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This is VAERS ID 992372

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 992372
VAERS Form:2
Age:73.0
Sex:Female
Location:Oregon
Vaccinated:2021-01-08
Onset:2021-01-08
Submitted:0000-00-00
Entered:2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011I20A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Asthenia, Atrophy, Cerebral haemorrhage, Chest X-ray normal, Death, Erythema, White blood cell count increased, Mental status changes, Laboratory test normal, Troponin increased, Embolic cerebral infarction, Cerebral small vessel ischaemic disease, Computerised tomogram head normal, Magnetic resonance imaging brain, Magnetic resonance imaging brain abnormal, Embolic cerebellar infarction, 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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: (1) Acetaminophen 500mg PO Q4H PRN pain (2) Albuterol inhaler 1 puff Q4H PRN (3) Cyanocobalamin 1000mg PO daily (4) Diazepam 5mg PO daily PRN anxiety (5) Ergocalciferol 48,000 units PO daily (6) Fluoxetine 20mg PO daily (7) Arnicare cream 1
Current Illness:
Preexisting Conditions: (1) Advanced dementia (2) Hypothyroidism (3) Anxiety (4) Hx falls
Allergies: (1) Etodolac (rxn = n/v, diarrhea, SOB) (2) Bee Pollen (3) Escitalopram (rxn = ''intolerance'') (4) Paroxetine (rxn = ''ineffective'') (5) Venlafaxine (rxn = ''ineffective'')
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This is a 73 year old female that received her 1st dose with Moderna vaccine on 1/8/21 at approximately 1600. Within one hour, the patient developed altered mental status and increasing weakness. She was transported to the hospital by the staff at her Assisted Living Facility for concern of a vaccine reaction. On admission, oxygen saturation was found to be 89% on room air, BP=137/86, HR=94. Labs were normal, with the exception of WBC=15 (leukocytes normal, chest xray clear, COVID test negative), and a detectable troponin=63. Head CT negative. Physical exam was only notable for ''slight superficial erythema over distal right forearm and dorsal hand. No significant edema.'' The patient was treated for a possible allergic reaction to vaccine with NS bolus, methylprednisolone 125mg, famotidine 20mg, and aspirin 300mg PR. She was admitted for monitoring given continued altered mental status/weakness. The next day, she continued to show no improvement, so a head MRI was ordered. MRI showed " 1. Numerous acute cerebral and cerebellar infarcts involving both anterior and posterior circulations consistent with a central embolic source. 2. Minimal right parietal petechial hemorrhage. 3. Moderate atrophy and moderate nonspecific white matter signal abnormalities compatible with chronic microvascular ischemia " Neurology was consulted, who approved the start of aspirin and to continue DVT prophylaxis. The patient''s advanced dementia and timeline preclude other intervention. The patient''s status was DNR/DNI. The patient was discharged on hospice to her assisted living facility on 1/11/21 (with reports of continued somnolence). It was reported that date of death was 1/24/21.


