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This is VAERS ID 1044352

History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 1044352
VAERS Form:2
Age:64.0
Sex:Male
Location:Illinois
Vaccinated:2021-02-08
Onset:2021-02-14
Submitted:0000-00-00
Entered:2021-02-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 AR / UN

Administered by: Unknown      Purchased by: ??
Symptoms: Abdominal discomfort, Cardiac failure, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-14
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: Synthroid; Cosentix; Multivitamin; Vitamin C; Omeprazole; Loratadine
Current Illness: None
Preexisting Conditions: Psoriatic Arthritis; Hypothyroidism
Allergies: None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Stomach upset, sudden heart failure, death


Changed on 5/7/2021

VAERS ID: 1044352 Before After
VAERS Form:2
Age:64.0
Sex:Male
Location:Illinois
Vaccinated:2021-02-08
Onset:2021-02-14
Submitted:0000-00-00
Entered:2021-02-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 AR / UN

Administered by: Unknown      Purchased by: ??
Symptoms: Abdominal discomfort, Cardiac failure, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-14
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: Synthroid; Cosentix; Multivitamin; Vitamin C; Omeprazole; Loratadine
Current Illness: None
Preexisting Conditions: Psoriatic Arthritis; Hypothyroidism
Allergies: None None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Stomach upset, sudden heart failure, death


Changed on 5/14/2021

VAERS ID: 1044352 Before After
VAERS Form:2
Age:64.0
Sex:Male
Location:Illinois
Vaccinated:2021-02-08
Onset:2021-02-14
Submitted:0000-00-00
Entered:2021-02-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 AR / UN

Administered by: Unknown      Purchased by: ??
Symptoms: Abdominal discomfort, Cardiac failure, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-14
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: Synthroid; Cosentix; Multivitamin; Vitamin C; Omeprazole; Loratadine
Current Illness: None
Preexisting Conditions: Psoriatic Arthritis; Hypothyroidism
Allergies: None None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Stomach upset, sudden heart failure, death

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1044352&WAYBACKHISTORY=ON

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