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This is VAERS ID 1027502

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1027502
VAERS Form:2
Age:86.0
Sex:Male
Location:Missouri
Vaccinated:2021-01-14
Onset:2021-01-16
Submitted:0000-00-00
Entered:2021-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK UN / -

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-16
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:
Other Medications: Symbicort, Xanax, Albuterol, Flomax, Polyethylene glycol
Current Illness: N/A
Preexisting Conditions: COPD
Allergies: N/A
Diagnostic Lab Data: No tests were taken. No autopsy completed unless I paid them $5000
CDC 'Split Type':

Write-up: My dad received his first COVID vaccine on January 14, 2021. On January 16, 2021 he ate breakfast around 7:00 am and went back to his room. When the staff checked on him around 8:00 am they found my dad unresponsive. His blood pressure was over 220 and his pulse was 43. They began manual CPR until the paramedics arrived, but my dad died.


Changed on 5/7/2021

VAERS ID: 1027502 Before After
VAERS Form:2
Age:86.0
Sex:Male
Location:Missouri
Vaccinated:2021-01-14
Onset:2021-01-16
Submitted:0000-00-00
Entered:2021-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK UN / -

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-16
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:
Other Medications: Symbicort, Xanax, Albuterol, Flomax, Polyethylene glycol
Current Illness: N/A
Preexisting Conditions: COPD
Allergies: N/A N/A
Diagnostic Lab Data: No tests were taken. No autopsy completed unless I paid them $5000
CDC 'Split Type':

Write-up: My dad received his first COVID vaccine on January 14, 2021. On January 16, 2021 he ate breakfast around 7:00 am and went back to his room. When the staff checked on him around 8:00 am they found my dad unresponsive. His blood pressure was over 220 and his pulse was 43. They began manual CPR until the paramedics arrived, but my dad died.


Changed on 5/14/2021

VAERS ID: 1027502 Before After
VAERS Form:2
Age:86.0
Sex:Male
Location:Missouri
Vaccinated:2021-01-14
Onset:2021-01-16
Submitted:0000-00-00
Entered:2021-02-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK UN / -

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-16
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:
Other Medications: Symbicort, Xanax, Albuterol, Flomax, Polyethylene glycol
Current Illness: N/A
Preexisting Conditions: COPD
Allergies: N/A N/A
Diagnostic Lab Data: No tests were taken. No autopsy completed unless I paid them $5000
CDC 'Split Type':

Write-up: My dad received his first COVID vaccine on January 14, 2021. On January 16, 2021 he ate breakfast around 7:00 am and went back to his room. When the staff checked on him around 8:00 am they found my dad unresponsive. His blood pressure was over 220 and his pulse was 43. They began manual CPR until the paramedics arrived, but my dad died.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1027502&WAYBACKHISTORY=ON


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