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This is VAERS ID 998770

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 998770
VAERS Form:2
Age:91.0
Sex:Female
Location:Arkansas
Vaccinated:2021-01-28
Onset:2021-01-29
Submitted:0000-00-00
Entered:2021-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Dyspnoea, Hypopnoea, Palpitations

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-30
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: OTC APAP prn Tradjenta 5mg daily amlodipine 10mg daily naproxen 500mg BID trazodone 100mg HS atorvastatin 20mg daily gabapentin 100mg TID timolol 0.5% eye drops 1 drop each eye BID metformin ER 500mg daily glipizide 10mg BID lisinopril 20m
Current Illness:
Preexisting Conditions: High blood pressure High Cholesterol Diabetes Restless Legs syndrome depression/anxiety
Allergies: NKA
Diagnostic Lab Data: unknown
CDC 'Split Type':

Write-up: Patient had no symptoms or adverse events until the next evening after shot (1/29/21) where daughter reported her having heart palpitations. Family told her to rest and did not seek medical attention. Saturday afternoon (1/30/2021), patient started experiencing labored breathing. Daughter called 911 and before the ambulance arrived, the patient''s breathing became more and more shallow. Patient was taken to the local hospital and passed away Saturday evening around 5:30 pm.


Changed on 5/7/2021

VAERS ID: 998770 Before After
VAERS Form:2
Age:91.0
Sex:Female
Location:Arkansas
Vaccinated:2021-01-28
Onset:2021-01-29
Submitted:0000-00-00
Entered:2021-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Dyspnoea, Hypopnoea, Palpitations

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-30
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: OTC APAP prn Tradjenta 5mg daily amlodipine 10mg daily naproxen 500mg BID trazodone 100mg HS atorvastatin 20mg daily gabapentin 100mg TID timolol 0.5% eye drops 1 drop each eye BID metformin ER 500mg daily glipizide 10mg BID lisinopril 20m
Current Illness:
Preexisting Conditions: High blood pressure High Cholesterol Diabetes Restless Legs syndrome depression/anxiety
Allergies: NKA NKA
Diagnostic Lab Data: unknown
CDC 'Split Type':

Write-up: Patient had no symptoms or adverse events until the next evening after shot (1/29/21) where daughter reported her having heart palpitations. Family told her to rest and did not seek medical attention. Saturday afternoon (1/30/2021), patient started experiencing labored breathing. Daughter called 911 and before the ambulance arrived, the patient''s breathing became more and more shallow. Patient was taken to the local hospital and passed away Saturday evening around 5:30 pm.


Changed on 5/14/2021

VAERS ID: 998770 Before After
VAERS Form:2
Age:91.0
Sex:Female
Location:Arkansas
Vaccinated:2021-01-28
Onset:2021-01-29
Submitted:0000-00-00
Entered:2021-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Dyspnoea, Hypopnoea, Palpitations

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-30
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: OTC APAP prn Tradjenta 5mg daily amlodipine 10mg daily naproxen 500mg BID trazodone 100mg HS atorvastatin 20mg daily gabapentin 100mg TID timolol 0.5% eye drops 1 drop each eye BID metformin ER 500mg daily glipizide 10mg BID lisinopril 20m
Current Illness:
Preexisting Conditions: High blood pressure High Cholesterol Diabetes Restless Legs syndrome depression/anxiety
Allergies: NKA NKA
Diagnostic Lab Data: unknown
CDC 'Split Type':

Write-up: Patient had no symptoms or adverse events until the next evening after shot (1/29/21) where daughter reported her having heart palpitations. Family told her to rest and did not seek medical attention. Saturday afternoon (1/30/2021), patient started experiencing labored breathing. Daughter called 911 and before the ambulance arrived, the patient''s breathing became more and more shallow. Patient was taken to the local hospital and passed away Saturday evening around 5:30 pm.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=998770&WAYBACKHISTORY=ON

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