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This is VAERS ID 1273475

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History of Changes from the VAERS Wayback Machine

First Appeared on 5/7/2021

VAERS ID: 1273475
VAERS Form:2
Age:24.0
Sex:Female
Location:Mississippi
Vaccinated:2021-04-28
Onset:2021-04-29
Submitted:0000-00-00
Entered:2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Apnoea, Death, Pulse absent, Resuscitation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-29
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: Isosource Continuous feeding, Tylenol 650mg PRN; Ibuprofen 400mg PRN; Metoprolol 50mg BID
Current Illness: Anoxic Brain Injury, History of MI, Uterine rupture, dysphagia, PEG TUBE, Tracheostomy
Preexisting Conditions: Anoxic Brain Injury
Allergies: NKA
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: on 04/29/2021 Resident was checked at 1830 and found to be at baseline status. At approximately 1855, resident was found pulses and apneic. CPR initiated and resident transferred to medical center. Resident expired 1939.


Changed on 5/14/2021

VAERS ID: 1273475 Before After
VAERS Form:2
Age:24.0
Sex:Female
Location:Mississippi
Vaccinated:2021-04-28
Onset:2021-04-29
Submitted:0000-00-00
Entered:2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016C21A / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Apnoea, Death, Pulse absent, Resuscitation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-29
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: Isosource Continuous feeding, Tylenol 650mg PRN; Ibuprofen 400mg PRN; Metoprolol 50mg BID
Current Illness: Anoxic Brain Injury, History of MI, Uterine rupture, dysphagia, PEG TUBE, Tracheostomy
Preexisting Conditions: Anoxic Brain Injury
Allergies: NKA NKA
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: on 04/29/2021 Resident was checked at 1830 and found to be at baseline status. At approximately 1855, resident was found pulses and apneic. CPR initiated and resident transferred to medical center. Resident expired 1939.

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