National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1156266

History of Changes from the VAERS Wayback Machine

First Appeared on 4/1/2021

VAERS ID: 1156266
VAERS Form:2
Age:45.0
Sex:Female
Location:Unknown
Vaccinated:2021-03-04
Onset:2021-03-17
Submitted:0000-00-00
Entered:2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001A21A / 1 AR / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Back pain, Blood creatine abnormal, Death, Dyspnoea, Dysuria, Feeling abnormal, Glomerular filtration rate, Renal failure, Urinary tract infection, White blood cell disorder, Candida infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-27
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: spironolactone 25 mg po bid, bispirone 10 mg po daily, contin, trazodone 300 mg po hs, gabapentin 800 mg po bid, ultram 50 mg po q4-6 hours prn, tizanidine 4 mg po bid prn, Metformin 500 daily, hctz 25 mg po daily, breo ellipta daily, hydro
Current Illness: UTI With back pain
Preexisting Conditions: Type 2 diabetes, hepatitis C, hypertension, hyperlipidemia, osteoarthritis, COPD, BMI 43.4
Allergies: morphine, lithium
Diagnostic Lab Data: 3/17/21 sCr 1.48 GFR 41 WBC 4.5 (ER) 3/19/21 sCr 1.55 GFR 66.16 (CLINIC) 3/26/21 sCr 2.29 GFR 25 WBC 10.9 (CLINIC) 3/27/21 sCr 4.01 GFR 13 WBC 12.0 (ER)
CDC 'Split Type':

Write-up: pt presented in ER 3/17/21 with SOB and back pain; felt bad since vaccine given; UTI diagnosis-given keflex 500 tid and rocephin shot pt presented to clinic 3/19/21 with continuing back pain dx low back pain and candidia given methocarbamol, diflucan, and ibuprofen pt presented to clinic 3/26/21 with continuing back pain, difficulty urination. given ceftin and rocephin shot pt presented to ER 3/27/21 renal failure and expired within 10 min of arrival no fever documented at any visit


Changed on 5/7/2021

VAERS ID: 1156266 Before After
VAERS Form:2
Age:45.0
Sex:Female
Location:Unknown
Vaccinated:2021-03-04
Onset:2021-03-17
Submitted:0000-00-00
Entered:2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001A21A / 1 AR / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Back pain, Blood creatine abnormal, Death, Dyspnoea, Dysuria, Feeling abnormal, Glomerular filtration rate, Renal failure, Urinary tract infection, White blood cell disorder, Candida infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-27
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: spironolactone 25 mg po bid, bispirone 10 mg po daily, contin, trazodone 300 mg po hs, gabapentin 800 mg po bid, ultram 50 mg po q4-6 hours prn, tizanidine 4 mg po bid prn, Metformin 500 daily, hctz 25 mg po daily, breo ellipta daily, hydro
Current Illness: UTI With back pain
Preexisting Conditions: Type 2 diabetes, hepatitis C, hypertension, hyperlipidemia, osteoarthritis, COPD, BMI 43.4
Allergies: morphine, lithium lithium
Diagnostic Lab Data: 3/17/21 sCr 1.48 GFR 41 WBC 4.5 (ER) 3/19/21 sCr 1.55 GFR 66.16 (CLINIC) 3/26/21 sCr 2.29 GFR 25 WBC 10.9 (CLINIC) 3/27/21 sCr 4.01 GFR 13 WBC 12.0 (ER)
CDC 'Split Type':

Write-up: pt presented in ER 3/17/21 with SOB and back pain; felt bad since vaccine given; UTI diagnosis-given keflex 500 tid and rocephin shot pt presented to clinic 3/19/21 with continuing back pain dx low back pain and candidia given methocarbamol, diflucan, and ibuprofen pt presented to clinic 3/26/21 with continuing back pain, difficulty urination. given ceftin and rocephin shot pt presented to ER 3/27/21 renal failure and expired within 10 min of arrival no fever documented at any visit

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1156266&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166