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This is VAERS ID 1045895

History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 1045895
VAERS Form:2
Age:89.0
Sex:Male
Location:Florida
Vaccinated:2021-02-21
Onset:2021-02-21
Submitted:0000-00-00
Entered:2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 UN / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-21
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: Heart meds recently changed by cardiologist . Inhalers for asthma. Other unknown
Current Illness: None know
Preexisting Conditions: Heart arrhythmia, enlarged prostate, low blood pressure, CAD, asthma, season allergies/hay fever, spinal stenosis, with neuropathy
Allergies: Unknown
Diagnostic Lab Data: None at this time
CDC 'Split Type':

Write-up: He was found deceased in his home by Sheriff and paramedics evening of 2/21/21.


Changed on 5/7/2021

VAERS ID: 1045895 Before After
VAERS Form:2
Age:89.0
Sex:Male
Location:Florida
Vaccinated:2021-02-21
Onset:2021-02-21
Submitted:0000-00-00
Entered:2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 UN / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-21
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: Heart meds recently changed by cardiologist . Inhalers for asthma. Other unknown
Current Illness: None know
Preexisting Conditions: Heart arrhythmia, enlarged prostate, low blood pressure, CAD, asthma, season allergies/hay fever, spinal stenosis, with neuropathy
Allergies: Unknown Unknown
Diagnostic Lab Data: None at this time
CDC 'Split Type':

Write-up: He was found deceased in his home by Sheriff and paramedics evening of 2/21/21.


Changed on 5/14/2021

VAERS ID: 1045895 Before After
VAERS Form:2
Age:89.0
Sex:Male
Location:Florida
Vaccinated:2021-02-21
Onset:2021-02-21
Submitted:0000-00-00
Entered:2021-02-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013M20A / 2 UN / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-21
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: Heart meds recently changed by cardiologist . Inhalers for asthma. Other unknown
Current Illness: None know
Preexisting Conditions: Heart arrhythmia, enlarged prostate, low blood pressure, CAD, asthma, season allergies/hay fever, spinal stenosis, with neuropathy
Allergies: Unknown Unknown
Diagnostic Lab Data: None at this time
CDC 'Split Type':

Write-up: He was found deceased in his home by Sheriff and paramedics evening of 2/21/21.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1045895&WAYBACKHISTORY=ON

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