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This is VAERS ID 958745

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/22/2021

VAERS ID: 958745
VAERS Form:2
Age:73.0
Sex:Male
Location:Colorado
Vaccinated:2021-01-12
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Asthenia, Fall, Pulse absent, Pyrexia, Skin warm, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-16
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: Divalproex Sodium Tab DR 250mg and 500mg, Lexapro 20mg, Quetiapine Fumarate 200mg tab, Senna 8.6 mg, Latanoprost drops,
Current Illness: Hx of TBI and schizophrenia with worsening behaviors over the past few months including refusing care including meals and medications and striking out with care. Resident had a fall on 1/14/2021. Resident received treatment for a UTI with Keflex for 7 days starting 12/6/2020.
Preexisting Conditions: Traumatic Brain Injury, Shizophrenia, hydrocephalus, hemiplegia following cerebrovascular disease affecting right side, aphasia, reduced mobility with use of w/c, repeated falls, dysphagia, major depression, thrombocytopenia, gluacoma, epilepsy.
Allergies: No Known Allergies
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Resident was noted to have increase weakness on 1/15/2021. Resident was warm to touch with low grade fever of 99.3 F. Resident was up propelling self in w/c on 1/16/2021 he was pleasant, accepted medications and ate lunch. He was found slumped over in his w/c not responding and vital signs absent.


Changed on 5/7/2021

VAERS ID: 958745 Before After
VAERS Form:2
Age:73.0
Sex:Male
Location:Colorado
Vaccinated:2021-01-12
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Asthenia, Fall, Pulse absent, Pyrexia, Skin warm, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-16
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: Divalproex Sodium Tab DR 250mg and 500mg, Lexapro 20mg, Quetiapine Fumarate 200mg tab, Senna 8.6 mg, Latanoprost drops,
Current Illness: Hx of TBI and schizophrenia with worsening behaviors over the past few months including refusing care including meals and medications and striking out with care. Resident had a fall on 1/14/2021. Resident received treatment for a UTI with Keflex for 7 days starting 12/6/2020.
Preexisting Conditions: Traumatic Brain Injury, Shizophrenia, hydrocephalus, hemiplegia following cerebrovascular disease affecting right side, aphasia, reduced mobility with use of w/c, repeated falls, dysphagia, major depression, thrombocytopenia, gluacoma, epilepsy.
Allergies: No Known Allergies Allergies
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Resident was noted to have increase weakness on 1/15/2021. Resident was warm to touch with low grade fever of 99.3 F. Resident was up propelling self in w/c on 1/16/2021 he was pleasant, accepted medications and ate lunch. He was found slumped over in his w/c not responding and vital signs absent.


Changed on 5/14/2021

VAERS ID: 958745 Before After
VAERS Form:2
Age:73.0
Sex:Male
Location:Colorado
Vaccinated:2021-01-12
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Asthenia, Fall, Pulse absent, Pyrexia, Skin warm, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-16
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: Divalproex Sodium Tab DR 250mg and 500mg, Lexapro 20mg, Quetiapine Fumarate 200mg tab, Senna 8.6 mg, Latanoprost drops,
Current Illness: Hx of TBI and schizophrenia with worsening behaviors over the past few months including refusing care including meals and medications and striking out with care. Resident had a fall on 1/14/2021. Resident received treatment for a UTI with Keflex for 7 days starting 12/6/2020.
Preexisting Conditions: Traumatic Brain Injury, Shizophrenia, hydrocephalus, hemiplegia following cerebrovascular disease affecting right side, aphasia, reduced mobility with use of w/c, repeated falls, dysphagia, major depression, thrombocytopenia, gluacoma, epilepsy.
Allergies: No Known Allergies Allergies
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Resident was noted to have increase weakness on 1/15/2021. Resident was warm to touch with low grade fever of 99.3 F. Resident was up propelling self in w/c on 1/16/2021 he was pleasant, accepted medications and ate lunch. He was found slumped over in his w/c not responding and vital signs absent.

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