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This is VAERS ID 1219404

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History of Changes from the VAERS Wayback Machine

First Appeared on 5/7/2021

VAERS ID: 1219404
VAERS Form:2
Age:83.0
Sex:Female
Location:Ohio
Vaccinated:2021-02-19
Onset:2021-04-14
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Acute myocardial infarction, Acute respiratory distress syndrome, Diabetic ketoacidosis, Chronic kidney disease, Acute kidney injury, SARS-CoV-2 test positive, COVID-19 pneumonia

Life Threatening? Yes
Birth Defect? No
Died? No
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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin, Lipitor, Insulin, Nifedipine, Gabapentin, Hydroxyurea
Current Illness:
Preexisting Conditions: HTN, CAD status bypass graft x4, T2DM, peripheral and retinal neuropathy, CKD 3b, thrombocytosis, diabetic foot ulcer, remote ovarian cancer
Allergies: Sulfa
Diagnostic Lab Data: COVID-19 PCR positive 4/15
CDC 'Split Type':

Write-up: Pt was admitted with COVID-19 pneumonia on 4/15 that has progressed to COVID ARDS, DKA, AKI on CKD, NSTEMI


Changed on 5/14/2021

VAERS ID: 1219404 Before After
VAERS Form:2
Age:83.0
Sex:Female
Location:Ohio
Vaccinated:2021-02-19
Onset:2021-04-14
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Acute myocardial infarction, Acute respiratory distress syndrome, Diabetic ketoacidosis, Chronic kidney disease, Acute kidney injury, SARS-CoV-2 test positive, COVID-19 pneumonia

Life Threatening? Yes
Birth Defect? No
Died? No
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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin, Lipitor, Insulin, Nifedipine, Gabapentin, Hydroxyurea
Current Illness:
Preexisting Conditions: HTN, CAD status bypass graft x4, T2DM, peripheral and retinal neuropathy, CKD 3b, thrombocytosis, diabetic foot ulcer, remote ovarian cancer
Allergies: Sulfa Sulfa
Diagnostic Lab Data: COVID-19 PCR positive 4/15
CDC 'Split Type':

Write-up: Pt was admitted with COVID-19 pneumonia on 4/15 that has progressed to COVID ARDS, DKA, AKI on CKD, NSTEMI


Changed on 7/16/2021

VAERS ID: 1219404 Before After
VAERS Form:2
Age:83.0
Sex:Female
Location:Ohio
Vaccinated:2021-02-19
Onset:2021-04-14
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Acute myocardial infarction, Acute respiratory distress syndrome, Diabetic ketoacidosis, Chronic kidney disease, Acute kidney injury, SARS-CoV-2 test positive, COVID-19 pneumonia

Life Threatening? Yes
Birth Defect? No
Died? No Yes
   Date died:0000-00-00 2021-04-17
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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin, Lipitor, Insulin, Nifedipine, Gabapentin, Hydroxyurea
Current Illness:
Preexisting Conditions: HTN, CAD status bypass graft x4, T2DM, peripheral and retinal neuropathy, CKD 3b, thrombocytosis, diabetic foot ulcer, remote ovarian cancer
Allergies: Sulfa
Diagnostic Lab Data: COVID-19 PCR positive 4/15
CDC 'Split Type':

Write-up: Pt was admitted with COVID-19 pneumonia on 4/15 that has progressed to COVID ARDS, DKA, AKI on CKD, NSTEMI

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1219404&WAYBACKHISTORY=ON


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