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This is VAERS ID 979533

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 979533
VAERS Form:2
Age:82.0
Sex:Female
Location:Arizona
Vaccinated:2021-01-19
Onset:2021-01-20
Submitted:0000-00-00
Entered:2021-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / IM

Administered by: Other      Purchased by: ??
Symptoms: Chest X-ray normal, Death, Dizziness, Fall, Feeling abnormal, Memory impairment, Oxygen saturation decreased, X-ray of pelvis and hip normal, Laboratory test normal, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-25
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: dexamethasone, losartan, amlodipine, Ensure supplement drink
Current Illness: chronic copd is stable condition; no illnesses at time of vaccination
Preexisting Conditions: copd hypertension
Allergies: none
Diagnostic Lab Data: labs were fairly normal; chest xray showed no acute changes; hip xrays showed no fractures, covid 19 rapid screen was negative
CDC 'Split Type':

Write-up: Patient recieved vaccine 1 of covid 19 i 1/19/2021. She felt poorly on 1/20/2021. She felt dizzy and fell at 3 AM on 1/23/2021. She felt poorly and did not know her son''s name which was not normal. She went to ER on 1/24. She was assessed as not having fractures. She was going to be transferred to a skilled nursing facility. She was not having respiratory complaints. She was awaiting transfer when her O2 levels started dropping substantially. She declined aggressive intervention and she died within a few hours.


Changed on 5/7/2021

VAERS ID: 979533 Before After
VAERS Form:2
Age:82.0
Sex:Female
Location:Arizona
Vaccinated:2021-01-19
Onset:2021-01-20
Submitted:0000-00-00
Entered:2021-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / IM

Administered by: Other      Purchased by: ??
Symptoms: Chest X-ray normal, Death, Dizziness, Fall, Feeling abnormal, Memory impairment, Oxygen saturation decreased, X-ray of pelvis and hip normal, Laboratory test normal, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-25
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: dexamethasone, losartan, amlodipine, Ensure supplement drink
Current Illness: chronic copd is stable condition; no illnesses at time of vaccination
Preexisting Conditions: copd hypertension
Allergies: none none
Diagnostic Lab Data: labs were fairly normal; chest xray showed no acute changes; hip xrays showed no fractures, covid 19 rapid screen was negative
CDC 'Split Type':

Write-up: Patient recieved vaccine 1 of covid 19 i 1/19/2021. She felt poorly on 1/20/2021. She felt dizzy and fell at 3 AM on 1/23/2021. She felt poorly and did not know her son''s name which was not normal. She went to ER on 1/24. She was assessed as not having fractures. She was going to be transferred to a skilled nursing facility. She was not having respiratory complaints. She was awaiting transfer when her O2 levels started dropping substantially. She declined aggressive intervention and she died within a few hours.


Changed on 5/21/2021

VAERS ID: 979533 Before After
VAERS Form:2
Age:82.0
Sex:Female
Location:Arizona
Vaccinated:2021-01-19
Onset:2021-01-20
Submitted:0000-00-00
Entered:2021-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / IM

Administered by: Other      Purchased by: ??
Symptoms: Chest X-ray normal, Death, Dizziness, Fall, Feeling abnormal, Memory impairment, Oxygen saturation decreased, X-ray of pelvis and hip normal, Laboratory test normal, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-25
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: dexamethasone, losartan, amlodipine, Ensure supplement drink
Current Illness: chronic copd is stable condition; no illnesses at time of vaccination
Preexisting Conditions: copd hypertension
Allergies: none none
Diagnostic Lab Data: labs were fairly normal; chest xray showed no acute changes; hip xrays showed no fractures, covid 19 rapid screen was negative
CDC 'Split Type':

Write-up: Patient recieved vaccine 1 of covid 19 i 1/19/2021. She felt poorly on 1/20/2021. She felt dizzy and fell at 3 AM on 1/23/2021. She felt poorly and did not know her son''s name which was not normal. She went to ER on 1/24. She was assessed as not having fractures. She was going to be transferred to a skilled nursing facility. She was not having respiratory complaints. She was awaiting transfer when her O2 levels started dropping substantially. She declined aggressive intervention and she died within a few hours.

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