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This is VAERS ID 1036881

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1036881
VAERS Form:2
Age:70.0
Sex:Male
Location:Alaska
Vaccinated:2021-01-11
Onset:2021-01-20
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Myocardial infarction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-20
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? No
Previous Vaccinations:
Other Medications: Multiple cardiac medications including anticoagulation; medications for chronic lung condition
Current Illness:
Preexisting Conditions: Chronic cardiac conditions, chronic lung. Chronic smoker
Allergies: Penicillins
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Myocardial Infarction


Changed on 5/7/2021

VAERS ID: 1036881 Before After
VAERS Form:2
Age:70.0
Sex:Male
Location:Alaska
Vaccinated:2021-01-11
Onset:2021-01-20
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Myocardial infarction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-20
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? No
Previous Vaccinations:
Other Medications: Multiple cardiac medications including anticoagulation; medications for chronic lung condition
Current Illness:
Preexisting Conditions: Chronic cardiac conditions, chronic lung. Chronic smoker
Allergies: Penicillins Penicillins
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Myocardial Infarction


Changed on 5/21/2021

VAERS ID: 1036881 Before After
VAERS Form:2
Age:70.0
Sex:Male
Location:Alaska
Vaccinated:2021-01-11
Onset:2021-01-20
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Myocardial infarction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-20
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? No
Previous Vaccinations:
Other Medications: Multiple cardiac medications including anticoagulation; medications for chronic lung condition
Current Illness:
Preexisting Conditions: Chronic cardiac conditions, chronic lung. Chronic smoker
Allergies: Penicillins Penicillins
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Myocardial Infarction

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