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This is VAERS ID 1002931

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 1002931
VAERS Form:2
Age:77.0
Sex:Male
Location:Unknown
Vaccinated:2021-01-21
Onset:2021-01-24
Submitted:0000-00-00
Entered:2021-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Cardiac arrest, Cardio-respiratory arrest, Death, Electrocardiogram ST segment elevation, Resuscitation, Pulseless electrical activity, Endotracheal intubation, Absence of immediate treatment response

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-24
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: CARDIAC ARREST, DEATH Narrative: The patient presents to the emergency department in cardiopulmonary arrest. CPR was continued upon arrival. The Combi tube was removed and an endotracheal tube was placed without complications. ROSC was obtained multiple times but the patient continued to go into PEA. The patient was seen in the emergency department by both critical care and Cardiology. EKG shows ST elevations, but the patient was unstable to go to catheterization. The patient had 1 episode of asystole. Despite best efforts and multiple attempts we were unable to resuscitate the patient. Time of death 1253 on 1/24/21.


Changed on 5/7/2021

VAERS ID: 1002931 Before After
VAERS Form:2
Age:77.0
Sex:Male
Location:Unknown
Vaccinated:2021-01-21
Onset:2021-01-24
Submitted:0000-00-00
Entered:2021-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Cardiac arrest, Cardio-respiratory arrest, Death, Electrocardiogram ST segment elevation, Resuscitation, Pulseless electrical activity, Endotracheal intubation, Absence of immediate treatment response

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-24
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: CARDIAC ARREST, DEATH Narrative: The patient presents to the emergency department in cardiopulmonary arrest. CPR was continued upon arrival. The Combi tube was removed and an endotracheal tube was placed without complications. ROSC was obtained multiple times but the patient continued to go into PEA. The patient was seen in the emergency department by both critical care and Cardiology. EKG shows ST elevations, but the patient was unstable to go to catheterization. The patient had 1 episode of asystole. Despite best efforts and multiple attempts we were unable to resuscitate the patient. Time of death 1253 on 1/24/21.


Changed on 5/14/2021

VAERS ID: 1002931 Before After
VAERS Form:2
Age:77.0
Sex:Male
Location:Unknown
Vaccinated:2021-01-21
Onset:2021-01-24
Submitted:0000-00-00
Entered:2021-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Cardiac arrest, Cardio-respiratory arrest, Death, Electrocardiogram ST segment elevation, Resuscitation, Pulseless electrical activity, Endotracheal intubation, Absence of immediate treatment response

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-24
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: CARDIAC ARREST, DEATH Narrative: The patient presents to the emergency department in cardiopulmonary arrest. CPR was continued upon arrival. The Combi tube was removed and an endotracheal tube was placed without complications. ROSC was obtained multiple times but the patient continued to go into PEA. The patient was seen in the emergency department by both critical care and Cardiology. EKG shows ST elevations, but the patient was unstable to go to catheterization. The patient had 1 episode of asystole. Despite best efforts and multiple attempts we were unable to resuscitate the patient. Time of death 1253 on 1/24/21.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1002931&WAYBACKHISTORY=ON

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