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This is VAERS ID 978529

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 978529
VAERS Form:2
Age:88.0
Sex:Female
Location:West Virginia
Vaccinated:2020-12-31
Onset:2021-01-15
Submitted:0000-00-00
Entered:2021-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chest X-ray, Death, Computerised tomogram thorax, Computerised tomogram abdomen, COVID-19 pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-15
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lasix 20 mg daily, KCL ER 20 MEQ daily, Eliquis 2.5 mg twice daily, allopurinol 300 mg daily, Lyrica 50 mg daily, Metoprolol Succinate ER 50 mg daily, Amlodipine 5 mg daily, Pravstatin 20mg daily, Vit d3 25mcg daily
Current Illness: None
Preexisting Conditions: Diabetes
Allergies: Bee Stings, Statins, Flecinide
Diagnostic Lab Data: Chest XR 1/15/21 CT chest/abdomen 1/15/21
CDC 'Split Type':

Write-up: Patient developed Covid pneumonia dx 1/15/21, patient expired


Changed on 4/1/2021

VAERS ID: 978529 Before After
VAERS Form:2
Age:88.0
Sex:Female
Location:West Virginia
Vaccinated:2020-12-31
Onset:2021-01-15
Submitted:0000-00-00
Entered:2021-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chest X-ray, Death, Computerised tomogram thorax, Computerised tomogram abdomen, COVID-19 pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-15
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lasix 20 mg daily, KCL ER 20 MEQ daily, Eliquis 2.5 mg twice daily, allopurinol 300 mg daily, Lyrica 50 mg daily, Metoprolol Succinate ER 50 mg daily, Amlodipine 5 mg daily, Pravstatin 20mg daily, Vit d3 25mcg daily
Current Illness: None
Preexisting Conditions: Diabetes
Allergies: Bee Stings, Statins, Flecinide
Diagnostic Lab Data: Chest XR 1/15/21 CT chest/abdomen 1/15/21
CDC 'Split Type':

Write-up: Patient developed Covid pneumonia dx 1/15/21, patient expired


Changed on 5/7/2021

VAERS ID: 978529 Before After
VAERS Form:2
Age:88.0
Sex:Female
Location:West Virginia
Vaccinated:2020-12-31
Onset:2021-01-15
Submitted:0000-00-00
Entered:2021-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chest X-ray, Death, Computerised tomogram thorax, Computerised tomogram abdomen

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-15
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lasix 20 mg daily, KCL ER 20 MEQ daily, Eliquis 2.5 mg twice daily, allopurinol 300 mg daily, Lyrica 50 mg daily, Metoprolol Succinate ER 50 mg daily, Amlodipine 5 mg daily, Pravstatin 20mg daily, Vit d3 25mcg daily
Current Illness: None
Preexisting Conditions: Diabetes
Allergies: Bee Stings, Statins, Flecinide Flecinide
Diagnostic Lab Data: Chest XR 1/15/21 CT chest/abdomen 1/15/21
CDC 'Split Type':

Write-up: Patient developed Covid pneumonia dx 1/15/21, patient expired


Changed on 5/14/2021

VAERS ID: 978529 Before After
VAERS Form:2
Age:88.0
Sex:Female
Location:West Virginia
Vaccinated:2020-12-31
Onset:2021-01-15
Submitted:0000-00-00
Entered:2021-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chest X-ray, Death, Computerised tomogram thorax, Computerised tomogram abdomen

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-15
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lasix 20 mg daily, KCL ER 20 MEQ daily, Eliquis 2.5 mg twice daily, allopurinol 300 mg daily, Lyrica 50 mg daily, Metoprolol Succinate ER 50 mg daily, Amlodipine 5 mg daily, Pravstatin 20mg daily, Vit d3 25mcg daily
Current Illness: None
Preexisting Conditions: Diabetes
Allergies: Bee Stings, Statins, Flecinide Flecinide
Diagnostic Lab Data: Chest XR 1/15/21 CT chest/abdomen 1/15/21
CDC 'Split Type':

Write-up: Patient developed Covid pneumonia dx 1/15/21, patient expired


Changed on 7/30/2021

VAERS ID: 978529 Before After
VAERS Form:2
Age:88.0
Sex:Female
Location:West Virginia
Vaccinated:2020-12-31
Onset:2021-01-15
Submitted:0000-00-00
Entered:2021-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chest X-ray, Death, Computerised tomogram thorax, Computerised tomogram abdomen, COVID-19 pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-15
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lasix 20 mg daily, KCL ER 20 MEQ daily, Eliquis 2.5 mg twice daily, allopurinol 300 mg daily, Lyrica 50 mg daily, Metoprolol Succinate ER 50 mg daily, Amlodipine 5 mg daily, Pravstatin 20mg daily, Vit d3 25mcg daily
Current Illness: None
Preexisting Conditions: Diabetes
Allergies: Bee Stings, Statins, Flecinide
Diagnostic Lab Data: Chest XR 1/15/21 CT chest/abdomen 1/15/21
CDC 'Split Type':

Write-up: Patient developed Covid pneumonia dx 1/15/21, patient expired

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