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This is VAERS ID 1490965

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1490965
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Senior Living      Purchased by: ??
Symptoms: Aspiration, Clostridium difficile colitis, Cough, Death, Dyspnoea, Lethargy, Pneumonia, Pneumonia aspiration, Pneumonitis, Sepsis, Laboratory test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-07-08
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: Not aware of meds at time of vaccination. Admitted to Beecher Manor 6/28/2021.
Current Illness: Not aware of illnesses at time of vaccination. Admitted to Beecher Manor 6/28/2021.
Preexisting Conditions: COPD, CHF, Chronic Kidney Disease.
Allergies: Cipro, Medrol
Diagnostic Lab Data: Testing and labs completed at hospital.
CDC 'Split Type':

Write-up: Resident was vaccinated. Pt was admitted on 6/28 with dx of pneumonia, cdiff and sepsis. On admission pt noted to have dry cough and lethargy. Pt had signs of aspiration and dyspnea and was sent to ED for evaluation within five hours of admission to Beecher Manor. She was treated for aspiration pneumonia w/diagnosis of pneumonitis r/t food and vomit. She was re-admitted to Beecher Manor on 7/3 with orders for Augmentin PO 7/4 - 7/9. She continued to decline w/plans by family to begin Hospice care. She expired during process of initiating hospice care.

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