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This is VAERS ID 1026581

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1026581
VAERS Form:2
Age:71.0
Sex:Male
Location:Washington
Vaccinated:2021-01-15
Onset:2021-02-04
Submitted:0000-00-00
Entered:2021-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-04
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? No
Previous Vaccinations: tetanus toxoid
Other Medications: Spironolactone, amlodipine, tamsulosin, losartan, pantoprazole, tadalafil, propranolol
Current Illness: He had sudden death on Feb 4th. Unclear if this could be related to vaccination but since it was close in timing report has been filed.
Preexisting Conditions: Hyperparathyroidism s/p surgical correction in 2020, MGUS, Idiopathic peripheral neuropathy, gout, OSA
Allergies: Erythromycin, PCN, Hmg-coa reductase inhibitors, nifedipine, tetanus toxoids, tetracyclines
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: He had sudden death on Feb 4th. Unclear if this could be related to vaccination but since it was close in timing report has been filed. No known immediate reaction to vaccination.


Changed on 5/7/2021

VAERS ID: 1026581 Before After
VAERS Form:2
Age:71.0
Sex:Male
Location:Washington
Vaccinated:2021-01-15
Onset:2021-02-04
Submitted:0000-00-00
Entered:2021-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-04
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? No
Previous Vaccinations: tetanus toxoid
Other Medications: Spironolactone, amlodipine, tamsulosin, losartan, pantoprazole, tadalafil, propranolol
Current Illness: He had sudden death on Feb 4th. Unclear if this could be related to vaccination but since it was close in timing report has been filed.
Preexisting Conditions: Hyperparathyroidism s/p surgical correction in 2020, MGUS, Idiopathic peripheral neuropathy, gout, OSA
Allergies: Erythromycin, PCN, Hmg-coa reductase inhibitors, nifedipine, tetanus toxoids, tetracyclines tetracyclines
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: He had sudden death on Feb 4th. Unclear if this could be related to vaccination but since it was close in timing report has been filed. No known immediate reaction to vaccination.


Changed on 5/14/2021

VAERS ID: 1026581 Before After
VAERS Form:2
Age:71.0
Sex:Male
Location:Washington
Vaccinated:2021-01-15
Onset:2021-02-04
Submitted:0000-00-00
Entered:2021-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-04
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? No
Previous Vaccinations: tetanus toxoid
Other Medications: Spironolactone, amlodipine, tamsulosin, losartan, pantoprazole, tadalafil, propranolol
Current Illness: He had sudden death on Feb 4th. Unclear if this could be related to vaccination but since it was close in timing report has been filed.
Preexisting Conditions: Hyperparathyroidism s/p surgical correction in 2020, MGUS, Idiopathic peripheral neuropathy, gout, OSA
Allergies: Erythromycin, PCN, Hmg-coa reductase inhibitors, nifedipine, tetanus toxoids, tetracyclines tetracyclines
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: He had sudden death on Feb 4th. Unclear if this could be related to vaccination but since it was close in timing report has been filed. No known immediate reaction to vaccination.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1026581&WAYBACKHISTORY=ON


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