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This is VAERS ID 1223867

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1223867
VAERS Form:2
Age:83.0
Sex:Female
Location:New Mexico
Vaccinated:2020-12-29
Onset:2021-01-18
Submitted:0000-00-00
Entered:2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Senior Living      Purchased by: ??
Symptoms: Cardiac arrest, Death, Dysarthria, Facial paralysis, Pupil fixed, Respiratory arrest, Unresponsive to stimuli, Carotid pulse abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Current Illness:
Preexisting Conditions: Dementia with Behavior disturbance
Allergies: Penicillin
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Approximately 1800, nursing staff reported patient had facial drooping and slurred speech. Patient vitals were stable. Symptoms resolved. 2/1/2021 Resident observed in the bedroom, unresponsive. No heartbeat or lung sounds upon auscultation. Pupils mid-dilated and fixated, no reaction to light. Carotid pulses were not palpable. Pronounced dead at 1422 by nurse practitioner.


Changed on 5/7/2021

VAERS ID: 1223867 Before After
VAERS Form:2
Age:83.0
Sex:Female
Location:New Mexico
Vaccinated:2020-12-29
Onset:2021-01-18
Submitted:0000-00-00
Entered:2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Senior Living      Purchased by: ??
Symptoms: Cardiac arrest, Death, Dysarthria, Facial paralysis, Pupil fixed, Respiratory arrest, Unresponsive to stimuli, Carotid pulse abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Current Illness:
Preexisting Conditions: Dementia with Behavior disturbance
Allergies: Penicillin Penicillin
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Approximately 1800, nursing staff reported patient had facial drooping and slurred speech. Patient vitals were stable. Symptoms resolved. 2/1/2021 Resident observed in the bedroom, unresponsive. No heartbeat or lung sounds upon auscultation. Pupils mid-dilated and fixated, no reaction to light. Carotid pulses were not palpable. Pronounced dead at 1422 by nurse practitioner.


Changed on 5/14/2021

VAERS ID: 1223867 Before After
VAERS Form:2
Age:83.0
Sex:Female
Location:New Mexico
Vaccinated:2020-12-29
Onset:2021-01-18
Submitted:0000-00-00
Entered:2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Senior Living      Purchased by: ??
Symptoms: Cardiac arrest, Death, Dysarthria, Facial paralysis, Pupil fixed, Respiratory arrest, Unresponsive to stimuli, Carotid pulse abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Current Illness:
Preexisting Conditions: Dementia with Behavior disturbance
Allergies: Penicillin Penicillin
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Approximately 1800, nursing staff reported patient had facial drooping and slurred speech. Patient vitals were stable. Symptoms resolved. 2/1/2021 Resident observed in the bedroom, unresponsive. No heartbeat or lung sounds upon auscultation. Pupils mid-dilated and fixated, no reaction to light. Carotid pulses were not palpable. Pronounced dead at 1422 by nurse practitioner.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1223867&WAYBACKHISTORY=ON

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