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This is VAERS ID 1362130

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1362130
VAERS Form:2
Age:64.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-03-17
Onset:2021-04-13
Submitted:0000-00-00
Entered:2021-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 2 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Angiogram pulmonary, Aortic thrombosis, Brain herniation, Cerebrovascular accident, Death, Computerised tomogram thorax abnormal, Laboratory test, Neurological symptom, Ischaemic stroke, Computerised tomogram head abnormal, Peripheral artery thrombosis, Magnetic resonance imaging

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-14
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Abaloparatide 80mg sc daily Colestipol 1gm BID Famotidine 20mg daily Gabapentin HCTZ 25mg daily Metformin 500mg BID Venlafaxine 1 cap daily Hydromorphone 4mg prn pain
Current Illness:
Preexisting Conditions: T2DM HTN Obesity Esophageal stricture Depression Eczema He H pylori infection
Allergies: Benzoic acid
Diagnostic Lab Data: Multiple labs, head & chest CT scans, CTA chest, MRI?s.
CDC 'Split Type':

Write-up: Acute onset stroke symptoms the afternoon of 4/13/21 after returning home from room. EMS transported pt to local hospital. Dx with aortic arch/proximal subclavian artery thrombus, migration into axillary artery. Treated at local hospital with TNK for aortic arch clot & ischemic stroke. Transferred to tertiary medical center. Pt had massive stroke (left & right side) with brain stem herniation. Pt CMO after 16hrs and expired on 4/14, <32 hrs after symptom onset.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1362130&WAYBACKHISTORY=ON

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