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This is VAERS ID 1029511

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1029511
VAERS Form:2
Age:80.0
Sex:Male
Location:Virginia
Vaccinated:2021-01-21
Onset:2021-01-24
Submitted:0000-00-00
Entered:2021-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR

Administered by: Public      Purchased by: ??
Symptoms: Dyspnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol 500mg as needed Zyrtec 10mg daily Lysine 500mg daily Nyquil/Dayquil as needed Pepcid 20mg at bedtime
Current Illness: None
Preexisting Conditions: None, never sick
Allergies: None
Diagnostic Lab Data: Jan. 27 2021 when taken to the E.R
CDC 'Split Type':

Write-up: Developed severe shortness of breath.


Changed on 5/7/2021

VAERS ID: 1029511 Before After
VAERS Form:2
Age:80.0
Sex:Male
Location:Virginia
Vaccinated:2021-01-21
Onset:2021-01-24
Submitted:0000-00-00
Entered:2021-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR

Administered by: Public      Purchased by: ??
Symptoms: Dyspnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol 500mg as needed Zyrtec 10mg daily Lysine 500mg daily Nyquil/Dayquil as needed Pepcid 20mg at bedtime
Current Illness: None
Preexisting Conditions: None, never sick
Allergies: None None
Diagnostic Lab Data: Jan. 27 2021 when taken to the E.R
CDC 'Split Type':

Write-up: Developed severe shortness of breath.


Changed on 5/14/2021

VAERS ID: 1029511 Before After
VAERS Form:2
Age:80.0
Sex:Male
Location:Virginia
Vaccinated:2021-01-21
Onset:2021-01-24
Submitted:0000-00-00
Entered:2021-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR

Administered by: Public      Purchased by: ??
Symptoms: Dyspnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-08
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tylenol 500mg as needed Zyrtec 10mg daily Lysine 500mg daily Nyquil/Dayquil as needed Pepcid 20mg at bedtime
Current Illness: None
Preexisting Conditions: None, never sick
Allergies: None None
Diagnostic Lab Data: Jan. 27 2021 when taken to the E.R
CDC 'Split Type':

Write-up: Developed severe shortness of breath.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1029511&WAYBACKHISTORY=ON

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