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This is VAERS ID 1018448

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/12/2021

VAERS ID: 1018448
VAERS Form:2
Age:90.0
Sex:Male
Location:Hawaii
Vaccinated:2021-02-01
Onset:2021-02-06
Submitted:0000-00-00
Entered:2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Cerebrovascular accident, Condition aggravated, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-08
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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin 81 mg qd. vitamin D. duloxetine, cymbalta 20 mg qd. Jalyn one daily. ferrous sulfate. namenda. spiriva inhaler. zinc 50 mg qd
Current Illness: none
Preexisting Conditions: dementia. hx stroke. carotid disease. emphysema. hyperlipidemia. BPH
Allergies: oxycodone. penicillin. simvastatin
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 2/6/2021 stroke. 2/8/2021 he died


Changed on 5/7/2021

VAERS ID: 1018448 Before After
VAERS Form:2
Age:90.0
Sex:Male
Location:Hawaii
Vaccinated:2021-02-01
Onset:2021-02-06
Submitted:0000-00-00
Entered:2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Cerebrovascular accident, Condition aggravated, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-08
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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin 81 mg qd. vitamin D. duloxetine, cymbalta 20 mg qd. Jalyn one daily. ferrous sulfate. namenda. spiriva inhaler. zinc 50 mg qd
Current Illness: none
Preexisting Conditions: dementia. hx stroke. carotid disease. emphysema. hyperlipidemia. BPH
Allergies: oxycodone. penicillin. simvastatin simvastatin
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 2/6/2021 stroke. 2/8/2021 he died


Changed on 5/14/2021

VAERS ID: 1018448 Before After
VAERS Form:2
Age:90.0
Sex:Male
Location:Hawaii
Vaccinated:2021-02-01
Onset:2021-02-06
Submitted:0000-00-00
Entered:2021-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 007M20A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Cerebrovascular accident, Condition aggravated, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-08
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? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin 81 mg qd. vitamin D. duloxetine, cymbalta 20 mg qd. Jalyn one daily. ferrous sulfate. namenda. spiriva inhaler. zinc 50 mg qd
Current Illness: none
Preexisting Conditions: dementia. hx stroke. carotid disease. emphysema. hyperlipidemia. BPH
Allergies: oxycodone. penicillin. simvastatin simvastatin
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 2/6/2021 stroke. 2/8/2021 he died

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1018448&WAYBACKHISTORY=ON


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