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This is VAERS ID 1223971

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1223971
VAERS Form:2
Age:81.0
Sex:Female
Location:New York
Vaccinated:2021-03-13
Onset:2021-04-04
Submitted:0000-00-00
Entered:2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 2 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Cardiac arrest, Cerebral haemorrhage, Computerised tomogram abnormal, Death, Snoring, Unresponsive to stimuli, Blood test, Mechanical ventilation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-11
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Escitalopram 10mg once a day Atorvastatin 40mg once a day Folic acid once a day Vitamin D once a week Labetalol 100 mg twice a day Aspirin 81mg once a day Vitamin B 12 1000mcg once a day Memantine 10mg once a day
Current Illness: Hypertension, high cholesterol, depression, dementia, nose bleeds a week before the second dose
Preexisting Conditions: Hypertension, high cholesterol, depression, dementia
Allergies: none
Diagnostic Lab Data: 4/5/21 CT scan, blood tests
CDC 'Split Type':

Write-up: 4/4/21 at 11:30 pm the patient started to make snoring-like sounds in her sleep and could not be woken up. 911 was called and in the hospital a CT scan identified extensive large right-sided intraparenchymal hemorrhage within the frontal, parietal and temporal regions, extending into the ventricular system. The patient was put on the ventilator and administered blood pressure medication. A-line was inserted to read blood pressure. 4/11/21 at 8:11 pm the patient passed away due to cardiac arrest


Changed on 5/7/2021

VAERS ID: 1223971 Before After
VAERS Form:2
Age:81.0
Sex:Female
Location:New York
Vaccinated:2021-03-13
Onset:2021-04-04
Submitted:0000-00-00
Entered:2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 2 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Cardiac arrest, Cerebral haemorrhage, Computerised tomogram abnormal, Death, Snoring, Unresponsive to stimuli, Blood test, Mechanical ventilation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-11
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Escitalopram 10mg once a day Atorvastatin 40mg once a day Folic acid once a day Vitamin D once a week Labetalol 100 mg twice a day Aspirin 81mg once a day Vitamin B 12 1000mcg once a day Memantine 10mg once a day
Current Illness: Hypertension, high cholesterol, depression, dementia, nose bleeds a week before the second dose
Preexisting Conditions: Hypertension, high cholesterol, depression, dementia
Allergies: none none
Diagnostic Lab Data: 4/5/21 CT scan, blood tests
CDC 'Split Type':

Write-up: 4/4/21 at 11:30 pm the patient started to make snoring-like sounds in her sleep and could not be woken up. 911 was called and in the hospital a CT scan identified extensive large right-sided intraparenchymal hemorrhage within the frontal, parietal and temporal regions, extending into the ventricular system. The patient was put on the ventilator and administered blood pressure medication. A-line was inserted to read blood pressure. 4/11/21 at 8:11 pm the patient passed away due to cardiac arrest


Changed on 5/14/2021

VAERS ID: 1223971 Before After
VAERS Form:2
Age:81.0
Sex:Female
Location:New York
Vaccinated:2021-03-13
Onset:2021-04-04
Submitted:0000-00-00
Entered:2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 036A21A / 2 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Cardiac arrest, Cerebral haemorrhage, Computerised tomogram abnormal, Death, Snoring, Unresponsive to stimuli, Blood test, Mechanical ventilation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-11
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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Escitalopram 10mg once a day Atorvastatin 40mg once a day Folic acid once a day Vitamin D once a week Labetalol 100 mg twice a day Aspirin 81mg once a day Vitamin B 12 1000mcg once a day Memantine 10mg once a day
Current Illness: Hypertension, high cholesterol, depression, dementia, nose bleeds a week before the second dose
Preexisting Conditions: Hypertension, high cholesterol, depression, dementia
Allergies: none none
Diagnostic Lab Data: 4/5/21 CT scan, blood tests
CDC 'Split Type':

Write-up: 4/4/21 at 11:30 pm the patient started to make snoring-like sounds in her sleep and could not be woken up. 911 was called and in the hospital a CT scan identified extensive large right-sided intraparenchymal hemorrhage within the frontal, parietal and temporal regions, extending into the ventricular system. The patient was put on the ventilator and administered blood pressure medication. A-line was inserted to read blood pressure. 4/11/21 at 8:11 pm the patient passed away due to cardiac arrest

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