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This is VAERS ID 1033466

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1033466
VAERS Form:2
Age:70.0
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Cardiac arrest, Death, Resuscitation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Current Illness:
Preexisting Conditions: Asthma/COPD, Diabetes mellitus (DM), Hypertension (HTN), Renal Disease (e.g. CKD, HD, ESRF), A-fib, pulmonary hypertension, chronic loculated empsyema, chronic aspiration pneumonitis, pacemaker, chronic anticoagulation
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 70 yo man with multiple severe medical comorbidities received his first dose of Moderna COVID-19 vaccination without incident. 8.5 hours later, he was noted by his family to be in his usual state of health. 9.5 hours after the vaccination, he was found down by his family in cardiac arrest. Resuscitation attempts were not successful, and the patient died.


Changed on 5/7/2021

VAERS ID: 1033466 Before After
VAERS Form:2
Age:70.0
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Cardiac arrest, Death, Resuscitation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Current Illness:
Preexisting Conditions: Asthma/COPD, Diabetes mellitus (DM), Hypertension (HTN), Renal Disease (e.g. CKD, HD, ESRF), A-fib, pulmonary hypertension, chronic loculated empsyema, chronic aspiration pneumonitis, pacemaker, chronic anticoagulation
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 70 yo man with multiple severe medical comorbidities received his first dose of Moderna COVID-19 vaccination without incident. 8.5 hours later, he was noted by his family to be in his usual state of health. 9.5 hours after the vaccination, he was found down by his family in cardiac arrest. Resuscitation attempts were not successful, and the patient died.


Changed on 5/14/2021

VAERS ID: 1033466 Before After
VAERS Form:2
Age:70.0
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Cardiac arrest, Death, Resuscitation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Current Illness:
Preexisting Conditions: Asthma/COPD, Diabetes mellitus (DM), Hypertension (HTN), Renal Disease (e.g. CKD, HD, ESRF), A-fib, pulmonary hypertension, chronic loculated empsyema, chronic aspiration pneumonitis, pacemaker, chronic anticoagulation
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 70 yo man with multiple severe medical comorbidities received his first dose of Moderna COVID-19 vaccination without incident. 8.5 hours later, he was noted by his family to be in his usual state of health. 9.5 hours after the vaccination, he was found down by his family in cardiac arrest. Resuscitation attempts were not successful, and the patient died.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1033466&WAYBACKHISTORY=ON


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