulse abnormal, Pulse absent, Red blood cell count decreased, Unresponsive to stimuli, Vomiting, Mean platelet volume decreased, Blood urea nitrogen/creatinine ratio, Metabolic function test abnormal, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-21
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: Isosorbide Dinitrate (20mg TID); Lasix ( 40mg- BID); Omeprazole (20mg- Daily); Clonidine (0.1mg-BID); Trazodone (100mg- Daily)- Metoprolo Tartrate (25mg-BID); Norvasc (10mg- Daily); Coreg (6.25mg-BID); Zoloft (100mg- Daily); Cymbalata (30mg
Current Illness: 2/29/21- Acute Exacerbation of HFrEF, Medication non compliance; uncontrolled hypertension 03/05/2021- Bradycardic Arrest ( Resuscitated- intubated)
Preexisting Conditions: Cardiac Arrest, Anasarca, Uncontrolled Hypertension , Acute Chronic HFrEF; Non ischemic Cardiomyopathy, hyperkalemia, Medication non compliance, Type 2 Diabetes, Dysphagia, Adult Failure to Thrive, Cannabis Abuse, CHF Exacerbation, Major Depression Disorders
Allergies: Codeine, Hydralazine, Sulfa , Acetone Solution
Diagnostic Lab Data: 3/17/21- Covid Nasal Swab- negative 3/19/21 CBC & CMP Abnormal results ( RBC-3.17; HGB-8.3; Hct-26.6; MCH-26.1; MCHC-31.1; MPV-6.8; Glucose-136; BUN-43; Creatine-1.93-BUN/Cre-22.0; Co2-33.9; AGAP-4; Calcium lv-8.2- Total Protein-5.8, Albumin-2.55; A/G Ration-0.8
CDC 'Split Type':

Write-up: 3/20/21 06:22 pm Resident c/o Nausea and feeling full- Tube feeding placed on Hold- Resident started vomiting- Zofran 4 mg given- Positive outcomes. 03/21/2021- 0430 Resident found unresponsive on morning rounds- w/ weak pulse, shallow breathing. O2 via NC increased to 5 L, NP, Family ( Code Status DNR)- Power of attorney ordered to send out- MR notified- Upon arrival no rhythm detected- Death pronounced at 0445


Changed on 5/7/2021

VAERS ID: 1125778 Before After
VAERS Form:2
Age:64.0
Sex:Female
Location:Mississippi
Vaccinated:2021-03-19
Onset:2021-03-20
Submitted:0000-00-00
Entered:2021-03-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Abdominal distension, Albumin globulin ratio decreased, Anion gap decreased, Blood albumin decreased, Blood calcium decreased, Blood creatine increased, Blood glucose normal, Blood urea increased, Carbon dioxide increased, Death, Full blood count abnormal, Haematocrit decreased, Haemoglobin decreased, Hypopnoea, Mean cell haemoglobin concentration decreased, Mean cell haemoglobin decreased, Nausea, Protein total decreased, Pulse abnormal, Pulse absent, Red blood cell count decreased, Unresponsive to stimuli, Vomiting, Mean platelet volume decreased, Blood urea nitrogen/creatinine ratio, Metabolic function test abnormal, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-21
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: Isosorbide Dinitrate (20mg TID); Lasix ( 40mg- BID); Omeprazole (20mg- Daily); Clonidine (0.1mg-BID); Trazodone (100mg- Daily)- Metoprolo Tartrate (25mg-BID); Norvasc (10mg- Daily); Coreg (6.25mg-BID); Zoloft (100mg- Daily); Cymbalata (30mg
Current Illness: 2/29/21- Acute Exacerbation of HFrEF, Medication non compliance; uncontrolled hypertension 03/05/2021- Bradycardic Arrest ( Resuscitated- intubated)
Preexisting Conditions: Cardiac Arrest, Anasarca, Uncontrolled Hypertension , Acute Chronic HFrEF; Non ischemic Cardiomyopathy, hyperkalemia, Medication non compliance, Type 2 Diabetes, Dysphagia, Adult Failure to Thrive, Cannabis Abuse, CHF Exacerbation, Major Depression Disorders
Allergies: Codeine, Hydralazine, Sulfa , Acetone Solution Solution
Diagnostic Lab Data: 3/17/21- Covid Nasal Swab- negative 3/19/21 CBC & CMP Abnormal results ( RBC-3.17; HGB-8.3; Hct-26.6; MCH-26.1; MCHC-31.1; MPV-6.8; Glucose-136; BUN-43; Creatine-1.93-BUN/Cre-22.0; Co2-33.9; AGAP-4; Calcium lv-8.2- Total Protein-5.8, Albumin-2.55; A/G Ration-0.8
CDC 'Split Type':

Write-up: 3/20/21 06:22 pm Resident c/o Nausea and feeling full- Tube feeding placed on Hold- Resident started vomiting- Zofran 4 mg given- Positive outcomes. 03/21/2021- 0430 Resident found unresponsive on morning rounds- w/ weak pulse, shallow breathing. O2 via NC increased to 5 L, NP, Family ( Code Status DNR)- Power of attorney ordered to send out- MR notified- Upon arrival no rhythm detected- Death pronounced at 0445

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1125778&WAYBACKHISTORY=ON


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