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This is VAERS ID 1222324

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1222324
VAERS Form:2
Age:82.0
Sex:Female
Location:Puerto Rico
Vaccinated:2021-02-23
Onset:2021-03-11
Submitted:0000-00-00
Entered:2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 2 UN / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Renal failure, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-09
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: Metformin, Donozepil, Gabapentin. Simvastatin, Trazodone
Current Illness: None reported
Preexisting Conditions: Diabetes, Alzheimer''s, Dementia
Allergies: None reported
Diagnostic Lab Data: None reported
CDC 'Split Type': PR-102-21

Write-up: From 3/11/2021 until 3/29/2021 the patient was in the hospital due to lack of appetite and kidney failure. The doctor certifies that the cause was more natural


Changed on 5/7/2021

VAERS ID: 1222324 Before After
VAERS Form:2
Age:82.0
Sex:Female
Location:Puerto Rico
Vaccinated:2021-02-23
Onset:2021-03-11
Submitted:0000-00-00
Entered:2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 2 UN / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Renal failure, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-09
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: Metformin, Donozepil, Gabapentin. Simvastatin, Trazodone
Current Illness: None reported
Preexisting Conditions: Diabetes, Alzheimer''s, Dementia
Allergies: None reported reported
Diagnostic Lab Data: None reported
CDC 'Split Type': PR-102-21

Write-up: From 3/11/2021 until 3/29/2021 the patient was in the hospital due to lack of appetite and kidney failure. The doctor certifies that the cause was more natural


Changed on 5/14/2021

VAERS ID: 1222324 Before After
VAERS Form:2
Age:82.0
Sex:Female
Location:Puerto Rico
Vaccinated:2021-02-23
Onset:2021-03-11
Submitted:0000-00-00
Entered:2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 2 UN / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Renal failure, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-09
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: Metformin, Donozepil, Gabapentin. Simvastatin, Trazodone
Current Illness: None reported
Preexisting Conditions: Diabetes, Alzheimer''s, Dementia
Allergies: None reported reported
Diagnostic Lab Data: None reported
CDC 'Split Type': PR-102-21

Write-up: From 3/11/2021 until 3/29/2021 the patient was in the hospital due to lack of appetite and kidney failure. The doctor certifies that the cause was more natural

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1222324&WAYBACKHISTORY=ON

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