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This is VAERS ID 983766

History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 983766
VAERS Form:2
Age:90.0
Sex:Female
Location:North Carolina
Vaccinated:2021-01-16
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood pH decreased, Cardiac failure acute, Chest discomfort, Death, Dyspnoea, International normalised ratio increased, N-terminal prohormone brain natriuretic peptide increased, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-24
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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Furosemide 20mg 2poBID, Warfarin 5mgQD, Omeprazole 20mg BID, Propanolol 10mg BID, atorvastatin 40mg QD, vitamin D 1000IUQD
Current Illness: Heart failure with reduced EF, history of moderate pulmonary hypertension, history of moderate mitral valve regurgitation and moderate pulmonary valve regurgitation. History of A. fib.
Preexisting Conditions: Heart failure with reduced EF, history of moderate pulmonary hypertension, history of moderate mitral valve regurgitation and moderate pulmonary valve regurgitation. History of A.fib.
Allergies: No known allergies to drugs or food
Diagnostic Lab Data: ProBNP: 5000 on 1/21/21 Covid-19 test: negative on 1/21/21 INR: 3.2 on 1/21/21 pH: 7.33 on 1/21/21
CDC 'Split Type':

Write-up: Pt started complaining of chest heaviness and shortness of breath on the afternoon of 1/21/21. EMS was called to the patients home and she was found to have an O2 sat in the 70''s. She was admitted to hospital and found to have a proBNP of 5000. She tested negative for Covid-19. She was determined to be in acute-on-chronic heart failure and was referred for hospice care. She passed away on the evening of 1/24/21.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=983766&WAYBACKHISTORY=ON


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