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This is VAERS ID 1745752

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/1/2021

VAERS ID: 1745752
VAERS Form:2
Age:89.0
Sex:Female
Location:New Jersey
Vaccinated:2021-09-16
Onset:2021-09-17
Submitted:0000-00-00
Entered:2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050EZ1A / 3 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Asthenia, Computerised tomogram, Death, Depressed level of consciousness, Dysphagia, Monoplegia, Pyrexia, Respiratory distress, Speech disorder, General physical health deterioration, Computerised tomogram thorax, Magnetic resonance imaging head normal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-09-25
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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine /pantoprazole /vit d /vit b 12
Current Illness: none
Preexisting Conditions: hypertension
Allergies: none known
Diagnostic Lab Data: magnetic scans of brain x 2 / cat scans x 1 / cat scan of chest /
CDC 'Split Type':

Write-up: fever and weakness day after vaccine with increasing weakness at home /admitted to hospital 4 days later with weakness /progressive decline with weakness and paralysis of left arm / stroke suspected but could not be confirmed on 2 magnetic resonance scans /inability to speak and then swallow / treated for possible aspiration pneumonia /progressed to being obtunded and respiratory distress / died 9/25/21

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