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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 917790 |
VAERS Form: | 2 |
Age: | 90.0 |
Sex: | Female |
Location: | Arkansas |
Vaccinated: | 2020-12-22 |
Onset: | 2020-12-29 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-03 |
Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | - / 1 | AR / IM |
Administered by: Senior Living Purchased by: ??
Symptoms: Death, COVID-19, SARS-CoV-2 test positive, Exposure to SARS-CoV-2
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:2021-01-03
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: Torsemide, Trazadone, Amitizide, Morphine Sulfate, Fentanyl, Carbidoba-Levodopa, Prednisone, Potassium Chloride, Escalitapram, Incruse Ellipta, Mirtazipane, Clonazepam, Levothyroxine
Current Illness: Patient was a resident of a long term care facility and had numerous chronic conditions prior to vaccination.
Preexisting Conditions: Thyroid disease, chronic elderly conditions.
Allergies: None
Diagnostic Lab Data: Unknown
CDC 'Split Type':
Write-up: At the time of vaccination, there was an outbreak of residents who had already tested positive for COVID 19 at the nursing home where patient was a resident. About a week later, patient tested positive for COVID 19. She had a number of chronic, underlying health conditions. The vaccine did not have enough time to prevent COVID 19. There is no evidence that the vaccination caused patient''s death. It simply didn''t have time to save her life.
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