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This is VAERS ID 1223056

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1223056
VAERS Form:2
Age:62.0
Sex:Female
Location:Illinois
Vaccinated:2021-02-26
Onset:2021-03-14
Submitted:0000-00-00
Entered:2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 RA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Asthenia, Cerebral haemorrhage, Death, Fall, Loss of consciousness, Thrombosis

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)? Yes
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Topiramate-Eliquis-Montelukast-Fluticas-Gabapentin-Effexor-Buspirone-Diazepam-Trazodone-Aripiprazole-Dexilant-Linzess-Potassium-Rosuvastatin-Hydralazine-Hydrochlorothiazide-Norvasc-Propranolol-Folic Acid
Current Illness: Had prior strokes
Preexisting Conditions: High blood pressure
Allergies: None
Diagnostic Lab Data: See Hospital report
CDC 'Split Type':

Write-up: My wife started to fall and pass out had no strength to get up this happened two to three times cinch she got the shot the last time she past out in the shower and i rushed her to hospital were she pasted away from blood clots to the right side of the neck and stated bleed on the brain


Changed on 5/7/2021

VAERS ID: 1223056 Before After
VAERS Form:2
Age:62.0
Sex:Female
Location:Illinois
Vaccinated:2021-02-26
Onset:2021-03-14
Submitted:0000-00-00
Entered:2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 RA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Asthenia, Cerebral haemorrhage, Death, Fall, Loss of consciousness, Thrombosis

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)? Yes
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Topiramate-Eliquis-Montelukast-Fluticas-Gabapentin-Effexor-Buspirone-Diazepam-Trazodone-Aripiprazole-Dexilant-Linzess-Potassium-Rosuvastatin-Hydralazine-Hydrochlorothiazide-Norvasc-Propranolol-Folic Acid
Current Illness: Had prior strokes
Preexisting Conditions: High blood pressure
Allergies: None None
Diagnostic Lab Data: See Hospital report
CDC 'Split Type':

Write-up: My wife started to fall and pass out had no strength to get up this happened two to three times cinch she got the shot the last time she past out in the shower and i rushed her to hospital were she pasted away from blood clots to the right side of the neck and stated bleed on the brain


Changed on 5/14/2021

VAERS ID: 1223056 Before After
VAERS Form:2
Age:62.0
Sex:Female
Location:Illinois
Vaccinated:2021-02-26
Onset:2021-03-14
Submitted:0000-00-00
Entered:2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 1 RA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Asthenia, Cerebral haemorrhage, Death, Fall, Loss of consciousness, Thrombosis

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)? Yes
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Topiramate-Eliquis-Montelukast-Fluticas-Gabapentin-Effexor-Buspirone-Diazepam-Trazodone-Aripiprazole-Dexilant-Linzess-Potassium-Rosuvastatin-Hydralazine-Hydrochlorothiazide-Norvasc-Propranolol-Folic Acid
Current Illness: Had prior strokes
Preexisting Conditions: High blood pressure
Allergies: None None
Diagnostic Lab Data: See Hospital report
CDC 'Split Type':

Write-up: My wife started to fall and pass out had no strength to get up this happened two to three times cinch she got the shot the last time she past out in the shower and i rushed her to hospital were she pasted away from blood clots to the right side of the neck and stated bleed on the brain

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1223056&WAYBACKHISTORY=ON

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