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This is VAERS ID 1761994

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1761994
VAERS Form:2
Age:65.0
Sex:Female
Location:Florida
Vaccinated:2021-09-15
Onset:2021-09-16
Submitted:0000-00-00
Entered:2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Chest discomfort, Chest pain, Cough, Death, Dyspnoea, Feeling abnormal, Malaise, Somnolence, Respiratory tract congestion

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: Gabapentin, Busiprone, cyclobenzaprine, insuline
Current Illness:
Preexisting Conditions: Type-2 Diabetes with well maintained blood sugar levels.
Allergies: NKA
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: 09/16/2021-09/19/2021 Patient remained in bed coughing, feeling ill, drinking fluids and eating but slept mostly. 09/20/2021-Patient complained about being congested so she took mucus relief and cough drops 09/21/2021-09/23/2021-Patient began moving around the house feeling short of breath and a little foggy but symptoms felt to be slowly disipating and she was glad to be out of bed. Took a shower and sat outside to get fresh air and discussed how 09/16-09/19 she had never felt the burning in her chest and tightness like anything before and was glad it was over with. She was given water and left to her own accord at 10:30 pm. 09/24/21- At approximately 9:30 patient was discovered in her bed having died sometime throughout the night.

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