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This is VAERS ID 998463

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 998463
VAERS Form:2
Age:88.0
Sex:Female
Location:North Carolina
Vaccinated:2021-01-06
Onset:2021-01-19
Submitted:0000-00-00
Entered:2021-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Respiratory failure, Acute coronary syndrome, Laboratory test, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-19
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: acetaminophen amlodipine calcium carbonate + vitamin D3 Celebrex (PRN) Irbesartan lidocaine patch loratadine polyethylene glycol pravastatin
Current Illness: pneumonia, acute hypoxic respiratory failure
Preexisting Conditions: HTN HLD Osteoarthritis osteoporosis impaired mobility secondary to avascular necrosis or right humeral head, and s/p ankle fusions, bilateral knee replacements Sciatica open angle glaucoma
Allergies: horse chesnut seed extract
Diagnostic Lab Data: Tests/ results were performed in hospital, outside of our setting (nursing home).
CDC 'Split Type':

Write-up: Resident passed away unexpectedly on 01/19/21 after developing acute hypoxic respiratory failure on morning of 01/19/21. She was transferred to hospital via EMS where she was intubated, coded, and ultimately expired with uncertain underlying cause, potentially ACS.


Changed on 5/7/2021

VAERS ID: 998463 Before After
VAERS Form:2
Age:88.0
Sex:Female
Location:North Carolina
Vaccinated:2021-01-06
Onset:2021-01-19
Submitted:0000-00-00
Entered:2021-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Respiratory failure, Acute coronary syndrome, Laboratory test, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-19
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: acetaminophen amlodipine calcium carbonate + vitamin D3 Celebrex (PRN) Irbesartan lidocaine patch loratadine polyethylene glycol pravastatin
Current Illness: pneumonia, acute hypoxic respiratory failure
Preexisting Conditions: HTN HLD Osteoarthritis osteoporosis impaired mobility secondary to avascular necrosis or right humeral head, and s/p ankle fusions, bilateral knee replacements Sciatica open angle glaucoma
Allergies: horse chesnut seed extract extract
Diagnostic Lab Data: Tests/ results were performed in hospital, outside of our setting (nursing home).
CDC 'Split Type':

Write-up: Resident passed away unexpectedly on 01/19/21 after developing acute hypoxic respiratory failure on morning of 01/19/21. She was transferred to hospital via EMS where she was intubated, coded, and ultimately expired with uncertain underlying cause, potentially ACS.


Changed on 5/21/2021

VAERS ID: 998463 Before After
VAERS Form:2
Age:88.0
Sex:Female
Location:North Carolina
Vaccinated:2021-01-06
Onset:2021-01-19
Submitted:0000-00-00
Entered:2021-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Respiratory failure, Acute coronary syndrome, Laboratory test, Endotracheal intubation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-19
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: acetaminophen amlodipine calcium carbonate + vitamin D3 Celebrex (PRN) Irbesartan lidocaine patch loratadine polyethylene glycol pravastatin
Current Illness: pneumonia, acute hypoxic respiratory failure
Preexisting Conditions: HTN HLD Osteoarthritis osteoporosis impaired mobility secondary to avascular necrosis or right humeral head, and s/p ankle fusions, bilateral knee replacements Sciatica open angle glaucoma
Allergies: horse chesnut seed extract extract
Diagnostic Lab Data: Tests/ results were performed in hospital, outside of our setting (nursing home).
CDC 'Split Type':

Write-up: Resident passed away unexpectedly on 01/19/21 after developing acute hypoxic respiratory failure on morning of 01/19/21. She was transferred to hospital via EMS where she was intubated, coded, and ultimately expired with uncertain underlying cause, potentially ACS.

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