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This is VAERS ID 1050441

History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 1050441
VAERS Form:2
Age:86.0
Sex:Male
Location:Virginia
Vaccinated:2021-02-20
Onset:2021-02-21
Submitted:0000-00-00
Entered:2021-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 2 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death, Malaise, Resuscitation, Unresponsive to stimuli

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: reported "Zelcor", may have meant Zocor
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: None reported
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Vaccination and observation period successfully completed without adverse event. The patient''s significant other reported neither of them were feeling well on 2/21/2021. Approximately 28 hours after vaccination, the patient was found unresponsive in the bathtub. EMS arrived within 5 minutes, resuscitation attempt was unsuccessful, CPR terminated at 1503 and the patient pronounced dead. The Medical examiner refused the case on the basis of lack of jurisdiction, and the remains were moved to a local funeral home. No autopsy was performed. This event is not thought to be related to the vaccination event or the vaccine, the death is thought to be from natural causes.


Changed on 5/7/2021

VAERS ID: 1050441 Before After
VAERS Form:2
Age:86.0
Sex:Male
Location:Virginia
Vaccinated:2021-02-20
Onset:2021-02-21
Submitted:0000-00-00
Entered:2021-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 2 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death, Malaise, Resuscitation, Unresponsive to stimuli

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: reported "Zelcor", may have meant Zocor
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: None reported reported
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Vaccination and observation period successfully completed without adverse event. The patient''s significant other reported neither of them were feeling well on 2/21/2021. Approximately 28 hours after vaccination, the patient was found unresponsive in the bathtub. EMS arrived within 5 minutes, resuscitation attempt was unsuccessful, CPR terminated at 1503 and the patient pronounced dead. The Medical examiner refused the case on the basis of lack of jurisdiction, and the remains were moved to a local funeral home. No autopsy was performed. This event is not thought to be related to the vaccination event or the vaccine, the death is thought to be from natural causes.


Changed on 5/14/2021

VAERS ID: 1050441 Before After
VAERS Form:2
Age:86.0
Sex:Male
Location:Virginia
Vaccinated:2021-02-20
Onset:2021-02-21
Submitted:0000-00-00
Entered:2021-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / 2 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death, Malaise, Resuscitation, Unresponsive to stimuli

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: reported "Zelcor", may have meant Zocor
Current Illness: None reported
Preexisting Conditions: None reported
Allergies: None reported reported
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Vaccination and observation period successfully completed without adverse event. The patient''s significant other reported neither of them were feeling well on 2/21/2021. Approximately 28 hours after vaccination, the patient was found unresponsive in the bathtub. EMS arrived within 5 minutes, resuscitation attempt was unsuccessful, CPR terminated at 1503 and the patient pronounced dead. The Medical examiner refused the case on the basis of lack of jurisdiction, and the remains were moved to a local funeral home. No autopsy was performed. This event is not thought to be related to the vaccination event or the vaccine, the death is thought to be from natural causes.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1050441&WAYBACKHISTORY=ON

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