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This is VAERS ID 965807

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 965807
VAERS Form:2
Age:90.0
Sex:Female
Location:Georgia
Vaccinated:2021-01-08
Onset:2021-01-09
Submitted:0000-00-00
Entered:2021-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 LA / SYR

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Immobile, Pruritus, Respiratory disorder, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-16
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: metoprolol, methotrexate, calcitrol, digoxin, calcium prednisone, clopidogrel, levothyroxine, folic acid, pantoprazole, eliquis, atorvastatin, latanoprost, melatonin
Current Illness: nose bleeds
Preexisting Conditions: rheumatoid arthritis, atrial fibrillation
Allergies: Penicillin
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: began itching within 24 hours, within 5 days couldn''t move on her own, by 6th day was having respiratory issues, by day 7 unresponsive, by day 8 dead


Changed on 5/7/2021

VAERS ID: 965807 Before After
VAERS Form:2
Age:90.0
Sex:Female
Location:Georgia
Vaccinated:2021-01-08
Onset:2021-01-09
Submitted:0000-00-00
Entered:2021-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 LA / SYR

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Immobile, Pruritus, Respiratory disorder, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-16
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: metoprolol, methotrexate, calcitrol, digoxin, calcium prednisone, clopidogrel, levothyroxine, folic acid, pantoprazole, eliquis, atorvastatin, latanoprost, melatonin
Current Illness: nose bleeds
Preexisting Conditions: rheumatoid arthritis, atrial fibrillation
Allergies: Penicillin Penicillin
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: began itching within 24 hours, within 5 days couldn''t move on her own, by 6th day was having respiratory issues, by day 7 unresponsive, by day 8 dead


Changed on 5/14/2021

VAERS ID: 965807 Before After
VAERS Form:2
Age:90.0
Sex:Female
Location:Georgia
Vaccinated:2021-01-08
Onset:2021-01-09
Submitted:0000-00-00
Entered:2021-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 LA / SYR

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Immobile, Pruritus, Respiratory disorder, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-16
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: metoprolol, methotrexate, calcitrol, digoxin, calcium prednisone, clopidogrel, levothyroxine, folic acid, pantoprazole, eliquis, atorvastatin, latanoprost, melatonin
Current Illness: nose bleeds
Preexisting Conditions: rheumatoid arthritis, atrial fibrillation
Allergies: Penicillin Penicillin
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: began itching within 24 hours, within 5 days couldn''t move on her own, by 6th day was having respiratory issues, by day 7 unresponsive, by day 8 dead

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=965807&WAYBACKHISTORY=ON


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