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This is VAERS ID 1242118

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1242118
VAERS Form:2
Age:77.0
Sex:Female
Location:New Jersey
Vaccinated:2021-03-13
Onset:2021-03-26
Submitted:0000-00-00
Entered:2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Acute respiratory distress syndrome, Bacteraemia, Death, Gastrointestinal haemorrhage, Hyperkalaemia, Hypoxia, Oliguria, Sepsis, Shock, Therapeutic embolisation, Endotracheal intubation, Renal replacement therapy, COVID-19 pneumonia

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: aspirin EC 81 mg daily, metformin ER 500 mg BID, atorvastatin 40 mg daily
Current Illness: fall/trauma with rib fractures
Preexisting Conditions: CAD s/p CABG, dementia, diabetes, aortic valve replacement
Allergies: Iodine, penicillin (no reactions listed for either)
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient presented after being found down next to toilet found to have COVID-pneumonia and sepsis needing intubation for ARDS and CRRT for hyperkalemia and oliguria. Hospitalization complicated by GIB s/p rectal artery embolization by IR and GNR bacteremia requiring cefepime. Due to worsening hypoxia and shock, patient was made comfort care/hospice by family and passed away on 4/9.


Changed on 5/7/2021

VAERS ID: 1242118 Before After
VAERS Form:2
Age:77.0
Sex:Female
Location:New Jersey
Vaccinated:2021-03-13
Onset:2021-03-26
Submitted:0000-00-00
Entered:2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Acute respiratory distress syndrome, Bacteraemia, Death, Gastrointestinal haemorrhage, Hyperkalaemia, Hypoxia, Oliguria, Sepsis, Shock, Therapeutic embolisation, Endotracheal intubation, Renal replacement therapy, COVID-19 pneumonia

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: aspirin EC 81 mg daily, metformin ER 500 mg BID, atorvastatin 40 mg daily
Current Illness: fall/trauma with rib fractures
Preexisting Conditions: CAD s/p CABG, dementia, diabetes, aortic valve replacement
Allergies: Iodine, penicillin (no reactions listed for either) either)
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient presented after being found down next to toilet found to have COVID-pneumonia and sepsis needing intubation for ARDS and CRRT for hyperkalemia and oliguria. Hospitalization complicated by GIB s/p rectal artery embolization by IR and GNR bacteremia requiring cefepime. Due to worsening hypoxia and shock, patient was made comfort care/hospice by family and passed away on 4/9.


Changed on 5/14/2021

VAERS ID: 1242118 Before After
VAERS Form:2
Age:77.0
Sex:Female
Location:New Jersey
Vaccinated:2021-03-13
Onset:2021-03-26
Submitted:0000-00-00
Entered:2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Acute respiratory distress syndrome, Bacteraemia, Death, Gastrointestinal haemorrhage, Hyperkalaemia, Hypoxia, Oliguria, Sepsis, Shock, Therapeutic embolisation, Endotracheal intubation, Renal replacement therapy, COVID-19 pneumonia

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: aspirin EC 81 mg daily, metformin ER 500 mg BID, atorvastatin 40 mg daily
Current Illness: fall/trauma with rib fractures
Preexisting Conditions: CAD s/p CABG, dementia, diabetes, aortic valve replacement
Allergies: Iodine, penicillin (no reactions listed for either) either)
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient presented after being found down next to toilet found to have COVID-pneumonia and sepsis needing intubation for ARDS and CRRT for hyperkalemia and oliguria. Hospitalization complicated by GIB s/p rectal artery embolization by IR and GNR bacteremia requiring cefepime. Due to worsening hypoxia and shock, patient was made comfort care/hospice by family and passed away on 4/9.

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