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This is VAERS ID 1337701

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1337701
VAERS Form:2
Age:64.0
Sex:Female
Location:Arkansas
Vaccinated:2021-04-16
Onset:2021-05-18
Submitted:0000-00-00
Entered:2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 UN / UN

Administered by: Private      Purchased by: ??
Symptoms: Death, Dyspnoea, Pneumonia, Respiratory distress, Bilevel positive airway pressure, Hospice care, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-20
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: Unknown- received vaccine outside of hospital
Current Illness: Unknown- vaccine elsewhere
Preexisting Conditions: Chronic kidney disease, Congestive heart failure, Diabetes mellitus, blood clots
Allergies: No known allegries
Diagnostic Lab Data: Tested positive for COVID- expired
CDC 'Split Type':

Write-up: 64 y.o. female who presented with SOB. She has a history of CAD, diabetes, CHF, CKD and DVT presents to the ED in respiratory distress. Patient was brought in by EMS from nursing home. Patient had reported onset of shortness of breath and respiratory distress over the last 6-7 hours. Patient has O2 sat of 90% on 6 L. Patient only uses 2 L nasal cannula oxygen all day long. Patient is coherent and initially was placed on BIPAP but then stated she wanted to go back, now after ER doc spoke to her she is ok with being admitted but does not want BIPAP or to be placed in the ICU. She is DNR/DNI. She is working hard to breathe currently. Patient is unsure if she is making urine at this time. Workup in the ER revealed AKI on CKD and covid + pneumonia. Patient elected hospice and expired 5/20/2021. It was reported that patient had received vaccines at Walmart.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1337701&WAYBACKHISTORY=ON

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