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This is VAERS ID 1220012

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1220012
VAERS Form:2
Age:90.0
Sex:Female
Location:New Hampshire
Vaccinated:2021-01-08
Onset:2021-03-22
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood creatinine normal, Blood thyroid stimulating hormone decreased, Blood urea normal, Death, Diet refusal, Haemoglobin decreased, Herpes zoster, Lethargy, Red blood cell count decreased, Weight decreased, White blood cell count normal, General physical health deterioration, Refusal of treatment by patient, Hypophagia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-22
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: Aliskiren Fumarate, Citalopram Hydrobromide, Donezepil, HCL, Isosorbide Mononitrate ER, Miralax, Protonix, Remeron, Synthroid, Eliquis 2.5, Ferrous Sulfate, Keppra, Lamictal, Mighty Shake, Senokot S.
Current Illness: Hx of Covid-19- 05/09/2020. Receiving palliative care
Preexisting Conditions: Dementia, Cerebral infarct, PVD, Atherosclerotic heart disease, supraventricular tachycardia, Dyshphagia, Hypothyroidism, Essential HTN, Anxiety, Zoster, Postviral fatigue syndrome, Vitamin D deficiency, Hx of Pulmonary Embolism, long term use of anticoagulant, SIADH, TIA, Unspecified convulsion, Hyperlipidemia, MDD, Abnormal EEG.
Allergies: Lisinopril, Statins, Sulfa Antibiotics.
Diagnostic Lab Data: She has history of elevated D-Dimer. 3/10 WBC- 6.85, RBC- 3.63, HBG- 11.1, BUN-18, CREA- 0.89, TSH- 1.030.
CDC 'Split Type':

Write-up: 02/21/21- Resident has been refusing meds and meal with continued poor PO nutritional intake, and lethargic. She continue to have periods of medication refusal and continued poor PO intake. 3/8 She developed shingles to her R buttock and was started on Acyclovir cream x7 days. She continues to decline medically. Admitted to Hospice on 3/12, poor PO intake and weight loss. 3/23 Resident passed.


Changed on 5/7/2021

VAERS ID: 1220012 Before After
VAERS Form:2
Age:90.0
Sex:Female
Location:New Hampshire
Vaccinated:2021-01-08
Onset:2021-03-22
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood creatinine normal, Blood thyroid stimulating hormone decreased, Blood urea normal, Death, Diet refusal, Haemoglobin decreased, Herpes zoster, Lethargy, Red blood cell count decreased, Weight decreased, White blood cell count normal, General physical health deterioration, Refusal of treatment by patient, Hypophagia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-22
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: Aliskiren Fumarate, Citalopram Hydrobromide, Donezepil, HCL, Isosorbide Mononitrate ER, Miralax, Protonix, Remeron, Synthroid, Eliquis 2.5, Ferrous Sulfate, Keppra, Lamictal, Mighty Shake, Senokot S.
Current Illness: Hx of Covid-19- 05/09/2020. Receiving palliative care
Preexisting Conditions: Dementia, Cerebral infarct, PVD, Atherosclerotic heart disease, supraventricular tachycardia, Dyshphagia, Hypothyroidism, Essential HTN, Anxiety, Zoster, Postviral fatigue syndrome, Vitamin D deficiency, Hx of Pulmonary Embolism, long term use of anticoagulant, SIADH, TIA, Unspecified convulsion, Hyperlipidemia, MDD, Abnormal EEG.
Allergies: Lisinopril, Statins, Sulfa Antibiotics. Antibiotics.
Diagnostic Lab Data: She has history of elevated D-Dimer. 3/10 WBC- 6.85, RBC- 3.63, HBG- 11.1, BUN-18, CREA- 0.89, TSH- 1.030.
CDC 'Split Type':

Write-up: 02/21/21- Resident has been refusing meds and meal with continued poor PO nutritional intake, and lethargic. She continue to have periods of medication refusal and continued poor PO intake. 3/8 She developed shingles to her R buttock and was started on Acyclovir cream x7 days. She continues to decline medically. Admitted to Hospice on 3/12, poor PO intake and weight loss. 3/23 Resident passed.


Changed on 5/14/2021

VAERS ID: 1220012 Before After
VAERS Form:2
Age:90.0
Sex:Female
Location:New Hampshire
Vaccinated:2021-01-08
Onset:2021-03-22
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN5318 / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood creatinine normal, Blood thyroid stimulating hormone decreased, Blood urea normal, Death, Diet refusal, Haemoglobin decreased, Herpes zoster, Lethargy, Red blood cell count decreased, Weight decreased, White blood cell count normal, General physical health deterioration, Refusal of treatment by patient, Hypophagia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-22
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: Aliskiren Fumarate, Citalopram Hydrobromide, Donezepil, HCL, Isosorbide Mononitrate ER, Miralax, Protonix, Remeron, Synthroid, Eliquis 2.5, Ferrous Sulfate, Keppra, Lamictal, Mighty Shake, Senokot S.
Current Illness: Hx of Covid-19- 05/09/2020. Receiving palliative care
Preexisting Conditions: Dementia, Cerebral infarct, PVD, Atherosclerotic heart disease, supraventricular tachycardia, Dyshphagia, Hypothyroidism, Essential HTN, Anxiety, Zoster, Postviral fatigue syndrome, Vitamin D deficiency, Hx of Pulmonary Embolism, long term use of anticoagulant, SIADH, TIA, Unspecified convulsion, Hyperlipidemia, MDD, Abnormal EEG.
Allergies: Lisinopril, Statins, Sulfa Antibiotics. Antibiotics.
Diagnostic Lab Data: She has history of elevated D-Dimer. 3/10 WBC- 6.85, RBC- 3.63, HBG- 11.1, BUN-18, CREA- 0.89, TSH- 1.030.
CDC 'Split Type':

Write-up: 02/21/21- Resident has been refusing meds and meal with continued poor PO nutritional intake, and lethargic. She continue to have periods of medication refusal and continued poor PO intake. 3/8 She developed shingles to her R buttock and was started on Acyclovir cream x7 days. She continues to decline medically. Admitted to Hospice on 3/12, poor PO intake and weight loss. 3/23 Resident passed.

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