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This is VAERS ID 970412

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 970412
VAERS Form:2
Age:79.0
Sex:Female
Location:New York
Vaccinated:2021-01-18
Onset:2021-01-18
Submitted:0000-00-00
Entered:2021-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Public      Purchased by: ??
Symptoms: Death, Dyspnoea, Fatigue, Pyrexia, Cardio-respiratory distress, General physical condition abnormal, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-22
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: thiamine 100 MG tablet sevelamer carbonate 800 MG tablet Multiple Vitamins-Minerals (MULTIVITAMIN ADULT) Tab carvedilol 3.125 MG tablet ascorbic acid 500 MG tablet lisinopril 10 MG tablet
Current Illness: High blood pressure. Dialysis
Preexisting Conditions: kidney failure, Dialysis patient
Allergies: no
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Fever Feeling tired short of breath all night and morning after the vaccine My grandma had to be intubated and then passed away to a heart distress we think it was the vaccine because she was fine even with dialysis. When she got the vaccine it took hours and her health conditions changed.


Changed on 5/7/2021

VAERS ID: 970412 Before After
VAERS Form:2
Age:79.0
Sex:Female
Location:New York
Vaccinated:2021-01-18
Onset:2021-01-18
Submitted:0000-00-00
Entered:2021-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Public      Purchased by: ??
Symptoms: Death, Dyspnoea, Fatigue, Pyrexia, Cardio-respiratory distress, General physical condition abnormal, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-22
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: thiamine 100 MG tablet sevelamer carbonate 800 MG tablet Multiple Vitamins-Minerals (MULTIVITAMIN ADULT) Tab carvedilol 3.125 MG tablet ascorbic acid 500 MG tablet lisinopril 10 MG tablet
Current Illness: High blood pressure. Dialysis
Preexisting Conditions: kidney failure, Dialysis patient
Allergies: no no
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Fever Feeling tired short of breath all night and morning after the vaccine My grandma had to be intubated and then passed away to a heart distress we think it was the vaccine because she was fine even with dialysis. When she got the vaccine it took hours and her health conditions changed.


Changed on 5/14/2021

VAERS ID: 970412 Before After
VAERS Form:2
Age:79.0
Sex:Female
Location:New York
Vaccinated:2021-01-18
Onset:2021-01-18
Submitted:0000-00-00
Entered:2021-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / SYR

Administered by: Public      Purchased by: ??
Symptoms: Death, Dyspnoea, Fatigue, Pyrexia, Cardio-respiratory distress, General physical condition abnormal, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-22
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: thiamine 100 MG tablet sevelamer carbonate 800 MG tablet Multiple Vitamins-Minerals (MULTIVITAMIN ADULT) Tab carvedilol 3.125 MG tablet ascorbic acid 500 MG tablet lisinopril 10 MG tablet
Current Illness: High blood pressure. Dialysis
Preexisting Conditions: kidney failure, Dialysis patient
Allergies: no no
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Fever Feeling tired short of breath all night and morning after the vaccine My grandma had to be intubated and then passed away to a heart distress we think it was the vaccine because she was fine even with dialysis. When she got the vaccine it took hours and her health conditions changed.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=970412&WAYBACKHISTORY=ON


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