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This is VAERS ID 993072

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 993072
VAERS Form:2
Age:64.0
Sex:Female
Location:Minnesota
Vaccinated:2021-01-27
Onset:2021-01-27
Submitted:0000-00-00
Entered:2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / SYR

Administered by: Public      Purchased by: ??
Symptoms: Abdominal pain, Ascites, Blood chloride decreased, Blood creatinine increased, Blood culture positive, Blood lactic acid increased, Blood potassium decreased, Blood sodium decreased, C-reactive protein increased, Carbon dioxide decreased, Death, Malaise, Ovarian necrosis, Platelet count decreased, Septic shock, Surgery, White blood cell count decreased, Peritoneal lavage, Blood alkaline phosphatase increased, Streptococcus test positive, Omental necrosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-31
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metoprolol, Lipitor, Lisinopril, Asa,Demedex, Levimir, Jardiance, Metformin
Current Illness: None reported
Preexisting Conditions: Type 2 DM, MGUS, Cardiomyopathy with implanted Defib, Chronic heart failure
Allergies: Environmental and Magnesium succinate
Diagnostic Lab Data: WBC 1.2 with lactic acid 9.3, Plt. 113, Na 128, K 3.3, Cl 92, CO2 16, Cr 2.25, Alk phos 150, CRP 160.6. Blood cultures grew out strep A, Pt. taken to emergent surgery with no intra abdominal pathology. for sepsis found. Had massive ascites. Subsequently had a repeat wash out with necrotic ovaries/omentum noted. Never recovered and subsequently died from her illness.
CDC 'Split Type':

Write-up: Pt. presented to the ER with abd pain and septic shock. Pt. reported to feel ill shortly after receiving the vaccine.


Changed on 5/7/2021

VAERS ID: 993072 Before After
VAERS Form:2
Age:64.0
Sex:Female
Location:Minnesota
Vaccinated:2021-01-27
Onset:2021-01-27
Submitted:0000-00-00
Entered:2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / SYR

Administered by: Public      Purchased by: ??
Symptoms: Abdominal pain, Ascites, Blood chloride decreased, Blood creatinine increased, Blood culture positive, Blood lactic acid increased, Blood potassium decreased, Blood sodium decreased, C-reactive protein increased, Carbon dioxide decreased, Death, Malaise, Ovarian necrosis, Platelet count decreased, Septic shock, Surgery, White blood cell count decreased, Peritoneal lavage, Blood alkaline phosphatase increased, Streptococcus test positive, Omental necrosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-31
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metoprolol, Lipitor, Lisinopril, Asa,Demedex, Levimir, Jardiance, Metformin
Current Illness: None reported
Preexisting Conditions: Type 2 DM, MGUS, Cardiomyopathy with implanted Defib, Chronic heart failure
Allergies: Environmental and Magnesium succinate succinate
Diagnostic Lab Data: WBC 1.2 with lactic acid 9.3, Plt. 113, Na 128, K 3.3, Cl 92, CO2 16, Cr 2.25, Alk phos 150, CRP 160.6. Blood cultures grew out strep A, Pt. taken to emergent surgery with no intra abdominal pathology. for sepsis found. Had massive ascites. Subsequently had a repeat wash out with necrotic ovaries/omentum noted. Never recovered and subsequently died from her illness.
CDC 'Split Type':

Write-up: Pt. presented to the ER with abd pain and septic shock. Pt. reported to feel ill shortly after receiving the vaccine.


Changed on 5/14/2021

VAERS ID: 993072 Before After
VAERS Form:2
Age:64.0
Sex:Female
Location:Minnesota
Vaccinated:2021-01-27
Onset:2021-01-27
Submitted:0000-00-00
Entered:2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / SYR

Administered by: Public      Purchased by: ??
Symptoms: Abdominal pain, Ascites, Blood chloride decreased, Blood creatinine increased, Blood culture positive, Blood lactic acid increased, Blood potassium decreased, Blood sodium decreased, C-reactive protein increased, Carbon dioxide decreased, Death, Malaise, Ovarian necrosis, Platelet count decreased, Septic shock, Surgery, White blood cell count decreased, Peritoneal lavage, Blood alkaline phosphatase increased, Streptococcus test positive, Omental necrosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-31
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metoprolol, Lipitor, Lisinopril, Asa,Demedex, Levimir, Jardiance, Metformin
Current Illness: None reported
Preexisting Conditions: Type 2 DM, MGUS, Cardiomyopathy with implanted Defib, Chronic heart failure
Allergies: Environmental and Magnesium succinate succinate
Diagnostic Lab Data: WBC 1.2 with lactic acid 9.3, Plt. 113, Na 128, K 3.3, Cl 92, CO2 16, Cr 2.25, Alk phos 150, CRP 160.6. Blood cultures grew out strep A, Pt. taken to emergent surgery with no intra abdominal pathology. for sepsis found. Had massive ascites. Subsequently had a repeat wash out with necrotic ovaries/omentum noted. Never recovered and subsequently died from her illness.
CDC 'Split Type':

Write-up: Pt. presented to the ER with abd pain and septic shock. Pt. reported to feel ill shortly after receiving the vaccine.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=993072&WAYBACKHISTORY=ON

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