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This is VAERS ID 1229034

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1229034
VAERS Form:2
Age:97.0
Sex:Female
Location:Nebraska
Vaccinated:2021-04-08
Onset:2021-04-09
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA ER8729 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood lactic acid, Cardiac failure, Dyspnoea, Fatigue, Full blood count, Sepsis, Urinary tract infection, Urine analysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: DIGOXIN TAB 0.125MG 125MCG TABS 1 TAB ONCE DAILY *HOLD IF HR < 60* [Equiv To: LANOXIN] Schedule: DAILY AT 08:00 Orig Date: 25-Mar-2021 RX: 494372 Date Written: 25-Mar-2021 EUCERIN LOT LOTN (1) APPLY TOPICALLY TO AFFECTED AREAS AS NEEDED DR
Current Illness: UTI and Sepsis were DX just after and hospitalized Heart Failure A-Fib Anemia Type II DS Hypertension
Preexisting Conditions: CA
Allergies: None
Diagnostic Lab Data: Lactic acid, CBC, U/A
CDC 'Split Type':

Write-up: Pt. had hx of SOB prior to vaccination and Dx with hear failure Woke up day after vaccination with being very tired. Admitted to hospital with UTI, Sepsis


Changed on 5/7/2021

VAERS ID: 1229034 Before After
VAERS Form:2
Age:97.0
Sex:Female
Location:Nebraska
Vaccinated:2021-04-08
Onset:2021-04-09
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA ER8729 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood lactic acid, Cardiac failure, Dyspnoea, Fatigue, Full blood count, Sepsis, Urinary tract infection, Urine analysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: DIGOXIN TAB 0.125MG 125MCG TABS 1 TAB ONCE DAILY *HOLD IF HR < 60* [Equiv To: LANOXIN] Schedule: DAILY AT 08:00 Orig Date: 25-Mar-2021 RX: 494372 Date Written: 25-Mar-2021 EUCERIN LOT LOTN (1) APPLY TOPICALLY TO AFFECTED AREAS AS NEEDED DR
Current Illness: UTI and Sepsis were DX just after and hospitalized Heart Failure A-Fib Anemia Type II DS Hypertension
Preexisting Conditions: CA
Allergies: None None
Diagnostic Lab Data: Lactic acid, CBC, U/A
CDC 'Split Type':

Write-up: Pt. had hx of SOB prior to vaccination and Dx with hear failure Woke up day after vaccination with being very tired. Admitted to hospital with UTI, Sepsis


Changed on 5/14/2021

VAERS ID: 1229034 Before After
VAERS Form:2
Age:97.0
Sex:Female
Location:Nebraska
Vaccinated:2021-04-08
Onset:2021-04-09
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA ER8729 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood lactic acid, Cardiac failure, Dyspnoea, Fatigue, Full blood count, Sepsis, Urinary tract infection, Urine analysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: DIGOXIN TAB 0.125MG 125MCG TABS 1 TAB ONCE DAILY *HOLD IF HR < 60* [Equiv To: LANOXIN] Schedule: DAILY AT 08:00 Orig Date: 25-Mar-2021 RX: 494372 Date Written: 25-Mar-2021 EUCERIN LOT LOTN (1) APPLY TOPICALLY TO AFFECTED AREAS AS NEEDED DR
Current Illness: UTI and Sepsis were DX just after and hospitalized Heart Failure A-Fib Anemia Type II DS Hypertension
Preexisting Conditions: CA
Allergies: None None
Diagnostic Lab Data: Lactic acid, CBC, U/A
CDC 'Split Type':

Write-up: Pt. had hx of SOB prior to vaccination and Dx with hear failure Woke up day after vaccination with being very tired. Admitted to hospital with UTI, Sepsis

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