National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1030468

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1030468
VAERS Form:2
Age:76.0
Sex:Male
Location:Nebraska
Vaccinated:2021-02-11
Onset:2021-02-12
Submitted:0000-00-00
Entered:2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Asthenia, Blood creatinine increased, Blood potassium increased, C-reactive protein increased, Death, Hyperkalaemia, Hypotension, Hypoxia, White blood cell count increased, Brain natriuretic peptide increased, Acute kidney injury

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-13
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril, Flomax, Sotalol, simvastatin, Xarelto, Requip, Omeprazole, symbicort, Albuterol Aerosol, Furosemide.
Current Illness: ACUTE KIDNEY FAILURE, QUESTION SEPSIS, CHF, ATRIAL FIBRILLATION, COPD, GERD, RESTLESS LEG SYNDROME, HISTORY OF PROSTATE CANCER, HYPERTENSION, CURENT TOBACCO USAGE
Preexisting Conditions: COPD, CHF, ATRIAL FIBRILLATION, GERD, RESTLESS LEG, HISTORY OF PROSTATE CANCER, HYPERTENSION
Allergies: none
Diagnostic Lab Data: potassium 7.2, creatinine 4.3, CRP 50. BNP 3230. WBC 10,200.
CDC 'Split Type':

Write-up: Pt presents to ER with increased weakness, hypoxia, history of COPD, but not oxygen dependent., hypotension. Acute Kidney failure noted in labs, not previously diagnosed , new hyperkalemia. BP 73/39, HR 67. dopamine initiated, and switched to Levophed. Oxygen Sat 86%, requiring 10 L O2. Transferred from this critical access hospital to another Hospital. Expires later 2-13-2021


Changed on 5/7/2021

VAERS ID: 1030468 Before After
VAERS Form:2
Age:76.0
Sex:Male
Location:Nebraska
Vaccinated:2021-02-11
Onset:2021-02-12
Submitted:0000-00-00
Entered:2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Asthenia, Blood creatinine increased, Blood potassium increased, C-reactive protein increased, Death, Hyperkalaemia, Hypotension, Hypoxia, White blood cell count increased, Brain natriuretic peptide increased, Acute kidney injury

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-13
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril, Flomax, Sotalol, simvastatin, Xarelto, Requip, Omeprazole, symbicort, Albuterol Aerosol, Furosemide.
Current Illness: ACUTE KIDNEY FAILURE, QUESTION SEPSIS, CHF, ATRIAL FIBRILLATION, COPD, GERD, RESTLESS LEG SYNDROME, HISTORY OF PROSTATE CANCER, HYPERTENSION, CURENT TOBACCO USAGE
Preexisting Conditions: COPD, CHF, ATRIAL FIBRILLATION, GERD, RESTLESS LEG, HISTORY OF PROSTATE CANCER, HYPERTENSION
Allergies: none none
Diagnostic Lab Data: potassium 7.2, creatinine 4.3, CRP 50. BNP 3230. WBC 10,200.
CDC 'Split Type':

Write-up: Pt presents to ER with increased weakness, hypoxia, history of COPD, but not oxygen dependent., hypotension. Acute Kidney failure noted in labs, not previously diagnosed , new hyperkalemia. BP 73/39, HR 67. dopamine initiated, and switched to Levophed. Oxygen Sat 86%, requiring 10 L O2. Transferred from this critical access hospital to another Hospital. Expires later 2-13-2021


Changed on 5/14/2021

VAERS ID: 1030468 Before After
VAERS Form:2
Age:76.0
Sex:Male
Location:Nebraska
Vaccinated:2021-02-11
Onset:2021-02-12
Submitted:0000-00-00
Entered:2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Asthenia, Blood creatinine increased, Blood potassium increased, C-reactive protein increased, Death, Hyperkalaemia, Hypotension, Hypoxia, White blood cell count increased, Brain natriuretic peptide increased, Acute kidney injury

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-13
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril, Flomax, Sotalol, simvastatin, Xarelto, Requip, Omeprazole, symbicort, Albuterol Aerosol, Furosemide.
Current Illness: ACUTE KIDNEY FAILURE, QUESTION SEPSIS, CHF, ATRIAL FIBRILLATION, COPD, GERD, RESTLESS LEG SYNDROME, HISTORY OF PROSTATE CANCER, HYPERTENSION, CURENT TOBACCO USAGE
Preexisting Conditions: COPD, CHF, ATRIAL FIBRILLATION, GERD, RESTLESS LEG, HISTORY OF PROSTATE CANCER, HYPERTENSION
Allergies: none none
Diagnostic Lab Data: potassium 7.2, creatinine 4.3, CRP 50. BNP 3230. WBC 10,200.
CDC 'Split Type':

Write-up: Pt presents to ER with increased weakness, hypoxia, history of COPD, but not oxygen dependent., hypotension. Acute Kidney failure noted in labs, not previously diagnosed , new hyperkalemia. BP 73/39, HR 67. dopamine initiated, and switched to Levophed. Oxygen Sat 86%, requiring 10 L O2. Transferred from this critical access hospital to another Hospital. Expires later 2-13-2021

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1030468&WAYBACKHISTORY=ON


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