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This is VAERS ID 1032873

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1032873
VAERS Form:2
Age:92.0
Sex:Male
Location:Florida
Vaccinated:2021-02-13
Onset:2021-02-14
Submitted:0000-00-00
Entered:2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006M20A / 1 AR / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Chills, Death, Wheezing

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-15
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: Aspirin, Lipitor, Calcium, Plavix, Cardura, Finasteride, Prozac, Metoprolol, Sinemet, Januvia, Flomax, Vitamin B12, Vitamin C, Vitamin D3
Current Illness: Had Covid 19 in Dec. 2020, Tested negative at beginning of Feb. 2021. No other illness.
Preexisting Conditions: Type 2 diabetes. Controlled hypertension.
Allergies: NKA
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: He had rigors starting 6 pm the day after the vaccination. He was treated with one 500 mg tylenol. He had increased wheezing but did not complain of SOB. At 0400 the next morning, he died.

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