Changed on 2/18/2021

VAERS ID: 992372 Before After
VAERS Form:2
Age:73.0
Sex:Female
Location:Oregon
Vaccinated:2021-01-08
Onset:2021-01-08
Submitted:0000-00-00
Entered:2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011I20A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Asthenia, Atrophy, Cerebral haemorrhage, Chest X-ray normal, Death, Erythema, White blood cell count increased, Mental status changes, Laboratory test normal, Troponin increased, Embolic cerebral infarction, Cerebral small vessel ischaemic disease, Computerised tomogram head normal, Magnetic resonance imaging brain, Magnetic resonance imaging brain abnormal, Embolic cerebellar infarction, 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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: (1) Acetaminophen 500mg PO Q4H PRN pain (2) Albuterol inhaler 1 puff Q4H PRN (3) Cyanocobalamin 1000mg PO daily (4) Diazepam 5mg PO daily PRN anxiety (5) Ergocalciferol 48,000 units PO daily (6) Fluoxetine 20mg PO daily (7) Arnicare cream 1
Current Illness:
Preexisting Conditions: (1) Advanced dementia (2) Hypothyroidism (3) Anxiety (4) Hx falls
Allergies: (1) Etodolac (rxn = n/v, diarrhea, SOB) (2) Bee Pollen (3) Escitalopram (rxn = ''intolerance'') (4) Paroxetine (rxn = ''ineffective'') (5) Venlafaxine (rxn = ''ineffective'')
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This is a 73 year old female that received her 1st dose with Moderna vaccine on 1/8/21 at approximately 1600. Within one hour, the patient developed altered mental status and increasing weakness. She was transported to the hospital by the staff at her Assisted Living Facility for concern of a vaccine reaction. On admission, oxygen saturation was found to be 89% on room air, BP=137/86, HR=94. Labs were normal, with the exception of WBC=15 (leukocytes normal, chest xray clear, COVID test negative), and a detectable troponin=63. Head CT negative. Physical exam was only notable for ''slight superficial erythema over distal right forearm and dorsal hand. No significant edema.'' The patient was treated for a possible allergic reaction to vaccine with NS bolus, methylprednisolone 125mg, famotidine 20mg, and aspirin 300mg PR. She was admitted for monitoring given continued altered mental status/weakness. The next day, she continued to show no improvement, so a head MRI was ordered. MRI showed " 1. Numerous acute cerebral and cerebellar infarcts involving both anterior and posterior circulations consistent with a central embolic source. 2. Minimal right parietal petechial hemorrhage. 3. Moderate atrophy and moderate nonspecific white matter signal abnormalities compatible with chronic microvascular ischemia " Neurology was consulted, who approved the start of aspirin and to continue DVT prophylaxis. The patient''s advanced dementia and timeline preclude other intervention. The patient''s status was DNR/DNI. The patient was discharged on hospice to her assisted living facility on 1/11/21 (with reports of continued somnolence). It was reported that date of death was 1/24/21.


Changed on 5/7/2021

VAERS ID: 992372 Before After
VAERS Form:2
Age:73.0
Sex:Female
Location:Oregon
Vaccinated:2021-01-08
Onset:2021-01-08
Submitted:0000-00-00
Entered:2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011I20A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Asthenia, Atrophy, Cerebral haemorrhage, Chest X-ray normal, Death, Erythema, White blood cell count increased, Mental status changes, Laboratory test normal, Troponin increased, Embolic cerebral infarction, Cerebral small vessel ischaemic disease, Computerised tomogram head normal, Magnetic resonance imaging brain abnormal, Embolic cerebellar infarction, 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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: (1) Acetaminophen 500mg PO Q4H PRN pain (2) Albuterol inhaler 1 puff Q4H PRN (3) Cyanocobalamin 1000mg PO daily (4) Diazepam 5mg PO daily PRN anxiety (5) Ergocalciferol 48,000 units PO daily (6) Fluoxetine 20mg PO daily (7) Arnicare cream 1
Current Illness:
Preexisting Conditions: (1) Advanced dementia (2) Hypothyroidism (3) Anxiety (4) Hx falls
Allergies: (1) Etodolac (rxn = n/v, diarrhea, SOB) (2) Bee Pollen (3) Escitalopram (rxn = ''intolerance'') (4) Paroxetine (rxn = ''ineffective'') (5) Venlafaxine (rxn = ''ineffective'') ''ineffective'')
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This is a 73 year old female that received her 1st dose with Moderna vaccine on 1/8/21 at approximately 1600. Within one hour, the patient developed altered mental status and increasing weakness. She was transported to the hospital by the staff at her Assisted Living Facility for concern of a vaccine reaction. On admission, oxygen saturation was found to be 89% on room air, BP=137/86, HR=94. Labs were normal, with the exception of WBC=15 (leukocytes normal, chest xray clear, COVID test negative), and a detectable troponin=63. Head CT negative. Physical exam was only notable for ''slight superficial erythema over distal right forearm and dorsal hand. No significant edema.'' The patient was treated for a possible allergic reaction to vaccine with NS bolus, methylprednisolone 125mg, famotidine 20mg, and aspirin 300mg PR. She was admitted for monitoring given continued altered mental status/weakness. The next day, she continued to show no improvement, so a head MRI was ordered. MRI showed " 1. Numerous acute cerebral and cerebellar infarcts involving both anterior and posterior circulations consistent with a central embolic source. 2. Minimal right parietal petechial hemorrhage. 3. Moderate atrophy and moderate nonspecific white matter signal abnormalities compatible with chronic microvascular ischemia " Neurology was consulted, who approved the start of aspirin and to continue DVT prophylaxis. The patient''s advanced dementia and timeline preclude other intervention. The patient''s status was DNR/DNI. The patient was discharged on hospice to her assisted living facility on 1/11/21 (with reports of continued somnolence). It was reported that date of death was 1/24/21.


