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This is VAERS ID 1029514

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1029514
VAERS Form:2
Age:71.0
Sex:Male
Location:North Carolina
Vaccinated:2021-01-06
Onset:2021-02-09
Submitted:0000-00-00
Entered:2021-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-09
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: unknown
Current Illness: acid reflux
Preexisting Conditions: acid reflux
Allergies: n/a
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: patient deceased


Changed on 5/7/2021

VAERS ID: 1029514 Before After
VAERS Form:2
Age:71.0
Sex:Male
Location:North Carolina
Vaccinated:2021-01-06
Onset:2021-02-09
Submitted:0000-00-00
Entered:2021-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-09
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: unknown
Current Illness: acid reflux
Preexisting Conditions: acid reflux
Allergies: n/a n/a
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: patient deceased


Changed on 5/14/2021

VAERS ID: 1029514 Before After
VAERS Form:2
Age:71.0
Sex:Male
Location:North Carolina
Vaccinated:2021-01-06
Onset:2021-02-09
Submitted:0000-00-00
Entered:2021-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-09
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: unknown
Current Illness: acid reflux
Preexisting Conditions: acid reflux
Allergies: n/a n/a
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: patient deceased

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1029514&WAYBACKHISTORY=ON


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