National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 985004

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 985004
VAERS Form:2
Age:58.0
Sex:Female
Location:Michigan
Vaccinated:2021-01-08
Onset:2021-01-27
Submitted:0000-00-00
Entered:2021-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
UNK: VACCINE NOT SPECIFIED (OTHER) / UNKNOWN MANUFACTURER 012L20A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Abdominal pain, Constipation, Death, Fatigue, Hyperhidrosis, Resuscitation, Unresponsive to stimuli, Impaired work ability

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-27
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: None
Current Illness: none
Preexisting Conditions: Cardiac Issues. Hx of cardiac Stent but unknown in-depth.
Allergies: Codeine Penicillin V
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The week of 1/18/2021 The patient complained of Abdominal pain and called off work (we are also her employer) She was seen for constipation on 1/20/2021. Employee returned to work on 1/25/2021 Had occasional episodes during work where she would sweat and become tired but would rest until she felt better. On the Night of 1/27/2021 she was feeling fine no issues, later in the shift a co worker found her unresponsive, CPR was initiated but unsuccessful.


Changed on 3/26/2021

VAERS ID: 985004 Before After
VAERS Form:2
Age:58.0
Sex:Female
Location:Michigan
Vaccinated:2021-01-08
Onset:2021-01-27
Submitted:0000-00-00
Entered:2021-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 RA / IM
UNK: VACCINE NOT SPECIFIED (OTHER) / UNKNOWN MANUFACTURER 012L20A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Abdominal pain, Constipation, Death, Fatigue, Hyperhidrosis, Resuscitation, Unresponsive to stimuli, Impaired work ability

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-27
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: None
Current Illness: none
Preexisting Conditions: Cardiac Issues. Hx of cardiac Stent but unknown in-depth.
Allergies: Codeine Penicillin V
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The week of 1/18/2021 The patient complained of Abdominal pain and called off work (we are also her employer) She was seen for constipation on 1/20/2021. Employee returned to work on 1/25/2021 Had occasional episodes during work where she would sweat and become tired but would rest until she felt better. On the Night of 1/27/2021 she was feeling fine no issues, later in the shift a co worker found her unresponsive, CPR was initiated but unsuccessful.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=985004&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166