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This is VAERS ID 944641

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/22/2021

VAERS ID: 944641
VAERS Form:2
Age:83.0
Sex:Female
Location:Florida
Vaccinated:2021-01-12
Onset:2021-01-13
Submitted:0000-00-00
Entered:2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death

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: Atorvastatin 80mg daily, biotin 2500mg daily, Calcium-Mag-Zinc tab daily, Restasis eye drop q12hr, ezetimibe 10mg qhs, gabapentin 100mg bid, lysine 1000mg daily, metoprolol tart 50mg bid, fish oil 1000mg daily, prilosec 20mg daily, ranola
Current Illness: CAD, angina, coronary bypass in 1990''s, Cardiac Cath on 12/28/2020
Preexisting Conditions: CAD
Allergies: Sulfa
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: Patient died on 1/21-2021


Changed on 5/7/2021

VAERS ID: 944641 Before After
VAERS Form:2
Age:83.0
Sex:Female
Location:Florida
Vaccinated:2021-01-12
Onset:2021-01-13
Submitted:0000-00-00
Entered:2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death

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: Atorvastatin 80mg daily, biotin 2500mg daily, Calcium-Mag-Zinc tab daily, Restasis eye drop q12hr, ezetimibe 10mg qhs, gabapentin 100mg bid, lysine 1000mg daily, metoprolol tart 50mg bid, fish oil 1000mg daily, prilosec 20mg daily, ranola
Current Illness: CAD, angina, coronary bypass in 1990''s, Cardiac Cath on 12/28/2020
Preexisting Conditions: CAD
Allergies: Sulfa Sulfa
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: Patient died on 1/21-2021


Changed on 5/21/2021

VAERS ID: 944641 Before After
VAERS Form:2
Age:83.0
Sex:Female
Location:Florida
Vaccinated:2021-01-12
Onset:2021-01-13
Submitted:0000-00-00
Entered:2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death

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: Atorvastatin 80mg daily, biotin 2500mg daily, Calcium-Mag-Zinc tab daily, Restasis eye drop q12hr, ezetimibe 10mg qhs, gabapentin 100mg bid, lysine 1000mg daily, metoprolol tart 50mg bid, fish oil 1000mg daily, prilosec 20mg daily, ranola
Current Illness: CAD, angina, coronary bypass in 1990''s, Cardiac Cath on 12/28/2020
Preexisting Conditions: CAD
Allergies: Sulfa Sulfa
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: Patient died on 1/21-2021

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