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This is VAERS ID 1014865

History of Changes from the VAERS Wayback Machine

First Appeared on 2/12/2021

VAERS ID: 1014865
VAERS Form:2
Age:68.0
Sex:Male
Location:Illinois
Vaccinated:2021-01-23
Onset:2021-02-02
Submitted:0000-00-00
Entered:2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Senior Living      Purchased by: ??
Symptoms: Cardiac arrest, Death, Malaise, Pneumonia, Renal failure, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-03
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? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: Tested positive for Covid in November
Preexisting Conditions: Muscular dystrophy
Allergies: n/a
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: He had not been feeling well after his second Covid vaccination (on 01/23/2021) and was found unresponsive in his room at the nursing home (late evening on 02/02/2021). He was taken to a hospital where they did tests and he had pneumonia and kidney failure, but he was being transferred to a larger hospital when he arrested and died (02/03/2021)


Changed on 5/7/2021

VAERS ID: 1014865 Before After
VAERS Form:2
Age:68.0
Sex:Male
Location:Illinois
Vaccinated:2021-01-23
Onset:2021-02-02
Submitted:0000-00-00
Entered:2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Senior Living      Purchased by: ??
Symptoms: Cardiac arrest, Death, Malaise, Pneumonia, Renal failure, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-03
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? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: Tested positive for Covid in November
Preexisting Conditions: Muscular dystrophy
Allergies: n/a n/a
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: He had not been feeling well after his second Covid vaccination (on 01/23/2021) and was found unresponsive in his room at the nursing home (late evening on 02/02/2021). He was taken to a hospital where they did tests and he had pneumonia and kidney failure, but he was being transferred to a larger hospital when he arrested and died (02/03/2021)


Changed on 5/14/2021

VAERS ID: 1014865 Before After
VAERS Form:2
Age:68.0
Sex:Male
Location:Illinois
Vaccinated:2021-01-23
Onset:2021-02-02
Submitted:0000-00-00
Entered:2021-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Senior Living      Purchased by: ??
Symptoms: Cardiac arrest, Death, Malaise, Pneumonia, Renal failure, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-03
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? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: Tested positive for Covid in November
Preexisting Conditions: Muscular dystrophy
Allergies: n/a n/a
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: He had not been feeling well after his second Covid vaccination (on 01/23/2021) and was found unresponsive in his room at the nursing home (late evening on 02/02/2021). He was taken to a hospital where they did tests and he had pneumonia and kidney failure, but he was being transferred to a larger hospital when he arrested and died (02/03/2021)

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1014865&WAYBACKHISTORY=ON


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