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This is VAERS ID 1454827

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1454827
VAERS Form:2
Age:89.0
Sex:Female
Location:South Dakota
Vaccinated:2021-03-28
Onset:2021-04-18
Submitted:0000-00-00
Entered:2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002A21A / 2 UN / UN

Administered by: Private      Purchased by: ??
Symptoms: Death, Fall, Pulse absent, Cervical vertebral fracture, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-18
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Patient was in general poor health due to advanced age, was blind in one eye and required supplemental oxygen 24 hours a day.
Allergies:
Diagnostic Lab Data: Patient tested positive for COVID-19 on 04/18/2021 despite being fully vaccinated.
CDC 'Split Type':

Write-up: Patient fell down the stairs on 04/18/2021; EMT services found no pulse upon their arrival to the scene. Patient was transported to hospital and found to have several broken bones in neck and ultimately died on 04/18/2021 at the hospital. Patient tested positive for COVID-19 upon admission to hospital, despite being fully vaccinated. Patient did not have any known symptoms of COVID-19; the death is not thought to be related to COVID-19.

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