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This is VAERS ID 958069

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/22/2021

VAERS ID: 958069
VAERS Form:2
Age:94.0
Sex:Female
Location:Florida
Vaccinated:2021-01-14
Onset:2021-01-19
Submitted:0000-00-00
Entered:2021-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Cough, Dyspnoea, Feeling abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-20
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: Cartia XT 120mg daily, Zaditor 0.025% 1 drop into eye twice a day, Folic Acid 1mg daily, Metoprolol Succinate ER 100mg twice a day, Lasix 40mg daily, Erythromycin 2% to area twice a day, Hydroxychloroquine Sulfate 200mg 2 tabs daily, Ferrou
Current Illness: None
Preexisting Conditions: Rheumatoid arthritis, osteoarthritis, lumbar spinal stenosis, diabetes, bradycardia with pacemaker
Allergies: Codeine
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Started with cough, mild shortness of breath and feeling terrible in evening of 1/19.


Changed on 5/7/2021

VAERS ID: 958069 Before After
VAERS Form:2
Age:94.0
Sex:Female
Location:Florida
Vaccinated:2021-01-14
Onset:2021-01-19
Submitted:0000-00-00
Entered:2021-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Cough, Dyspnoea, Feeling abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-20
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: Cartia XT 120mg daily, Zaditor 0.025% 1 drop into eye twice a day, Folic Acid 1mg daily, Metoprolol Succinate ER 100mg twice a day, Lasix 40mg daily, Erythromycin 2% to area twice a day, Hydroxychloroquine Sulfate 200mg 2 tabs daily, Ferrou
Current Illness: None
Preexisting Conditions: Rheumatoid arthritis, osteoarthritis, lumbar spinal stenosis, diabetes, bradycardia with pacemaker
Allergies: Codeine Codeine
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Started with cough, mild shortness of breath and feeling terrible in evening of 1/19.


Changed on 5/21/2021

VAERS ID: 958069 Before After
VAERS Form:2
Age:94.0
Sex:Female
Location:Florida
Vaccinated:2021-01-14
Onset:2021-01-19
Submitted:0000-00-00
Entered:2021-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Cough, Dyspnoea, Feeling abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-20
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: Cartia XT 120mg daily, Zaditor 0.025% 1 drop into eye twice a day, Folic Acid 1mg daily, Metoprolol Succinate ER 100mg twice a day, Lasix 40mg daily, Erythromycin 2% to area twice a day, Hydroxychloroquine Sulfate 200mg 2 tabs daily, Ferrou
Current Illness: None
Preexisting Conditions: Rheumatoid arthritis, osteoarthritis, lumbar spinal stenosis, diabetes, bradycardia with pacemaker
Allergies: Codeine Codeine
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Started with cough, mild shortness of breath and feeling terrible in evening of 1/19.

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