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This is VAERS ID 1052164

History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 1052164
VAERS Form:2
Age:78.0
Sex:Male
Location:Tennessee
Vaccinated:2021-02-23
Onset:2021-02-24
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / UNK AR / IM

Administered by: Private      Purchased by: ??
Symptoms: Abdominal pain, Cardio-respiratory arrest, Death, Dyspnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-24
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: Stage 4 Kidney Disease Hypertension Ischemic Bowel Hyperlipidemia GERD CAD
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 911 called to patients house for trouble breathing and abdominal pain. Patient coded, wife presented DNR paperwork. Patient presented to Hospital DOA at 0958.


Changed on 5/7/2021

VAERS ID: 1052164 Before After
VAERS Form:2
Age:78.0
Sex:Male
Location:Tennessee
Vaccinated:2021-02-23
Onset:2021-02-24
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / UNK AR / IM

Administered by: Private      Purchased by: ??
Symptoms: Abdominal pain, Cardio-respiratory arrest, Death, Dyspnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-24
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: Stage 4 Kidney Disease Hypertension Ischemic Bowel Hyperlipidemia GERD CAD
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 911 called to patients house for trouble breathing and abdominal pain. Patient coded, wife presented DNR paperwork. Patient presented to Hospital DOA at 0958.


Changed on 5/14/2021

VAERS ID: 1052164 Before After
VAERS Form:2
Age:78.0
Sex:Male
Location:Tennessee
Vaccinated:2021-02-23
Onset:2021-02-24
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / UNK AR / IM

Administered by: Private      Purchased by: ??
Symptoms: Abdominal pain, Cardio-respiratory arrest, Death, Dyspnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-24
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: Stage 4 Kidney Disease Hypertension Ischemic Bowel Hyperlipidemia GERD CAD
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 911 called to patients house for trouble breathing and abdominal pain. Patient coded, wife presented DNR paperwork. Patient presented to Hospital DOA at 0958.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1052164&WAYBACKHISTORY=ON

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