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This is VAERS ID 937186

History of Changes from the VAERS Wayback Machine

First Appeared on 1/15/2021

VAERS ID: 937186
VAERS Form:2
Age:87.0
Sex:Female
Location:Arkansas
Vaccinated:2020-12-22
Onset:2020-12-24
Submitted:0000-00-00
Entered:2021-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-10
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: Hydrocodone-Acetamenaphin, Lidocaine, Cefritriaxone, Citalopram
Current Illness: Chronic pain
Preexisting Conditions: Pain
Allergies: None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The facility had a number of positive COVID 19 cases prior to patients vaccination. Due to her advanced age, chronic condition, and exposure, patient did not have the time to build immunity after exposure before becoming positive.


Changed on 5/7/2021

VAERS ID: 937186 Before After
VAERS Form:2
Age:87.0
Sex:Female
Location:Arkansas
Vaccinated:2020-12-22
Onset:2020-12-24
Submitted:0000-00-00
Entered:2021-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-10
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: Hydrocodone-Acetamenaphin, Lidocaine, Cefritriaxone, Citalopram
Current Illness: Chronic pain
Preexisting Conditions: Pain
Allergies: None None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The facility had a number of positive COVID 19 cases prior to patients vaccination. Due to her advanced age, chronic condition, and exposure, patient did not have the time to build immunity after exposure before becoming positive.


Changed on 5/14/2021

VAERS ID: 937186 Before After
VAERS Form:2
Age:87.0
Sex:Female
Location:Arkansas
Vaccinated:2020-12-22
Onset:2020-12-24
Submitted:0000-00-00
Entered:2021-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-10
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: Hydrocodone-Acetamenaphin, Lidocaine, Cefritriaxone, Citalopram
Current Illness: Chronic pain
Preexisting Conditions: Pain
Allergies: None None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The facility had a number of positive COVID 19 cases prior to patients vaccination. Due to her advanced age, chronic condition, and exposure, patient did not have the time to build immunity after exposure before becoming positive.

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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=937186&WAYBACKHISTORY=ON

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