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This is VAERS ID 916473

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 916473
VAERS Form:2
Age:54.0
Sex:Female
Location:Arizona
Vaccinated:2020-12-31
Onset:2020-12-31
Submitted:0000-00-00
Entered:2020-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Dyspnoea, Headache, Loss of consciousness, Seizure, Unresponsive to stimuli, Cardiac assistance device user

Life Threatening? No
Birth Defect? No
Died? No
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD, depression, pace-maker, diabetes, obesity, osteoarthritis, plantar fasciitis, localized edema, moderate persistent asthma, sleep apnea, and ovarian cyst.
Allergies: Penicillin and Blueberries
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient complained of a headache, then patient was losing consciousness and gasp for air. EpiPen was utilized due to being unresponsive then began to seizing. Patient started to flatline and an AED was used while a paramedic came. Patient was put on her side then facility gave something for seizures. Lastly, ,ambulance took her to the hospital.


Changed on 5/7/2021

VAERS ID: 916473 Before After
VAERS Form:2
Age:54.0
Sex:Female
Location:Arizona
Vaccinated:2020-12-31
Onset:2020-12-31
Submitted:0000-00-00
Entered:2020-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Dyspnoea, Headache, Loss of consciousness, Seizure, Unresponsive to stimuli, Cardiac assistance device user

Life Threatening? No
Birth Defect? No
Died? No
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD, depression, pace-maker, diabetes, obesity, osteoarthritis, plantar fasciitis, localized edema, moderate persistent asthma, sleep apnea, and ovarian cyst.
Allergies: Penicillin and Blueberries Blueberries
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient complained of a headache, then patient was losing consciousness and gasp for air. EpiPen was utilized due to being unresponsive then began to seizing. Patient started to flatline and an AED was used while a paramedic came. Patient was put on her side then facility gave something for seizures. Lastly, ,ambulance took her to the hospital.


Changed on 5/14/2021

VAERS ID: 916473 Before After
VAERS Form:2
Age:54.0
Sex:Female
Location:Arizona
Vaccinated:2020-12-31
Onset:2020-12-31
Submitted:0000-00-00
Entered:2020-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Dyspnoea, Headache, Loss of consciousness, Seizure, Unresponsive to stimuli, Cardiac assistance device user

Life Threatening? No
Birth Defect? No
Died? No
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: COPD, depression, pace-maker, diabetes, obesity, osteoarthritis, plantar fasciitis, localized edema, moderate persistent asthma, sleep apnea, and ovarian cyst.
Allergies: Penicillin and Blueberries Blueberries
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient complained of a headache, then patient was losing consciousness and gasp for air. EpiPen was utilized due to being unresponsive then began to seizing. Patient started to flatline and an AED was used while a paramedic came. Patient was put on her side then facility gave something for seizures. Lastly, ,ambulance took her to the hospital.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=916473&WAYBACKHISTORY=ON


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