Changed on 5/14/2021

VAERS ID: 992372 Before After
VAERS Form:2
Age:73.0
Sex:Female
Location:Oregon
Vaccinated:2021-01-08
Onset:2021-01-08
Submitted:0000-00-00
Entered:2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011I20A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Asthenia, Atrophy, Cerebral haemorrhage, Chest X-ray normal, Death, Erythema, White blood cell count increased, Mental status changes, Laboratory test normal, Troponin increased, Embolic cerebral infarction, Cerebral small vessel ischaemic disease, Computerised tomogram head normal, Magnetic resonance imaging brain abnormal, Embolic cerebellar infarction, 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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: (1) Acetaminophen 500mg PO Q4H PRN pain (2) Albuterol inhaler 1 puff Q4H PRN (3) Cyanocobalamin 1000mg PO daily (4) Diazepam 5mg PO daily PRN anxiety (5) Ergocalciferol 48,000 units PO daily (6) Fluoxetine 20mg PO daily (7) Arnicare cream 1
Current Illness:
Preexisting Conditions: (1) Advanced dementia (2) Hypothyroidism (3) Anxiety (4) Hx falls
Allergies: (1) Etodolac (rxn = n/v, diarrhea, SOB) (2) Bee Pollen (3) Escitalopram (rxn = ''intolerance'') (4) Paroxetine (rxn = ''ineffective'') (5) Venlafaxine (rxn = ''ineffective'') ''ineffective'')
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: This is a 73 year old female that received her 1st dose with Moderna vaccine on 1/8/21 at approximately 1600. Within one hour, the patient developed altered mental status and increasing weakness. She was transported to the hospital by the staff at her Assisted Living Facility for concern of a vaccine reaction. On admission, oxygen saturation was found to be 89% on room air, BP=137/86, HR=94. Labs were normal, with the exception of WBC=15 (leukocytes normal, chest xray clear, COVID test negative), and a detectable troponin=63. Head CT negative. Physical exam was only notable for ''slight superficial erythema over distal right forearm and dorsal hand. No significant edema.'' The patient was treated for a possible allergic reaction to vaccine with NS bolus, methylprednisolone 125mg, famotidine 20mg, and aspirin 300mg PR. She was admitted for monitoring given continued altered mental status/weakness. The next day, she continued to show no improvement, so a head MRI was ordered. MRI showed " 1. Numerous acute cerebral and cerebellar infarcts involving both anterior and posterior circulations consistent with a central embolic source. 2. Minimal right parietal petechial hemorrhage. 3. Moderate atrophy and moderate nonspecific white matter signal abnormalities compatible with chronic microvascular ischemia " Neurology was consulted, who approved the start of aspirin and to continue DVT prophylaxis. The patient''s advanced dementia and timeline preclude other intervention. The patient''s status was DNR/DNI. The patient was discharged on hospice to her assisted living facility on 1/11/21 (with reports of continued somnolence). It was reported that date of death was 1/24/21.

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