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This is VAERS ID 1054337

History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 1054337
VAERS Form:2
Age:90.0
Sex:Male
Location:Delaware
Vaccinated:2021-02-16
Onset:2021-02-17
Submitted:0000-00-00
Entered:2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / UNK UN / SYR

Administered by: Military      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-01
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: several including METOPROLOL ER SUCCINATE 50 MG TABS
Current Illness: NONE
Preexisting Conditions: HEART CONDITION
Allergies: UNKNOWN
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: FOUND DEAD IN HIS OWN BED


Changed on 5/7/2021

VAERS ID: 1054337 Before After
VAERS Form:2
Age:90.0
Sex:Male
Location:Delaware
Vaccinated:2021-02-16
Onset:2021-02-17
Submitted:0000-00-00
Entered:2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / UNK UN / SYR

Administered by: Military      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-01
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: several including METOPROLOL ER SUCCINATE 50 MG TABS
Current Illness: NONE
Preexisting Conditions: HEART CONDITION
Allergies: UNKNOWN UNKNOWN
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: FOUND DEAD IN HIS OWN BED


Changed on 5/14/2021

VAERS ID: 1054337 Before After
VAERS Form:2
Age:90.0
Sex:Male
Location:Delaware
Vaccinated:2021-02-16
Onset:2021-02-17
Submitted:0000-00-00
Entered:2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / UNK UN / SYR

Administered by: Military      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-01
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: several including METOPROLOL ER SUCCINATE 50 MG TABS
Current Illness: NONE
Preexisting Conditions: HEART CONDITION
Allergies: UNKNOWN UNKNOWN
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up: FOUND DEAD IN HIS OWN BED

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1054337&WAYBACKHISTORY=ON

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