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This is VAERS ID 1029335

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1029335
VAERS Form:2
Age:77.0
Sex:Male
Location:Iowa
Vaccinated:2021-02-09
Onset:2021-02-14
Submitted:0000-00-00
Entered:2021-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Cardio-respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-14
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: Eplerenone Amiloride KCl Entresto Metolazone Bumex Tamsulosin ASA Docusate prn
Current Illness: none
Preexisting Conditions: Coronary Artery disease with 2 stents Congestive Heart Failure Hyperaldosteronism History of Pulmonary embolus HTN Hyperlipidemia
Allergies: NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Cardiopulmonary arrest


Changed on 5/7/2021

VAERS ID: 1029335 Before After
VAERS Form:2
Age:77.0
Sex:Male
Location:Iowa
Vaccinated:2021-02-09
Onset:2021-02-14
Submitted:0000-00-00
Entered:2021-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Cardio-respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-14
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: Eplerenone Amiloride KCl Entresto Metolazone Bumex Tamsulosin ASA Docusate prn
Current Illness: none
Preexisting Conditions: Coronary Artery disease with 2 stents Congestive Heart Failure Hyperaldosteronism History of Pulmonary embolus HTN Hyperlipidemia
Allergies: NKDA NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Cardiopulmonary arrest


Changed on 5/14/2021

VAERS ID: 1029335 Before After
VAERS Form:2
Age:77.0
Sex:Male
Location:Iowa
Vaccinated:2021-02-09
Onset:2021-02-14
Submitted:0000-00-00
Entered:2021-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Cardio-respiratory arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-14
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: Eplerenone Amiloride KCl Entresto Metolazone Bumex Tamsulosin ASA Docusate prn
Current Illness: none
Preexisting Conditions: Coronary Artery disease with 2 stents Congestive Heart Failure Hyperaldosteronism History of Pulmonary embolus HTN Hyperlipidemia
Allergies: NKDA NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Cardiopulmonary arrest

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1029335&WAYBACKHISTORY=ON


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