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This is VAERS ID 1737526

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/1/2021

VAERS ID: 1737526
VAERS Form:2
Age:96.0
Sex:Male
Location:Colorado
Vaccinated:2021-09-08
Onset:2021-09-21
Submitted:0000-00-00
Entered:2021-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035C21A / 3 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Hypotension, Hypoxia, Tachycardia, General physical health deterioration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-09-24
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: Voltaren Gel 1 % (Diclofenac Sodium)Apply 1 application transdermally two times a day, Acetaminophen Liquid 160 MG/5ML give 30 ml by mouth three times a day, Refresh Optive Advanced Solution 0.5-1-0.5 % (Carboxymeth-Glycerin-Polysorb)Instil
Current Illness: Resident had been admitted to hospice in April 2021 d/t terminal diagnosis of Alzheimer''s dementia. He continued to have issues with dysphagia and needed a mechanically altered diet. He had increase difficulty was speech and making needs known. He was w/c bound and required total assistance.
Preexisting Conditions: Hypertensive heart and chronic kidney disease with heart failure, Diabetes Mellitus, Parkinson''s Disease, Alzheimer''s dementia, anemia, BPH, TIA
Allergies: TB Skin test
Diagnostic Lab Data: None due to end of life wishes.
CDC 'Split Type':

Write-up: Resident was administered 3rd dose d/t immunocompromising condition. He was on hospice at the time of vaccination living in a nursing home. He was observed to have a blood pressure lower than normal on 9/21/21 and hypoxia and tachycardia. The resident received morphine. He continued to decline and was provided comfort/end of life care.

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