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This is VAERS ID 1066852

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/5/2021

VAERS ID: 1066852
VAERS Form:2
Age:76.0
Sex:Male
Location:Kentucky
Vaccinated:2021-02-24
Onset:2021-02-28
Submitted:0000-00-00
Entered:2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-28
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: Steroids
Current Illness: None
Preexisting Conditions: Terminal cancer- Hospice care started 1/2021
Allergies: None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: History of terminal cancer, entered hospice care 1/2021, expired 2/28/2021. No reported adverse events from patient or family after receiving vaccine


Changed on 5/7/2021

VAERS ID: 1066852 Before After
VAERS Form:2
Age:76.0
Sex:Male
Location:Kentucky
Vaccinated:2021-02-24
Onset:2021-02-28
Submitted:0000-00-00
Entered:2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-28
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: Steroids
Current Illness: None
Preexisting Conditions: Terminal cancer- Hospice care started 1/2021
Allergies: None None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: History of terminal cancer, entered hospice care 1/2021, expired 2/28/2021. No reported adverse events from patient or family after receiving vaccine


Changed on 5/14/2021

VAERS ID: 1066852 Before After
VAERS Form:2
Age:76.0
Sex:Male
Location:Kentucky
Vaccinated:2021-02-24
Onset:2021-02-28
Submitted:0000-00-00
Entered:2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-28
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: Steroids
Current Illness: None
Preexisting Conditions: Terminal cancer- Hospice care started 1/2021
Allergies: None None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: History of terminal cancer, entered hospice care 1/2021, expired 2/28/2021. No reported adverse events from patient or family after receiving vaccine

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1066852&WAYBACKHISTORY=ON


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