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This is VAERS ID 1026534

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1026534
VAERS Form:2
Age:97.0
Sex:Male
Location:Missouri
Vaccinated:2021-02-03
Onset:2021-02-05
Submitted:0000-00-00
Entered:2021-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 2 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Cerebrovascular accident, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-09
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: senna, pantoprazole, vit D2, fluoxetine, folic acid, melatonin, metoprolol
Current Illness:
Preexisting Conditions: , HTN, CKD, Alzheimer''s
Allergies: ciprodex
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: resident had a stroke, sent to the hospital and died 4 days later


Changed on 5/7/2021

VAERS ID: 1026534 Before After
VAERS Form:2
Age:97.0
Sex:Male
Location:Missouri
Vaccinated:2021-02-03
Onset:2021-02-05
Submitted:0000-00-00
Entered:2021-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 2 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Cerebrovascular accident, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-09
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: senna, pantoprazole, vit D2, fluoxetine, folic acid, melatonin, metoprolol
Current Illness:
Preexisting Conditions: , HTN, CKD, Alzheimer''s
Allergies: ciprodex ciprodex
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: resident had a stroke, sent to the hospital and died 4 days later


Changed on 5/14/2021

VAERS ID: 1026534 Before After
VAERS Form:2
Age:97.0
Sex:Male
Location:Missouri
Vaccinated:2021-02-03
Onset:2021-02-05
Submitted:0000-00-00
Entered:2021-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 2 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Cerebrovascular accident, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-09
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: senna, pantoprazole, vit D2, fluoxetine, folic acid, melatonin, metoprolol
Current Illness:
Preexisting Conditions: , HTN, CKD, Alzheimer''s
Allergies: ciprodex ciprodex
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: resident had a stroke, sent to the hospital and died 4 days later

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1026534&WAYBACKHISTORY=ON


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