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This is VAERS ID 972890

History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 972890
VAERS Form:2
Age:96.0
Sex:Female
Location:New York
Vaccinated:2020-12-29
Onset:2021-01-10
Submitted:0000-00-00
Entered:2021-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / UN

Administered by: Senior Living      Purchased by: ??
Symptoms: Aphasia, Confusional state, Death, Oxygen saturation decreased, Pyrexia, Communication disorder, Feeding disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-17
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: unknown
Current Illness: COVID-19 positive on November 19, 2020 and didn''t test negative until December 26, 2020
Preexisting Conditions: Macular Degeneration
Allergies: None
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: On the evening of 10JAN2021, patient experienced a low grade fever, decreased oxygen saturation of 38%, heart rate of 124, confusion. Patient received oxygen via face mask, morphine and ativan. By 11JAN2021, patient was no longer verbal, able to eat or communicate and was kept on comfort measure only. On the morning of 17JAN2021, the patient passed away.


Changed on 5/7/2021

VAERS ID: 972890 Before After
VAERS Form:2
Age:96.0
Sex:Female
Location:New York
Vaccinated:2020-12-29
Onset:2021-01-10
Submitted:0000-00-00
Entered:2021-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / UN

Administered by: Senior Living      Purchased by: ??
Symptoms: Aphasia, Confusional state, Death, Oxygen saturation decreased, Pyrexia, Communication disorder, Feeding disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-17
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: unknown
Current Illness: COVID-19 positive on November 19, 2020 and didn''t test negative until December 26, 2020
Preexisting Conditions: Macular Degeneration
Allergies: None None
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: On the evening of 10JAN2021, patient experienced a low grade fever, decreased oxygen saturation of 38%, heart rate of 124, confusion. Patient received oxygen via face mask, morphine and ativan. By 11JAN2021, patient was no longer verbal, able to eat or communicate and was kept on comfort measure only. On the morning of 17JAN2021, the patient passed away.


Changed on 5/14/2021

VAERS ID: 972890 Before After
VAERS Form:2
Age:96.0
Sex:Female
Location:New York
Vaccinated:2020-12-29
Onset:2021-01-10
Submitted:0000-00-00
Entered:2021-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / UN

Administered by: Senior Living      Purchased by: ??
Symptoms: Aphasia, Confusional state, Death, Oxygen saturation decreased, Pyrexia, Communication disorder, Feeding disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-17
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: unknown
Current Illness: COVID-19 positive on November 19, 2020 and didn''t test negative until December 26, 2020
Preexisting Conditions: Macular Degeneration
Allergies: None None
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: On the evening of 10JAN2021, patient experienced a low grade fever, decreased oxygen saturation of 38%, heart rate of 124, confusion. Patient received oxygen via face mask, morphine and ativan. By 11JAN2021, patient was no longer verbal, able to eat or communicate and was kept on comfort measure only. On the morning of 17JAN2021, the patient passed away.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=972890&WAYBACKHISTORY=ON

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