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VAERS ID: | 941811 |
VAERS Form: | 2 |
Age: | 56.0 |
Sex: | Female |
Location: | Louisiana |
Vaccinated: | 2021-01-04 |
Onset: | 2021-01-11 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-13 |
Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 011J20A / 1 | LA / IM |
Administered by: Senior Living Purchased by: ??
Symptoms: Albumin urine present, Chest X-ray abnormal, Death, Hypoxia, Lung infiltration, Pyrexia, Respiratory distress, Respiratory failure, Sepsis, White blood cell count normal, White blood cells urine positive, Urine leukocyte esterase positive, Bacterial test positive, SARS-CoV-2 test negative
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:0000-00-00
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: Haldol 2mg TWICE DAILY, DEPAKENE 750MG THREE TIMES
Current Illness: NONE
Preexisting Conditions: HUNTINGTON''S CHOREA, HTN, HLP, HYPOTHYROID, DEPRESSION, CONSTIPATION, AND DYSPHAGIA
Allergies: NKDA & NO FOOD ALLERGIES
Diagnostic Lab Data: CXR on 1/11/21: Suspicion of minimal infrahilar infiltrates bilaterally. U/A on 1/11/21: Leuk Esterase 3+, Albumin 2+, Few Bacteria, White cells 10 CBC on 1/11/21: WBC 8.9
CDC 'Split Type':
Write-up: Resident began having fever on 1/11/21 @0600. VS= T-102 B/P- 100/57 P- 112 RR- 24 O2 Sat 92% on RA. MD called. Rapid COVID Test was negative. CBC,CMP, U/A were ordered as well as CXR. Resident''s condition declined. At 3:00pm resident started having respiratory distress and hypoxia O2 Sat 89%. Supplemental O2/mask @ 5LPM. Neb TX, EKG, and Rocephin 1 GM ordered. Condition worsened. Resident sent to nearest ER for evaluation. Later in the evening the staff AT Medical Center called to inform staff that resident had expired @ 2230 as a result of Respiratory Failure and Sepsis.
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