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This is VAERS ID 1219229

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1219229
VAERS Form:2
Age:83.0
Sex:Female
Location:Nebraska
Vaccinated:2021-02-10
Onset:2021-03-02
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20-A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Bradycardia, Cardiac pacemaker insertion, Cardiomegaly, Chest X-ray abnormal, Death, Dizziness, Fall, Fatigue, Hypotension, Hypoxia, Lactic acidosis, Syncope, Troponin increased, Laboratory test, Sinus node dysfunction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-03
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Garlic, Preservision AREDs Softgel, Multivitamins with minerals. Aspirin, Levothyroxine, Amlodipine, Losartan
Current Illness: Denied any illness at time of receiving vaccine, uncertain as to how pt. felt one month prior to vaccine.
Preexisting Conditions: Current everyday smoker, Hypothyroidism, HTN, Hyperlipidemia, Osteoarthritis, Osteoporosis
Allergies: NKA
Diagnostic Lab Data: Lab and CXR done in ER. Troponin level was 117; HR 40''s, BP 93/44. CXR indicated mild cardiomegaly and no acute infiltrates.
CDC 'Split Type':

Write-up: Pt. c/o symptoms of fatigue and dizziness on 3/2. On 3/3 pt. presents to ER, afebrile, c/o fatigue, feeling of being lightheaded, reports syncope and falling x''s 2. Pt. according to MD documentation was in good health. Denies any recent illness. Pt. was found to be bradycardic, sick sinus syndrome, r/o MI. Pt. was transferred to higher level of care hospital on 3/3. Pt. had emergency pacemaker insertion. She became hypotensive and hypoxic post-op and was found to in lactic acidosis. Pt. expired on 3/3/21.


Changed on 5/7/2021

VAERS ID: 1219229 Before After
VAERS Form:2
Age:83.0
Sex:Female
Location:Nebraska
Vaccinated:2021-02-10
Onset:2021-03-02
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20-A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Bradycardia, Cardiac pacemaker insertion, Cardiomegaly, Chest X-ray abnormal, Death, Dizziness, Fall, Fatigue, Hypotension, Hypoxia, Lactic acidosis, Syncope, Troponin increased, Laboratory test, Sinus node dysfunction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-03
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Garlic, Preservision AREDs Softgel, Multivitamins with minerals. Aspirin, Levothyroxine, Amlodipine, Losartan
Current Illness: Denied any illness at time of receiving vaccine, uncertain as to how pt. felt one month prior to vaccine.
Preexisting Conditions: Current everyday smoker, Hypothyroidism, HTN, Hyperlipidemia, Osteoarthritis, Osteoporosis
Allergies: NKA NKA
Diagnostic Lab Data: Lab and CXR done in ER. Troponin level was 117; HR 40''s, BP 93/44. CXR indicated mild cardiomegaly and no acute infiltrates.
CDC 'Split Type':

Write-up: Pt. c/o symptoms of fatigue and dizziness on 3/2. On 3/3 pt. presents to ER, afebrile, c/o fatigue, feeling of being lightheaded, reports syncope and falling x''s 2. Pt. according to MD documentation was in good health. Denies any recent illness. Pt. was found to be bradycardic, sick sinus syndrome, r/o MI. Pt. was transferred to higher level of care hospital on 3/3. Pt. had emergency pacemaker insertion. She became hypotensive and hypoxic post-op and was found to in lactic acidosis. Pt. expired on 3/3/21.


Changed on 5/14/2021

VAERS ID: 1219229 Before After
VAERS Form:2
Age:83.0
Sex:Female
Location:Nebraska
Vaccinated:2021-02-10
Onset:2021-03-02
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20-A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Bradycardia, Cardiac pacemaker insertion, Cardiomegaly, Chest X-ray abnormal, Death, Dizziness, Fall, Fatigue, Hypotension, Hypoxia, Lactic acidosis, Syncope, Troponin increased, Laboratory test, Sinus node dysfunction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-03
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Garlic, Preservision AREDs Softgel, Multivitamins with minerals. Aspirin, Levothyroxine, Amlodipine, Losartan
Current Illness: Denied any illness at time of receiving vaccine, uncertain as to how pt. felt one month prior to vaccine.
Preexisting Conditions: Current everyday smoker, Hypothyroidism, HTN, Hyperlipidemia, Osteoarthritis, Osteoporosis
Allergies: NKA NKA
Diagnostic Lab Data: Lab and CXR done in ER. Troponin level was 117; HR 40''s, BP 93/44. CXR indicated mild cardiomegaly and no acute infiltrates.
CDC 'Split Type':

Write-up: Pt. c/o symptoms of fatigue and dizziness on 3/2. On 3/3 pt. presents to ER, afebrile, c/o fatigue, feeling of being lightheaded, reports syncope and falling x''s 2. Pt. according to MD documentation was in good health. Denies any recent illness. Pt. was found to be bradycardic, sick sinus syndrome, r/o MI. Pt. was transferred to higher level of care hospital on 3/3. Pt. had emergency pacemaker insertion. She became hypotensive and hypoxic post-op and was found to in lactic acidosis. Pt. expired on 3/3/21.

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