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This is VAERS ID 1177076

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1177076
VAERS Form:2
Age:51.0
Sex:Female
Location:Kansas
Vaccinated:2021-03-30
Onset:2021-04-03
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death, Fatigue

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-04
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: Hydrocholorthiazide, Protonix, Colace, Plaxvix, Flexaril, Coreg, Carafate, Lomotil, ASA, Lyrica, Zofran, Norvasc, Xanax, Cymbalta, Lipitor, Lisinopril, Iron, Vitamin C, Vitamin D3, Omega 3 supplement, Garlic, Used an insulin pump that provi
Current Illness: Prior MI, December, 2020; Diabetes; Obesity; Hypertension; Kidney Disease and Anxiety.
Preexisting Conditions: Heart disease and Diabetes
Allergies: NKDA
Diagnostic Lab Data: No tests done. It is believed she did not have an autopsy, either.
CDC 'Split Type':

Write-up: On Saturday, April 3rd, patient told her son she was tired and was going to take a nap. Her son tried to wake her the next morning since she had not come out of her room from the day before. He was unable to wake her.


Changed on 5/7/2021

VAERS ID: 1177076 Before After
VAERS Form:2
Age:51.0
Sex:Female
Location:Kansas
Vaccinated:2021-03-30
Onset:2021-04-03
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death, Fatigue

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-04
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: Hydrocholorthiazide, Protonix, Colace, Plaxvix, Flexaril, Coreg, Carafate, Lomotil, ASA, Lyrica, Zofran, Norvasc, Xanax, Cymbalta, Lipitor, Lisinopril, Iron, Vitamin C, Vitamin D3, Omega 3 supplement, Garlic, Used an insulin pump that provi
Current Illness: Prior MI, December, 2020; Diabetes; Obesity; Hypertension; Kidney Disease and Anxiety.
Preexisting Conditions: Heart disease and Diabetes
Allergies: NKDA NKDA
Diagnostic Lab Data: No tests done. It is believed she did not have an autopsy, either.
CDC 'Split Type':

Write-up: On Saturday, April 3rd, patient told her son she was tired and was going to take a nap. Her son tried to wake her the next morning since she had not come out of her room from the day before. He was unable to wake her.


Changed on 5/14/2021

VAERS ID: 1177076 Before After
VAERS Form:2
Age:51.0
Sex:Female
Location:Kansas
Vaccinated:2021-03-30
Onset:2021-04-03
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death, Fatigue

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-04
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: Hydrocholorthiazide, Protonix, Colace, Plaxvix, Flexaril, Coreg, Carafate, Lomotil, ASA, Lyrica, Zofran, Norvasc, Xanax, Cymbalta, Lipitor, Lisinopril, Iron, Vitamin C, Vitamin D3, Omega 3 supplement, Garlic, Used an insulin pump that provi
Current Illness: Prior MI, December, 2020; Diabetes; Obesity; Hypertension; Kidney Disease and Anxiety.
Preexisting Conditions: Heart disease and Diabetes
Allergies: NKDA NKDA
Diagnostic Lab Data: No tests done. It is believed she did not have an autopsy, either.
CDC 'Split Type':

Write-up: On Saturday, April 3rd, patient told her son she was tired and was going to take a nap. Her son tried to wake her the next morning since she had not come out of her room from the day before. He was unable to wake her.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1177076&WAYBACKHISTORY=ON

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