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This is VAERS ID 1026233

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1026233
VAERS Form:2
Age:89.0
Sex:Male
Location:North Dakota
Vaccinated:2021-01-18
Onset:2021-02-02
Submitted:0000-00-00
Entered:2021-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Platelet count decreased, Immune thrombocytopenia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-11
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? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Plaquenil 200 mg bid/ mirtazapine 30 mg qhs / amlodipine 2.5 mg daily / atorvastatin 80 mg daily / Lasix 40 mg daily / imdur 30 mg qam/ losartan 100 mg daily / Plavix 75 mg daily/ NTG 0.4mg prn/ levothyroxine 150 mcg daily
Current Illness: none
Preexisting Conditions: hypothyroidism,/ acute on chronic diastolic heart failure / polymyalgia rheumatica / hx of cva / hx of CABG/ gerd / bph/ polyarthritis
Allergies: hayfever / Darvocet / norco
Diagnostic Lab Data: plt count of 1,000
CDC 'Split Type':

Write-up: patient developed autoimmune thrombocytopenia


Changed on 5/7/2021

VAERS ID: 1026233 Before After
VAERS Form:2
Age:89.0
Sex:Male
Location:North Dakota
Vaccinated:2021-01-18
Onset:2021-02-02
Submitted:0000-00-00
Entered:2021-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Platelet count decreased, Immune thrombocytopenia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-11
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? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Plaquenil 200 mg bid/ mirtazapine 30 mg qhs / amlodipine 2.5 mg daily / atorvastatin 80 mg daily / Lasix 40 mg daily / imdur 30 mg qam/ losartan 100 mg daily / Plavix 75 mg daily/ NTG 0.4mg prn/ levothyroxine 150 mcg daily
Current Illness: none
Preexisting Conditions: hypothyroidism,/ acute on chronic diastolic heart failure / polymyalgia rheumatica / hx of cva / hx of CABG/ gerd / bph/ polyarthritis
Allergies: hayfever / Darvocet / norco norco
Diagnostic Lab Data: plt count of 1,000
CDC 'Split Type':

Write-up: patient developed autoimmune thrombocytopenia


Changed on 5/14/2021

VAERS ID: 1026233 Before After
VAERS Form:2
Age:89.0
Sex:Male
Location:North Dakota
Vaccinated:2021-01-18
Onset:2021-02-02
Submitted:0000-00-00
Entered:2021-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Platelet count decreased, Immune thrombocytopenia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-11
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? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Plaquenil 200 mg bid/ mirtazapine 30 mg qhs / amlodipine 2.5 mg daily / atorvastatin 80 mg daily / Lasix 40 mg daily / imdur 30 mg qam/ losartan 100 mg daily / Plavix 75 mg daily/ NTG 0.4mg prn/ levothyroxine 150 mcg daily
Current Illness: none
Preexisting Conditions: hypothyroidism,/ acute on chronic diastolic heart failure / polymyalgia rheumatica / hx of cva / hx of CABG/ gerd / bph/ polyarthritis
Allergies: hayfever / Darvocet / norco norco
Diagnostic Lab Data: plt count of 1,000
CDC 'Split Type':

Write-up: patient developed autoimmune thrombocytopenia

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1026233&WAYBACKHISTORY=ON

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