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This is VAERS ID 941607

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/15/2021

VAERS ID: 941607
VAERS Form:2
Age:83.0
Sex:Female
Location:Indiana
Vaccinated:2021-01-12
Onset:2021-01-13
Submitted:0000-00-00
Entered:2021-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H20A / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Hypotonia, Unresponsive to stimuli, Anal incontinence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-13
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: Tylenol 325mg, Lasix 20mg, Senna 8.6mg, Aspirin 81mg, Levothyroxine 75mcg
Current Illness: N/A
Preexisting Conditions: End stage dementia, cerebro vascular disease, Hx left vertebral artery aneurysm
Allergies: NKA
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: The patient passed away today, 1/13/2021. She was a hospice patient. She showed no adverse effects after receiving the vaccine on 1/12/2021. This morning she woke up as normal and during her morning shower she had a bowel movement, went limp and was non-responsive. The patient passed away at 7:45 am.


Changed on 5/7/2021

VAERS ID: 941607 Before After
VAERS Form:2
Age:83.0
Sex:Female
Location:Indiana
Vaccinated:2021-01-12
Onset:2021-01-13
Submitted:0000-00-00
Entered:2021-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H20A / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Hypotonia, Unresponsive to stimuli, Anal incontinence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-13
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: Tylenol 325mg, Lasix 20mg, Senna 8.6mg, Aspirin 81mg, Levothyroxine 75mcg
Current Illness: N/A
Preexisting Conditions: End stage dementia, cerebro vascular disease, Hx left vertebral artery aneurysm
Allergies: NKA NKA
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: The patient passed away today, 1/13/2021. She was a hospice patient. She showed no adverse effects after receiving the vaccine on 1/12/2021. This morning she woke up as normal and during her morning shower she had a bowel movement, went limp and was non-responsive. The patient passed away at 7:45 am.


Changed on 5/14/2021

VAERS ID: 941607 Before After
VAERS Form:2
Age:83.0
Sex:Female
Location:Indiana
Vaccinated:2021-01-12
Onset:2021-01-13
Submitted:0000-00-00
Entered:2021-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H20A / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Hypotonia, Unresponsive to stimuli, Anal incontinence

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-13
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: Tylenol 325mg, Lasix 20mg, Senna 8.6mg, Aspirin 81mg, Levothyroxine 75mcg
Current Illness: N/A
Preexisting Conditions: End stage dementia, cerebro vascular disease, Hx left vertebral artery aneurysm
Allergies: NKA NKA
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: The patient passed away today, 1/13/2021. She was a hospice patient. She showed no adverse effects after receiving the vaccine on 1/12/2021. This morning she woke up as normal and during her morning shower she had a bowel movement, went limp and was non-responsive. The patient passed away at 7:45 am.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=941607&WAYBACKHISTORY=ON


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