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This is VAERS ID 1761528

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1761528
VAERS Form:2
Age:60.0
Sex:Female
Location:Michigan
Vaccinated:2021-03-10
Onset:2021-10-05
Submitted:0000-00-00
Entered:2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / 2 - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Acute respiratory distress syndrome, Atrial fibrillation, Cardiac failure, Condition aggravated, Death, Hypoxia, Intensive care, Pneumothorax, Renal failure, Respiratory failure, General physical health deterioration, Chest tube insertion, Anticoagulant therapy, Endotracheal intubation, Multiple organ dysfunction syndrome, COVID-19 pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-10-05
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:
Current Illness:
Preexisting Conditions: Hypertension, anxiety, vitamin D deficiency, obesity class 3, obstructive apnea, allergic rhinitis, chronic kidney disease, atrial fibriliation.
Allergies: Hydrocodone (itching), Robitussin (chest tightness), soaps, animal dander, cosmetics.
Diagnostic Lab Data: COVID positive test on 09/20/21.
CDC 'Split Type':

Write-up: Fully vaccinated patient admitted for COVID pneumonia. Provider discharge note: "Admitted to the hospital on September 20, 2021 for hypoxia. She was fully vaccinated against COVID-19. At that time she is requiring high-flow nasal cannula oxygenation. On 09/20 for a CT scan was done which showed a possible nonocclusive emboli in the left lower lung. She was started on heparin. She was transferred to the intensive care unit on the morning of 09/30/2021. She developed bilateral pneumothoracies that time. She was intubated and chest tubes were placed. Over the next 5 days she developed worsening ARDS with multiorgan system failure. This presented initially with AFib with RVR and progressed to kidney failure. On the morning of 10/04/2021 the patient''s family decided that they did not want to pursue additional care. Her respiratory cardiac function decreased until 9:45AM on 10/5/2021 when she passed away."

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