National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1027300

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1027300
VAERS Form:2
Age:90.0
Sex:Male
Location:Kansas
Vaccinated:2021-02-06
Onset:2021-02-11
Submitted:0000-00-00
Entered:2021-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / UNK UN / UN

Administered by: Unknown      Purchased by: ??
Symptoms: Asthenia, Nausea, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-12
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: Unknown
Current Illness: None known
Preexisting Conditions: Aortic aneurysm, aortic stenosis, CAD, HTN, CHF, A-Fib, HLD, Ischemic heart failure, pacemaker, V-Fib, PVD, palpitations, hypotension, and small bowel obstruction.
Allergies: Unknown
Diagnostic Lab Data: None known.
CDC 'Split Type':

Write-up: Nausea, vomiting and generalized weakness.


Changed on 5/7/2021

VAERS ID: 1027300 Before After
VAERS Form:2
Age:90.0
Sex:Male
Location:Kansas
Vaccinated:2021-02-06
Onset:2021-02-11
Submitted:0000-00-00
Entered:2021-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / UNK UN / UN

Administered by: Unknown      Purchased by: ??
Symptoms: Asthenia, Nausea, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-12
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: Unknown
Current Illness: None known
Preexisting Conditions: Aortic aneurysm, aortic stenosis, CAD, HTN, CHF, A-Fib, HLD, Ischemic heart failure, pacemaker, V-Fib, PVD, palpitations, hypotension, and small bowel obstruction.
Allergies: Unknown Unknown
Diagnostic Lab Data: None known.
CDC 'Split Type':

Write-up: Nausea, vomiting and generalized weakness.


Changed on 5/14/2021

VAERS ID: 1027300 Before After
VAERS Form:2
Age:90.0
Sex:Male
Location:Kansas
Vaccinated:2021-02-06
Onset:2021-02-11
Submitted:0000-00-00
Entered:2021-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / UNK UN / UN

Administered by: Unknown      Purchased by: ??
Symptoms: Asthenia, Nausea, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-12
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: Unknown
Current Illness: None known
Preexisting Conditions: Aortic aneurysm, aortic stenosis, CAD, HTN, CHF, A-Fib, HLD, Ischemic heart failure, pacemaker, V-Fib, PVD, palpitations, hypotension, and small bowel obstruction.
Allergies: Unknown Unknown
Diagnostic Lab Data: None known.
CDC 'Split Type':

Write-up: Nausea, vomiting and generalized weakness.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1027300&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166