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This is VAERS ID 1219402

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1219402
VAERS Form:2
Age:63.0
Sex:Female
Location:Alaska
Vaccinated:2021-04-14
Onset:2021-04-15
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-15
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: Acetaminophen 500mg q 4hr prn, alendronate 70mg q 7 days, aspirin 81mg daily, atrovastin 40mg daily, baclofen 20mg 4 x day, buspirone 30mg bid, calcium carbonate 1000mg bid, carvedilol 6.25 bid, vitamin D3 1000 units daily, diclofenac sodiu
Current Illness: Decubitus sacral ulcer, stage 3, iron deficiency anemia, urinary tract infection associated with cystostomy catheter, class 1 obesity, wound infection, dysautonomia orthostatic hypotension syndrome, hypersomnia with sleep apnea, obstructive sleep apnea, autonomic dysreflexia, t4 spinal cord injury (chronic), major depressive disorder, pain medication agreement, chronic suprapubic catheter, hypothyroidism, hyperlipidemia, generalized anxiety disorder, neurogenic bladder, chronic pain, osteoarthrosis involving lower legs, DM type 2.
Preexisting Conditions: See item 11
Allergies: metoprolol, mirtazapine, olanzapine, sulfamethoxazole, cephalexin, erythromycin base, pioglitazone
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Homebound visit complete 4/14/21 around 1230-1300, monitored for 15 minutes, left attended with home health nurse. Patient was found dead per EMS and had passed sometime during the night.


Changed on 5/7/2021

VAERS ID: 1219402 Before After
VAERS Form:2
Age:63.0
Sex:Female
Location:Alaska
Vaccinated:2021-04-14
Onset:2021-04-15
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-15
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: Acetaminophen 500mg q 4hr prn, alendronate 70mg q 7 days, aspirin 81mg daily, atrovastin 40mg daily, baclofen 20mg 4 x day, buspirone 30mg bid, calcium carbonate 1000mg bid, carvedilol 6.25 bid, vitamin D3 1000 units daily, diclofenac sodiu
Current Illness: Decubitus sacral ulcer, stage 3, iron deficiency anemia, urinary tract infection associated with cystostomy catheter, class 1 obesity, wound infection, dysautonomia orthostatic hypotension syndrome, hypersomnia with sleep apnea, obstructive sleep apnea, autonomic dysreflexia, t4 spinal cord injury (chronic), major depressive disorder, pain medication agreement, chronic suprapubic catheter, hypothyroidism, hyperlipidemia, generalized anxiety disorder, neurogenic bladder, chronic pain, osteoarthrosis involving lower legs, DM type 2.
Preexisting Conditions: See item 11
Allergies: metoprolol, mirtazapine, olanzapine, sulfamethoxazole, cephalexin, erythromycin base, pioglitazone pioglitazone
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Homebound visit complete 4/14/21 around 1230-1300, monitored for 15 minutes, left attended with home health nurse. Patient was found dead per EMS and had passed sometime during the night.


Changed on 5/14/2021

VAERS ID: 1219402 Before After
VAERS Form:2
Age:63.0
Sex:Female
Location:Alaska
Vaccinated:2021-04-14
Onset:2021-04-15
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-15
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: Acetaminophen 500mg q 4hr prn, alendronate 70mg q 7 days, aspirin 81mg daily, atrovastin 40mg daily, baclofen 20mg 4 x day, buspirone 30mg bid, calcium carbonate 1000mg bid, carvedilol 6.25 bid, vitamin D3 1000 units daily, diclofenac sodiu
Current Illness: Decubitus sacral ulcer, stage 3, iron deficiency anemia, urinary tract infection associated with cystostomy catheter, class 1 obesity, wound infection, dysautonomia orthostatic hypotension syndrome, hypersomnia with sleep apnea, obstructive sleep apnea, autonomic dysreflexia, t4 spinal cord injury (chronic), major depressive disorder, pain medication agreement, chronic suprapubic catheter, hypothyroidism, hyperlipidemia, generalized anxiety disorder, neurogenic bladder, chronic pain, osteoarthrosis involving lower legs, DM type 2.
Preexisting Conditions: See item 11
Allergies: metoprolol, mirtazapine, olanzapine, sulfamethoxazole, cephalexin, erythromycin base, pioglitazone pioglitazone
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Homebound visit complete 4/14/21 around 1230-1300, monitored for 15 minutes, left attended with home health nurse. Patient was found dead per EMS and had passed sometime during the night.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1219402&WAYBACKHISTORY=ON

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