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This is VAERS ID 1082850

History of Changes from the VAERS Wayback Machine

First Appeared on 3/11/2021

VAERS ID: 1082850
VAERS Form:2
Age:68.0
Sex:Male
Location:Michigan
Vaccinated:2021-02-19
Onset:2021-02-20
Submitted:0000-00-00
Entered:2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Electrocardiogram, Nausea, Vomiting, Mobility decreased, Computerised tomogram abdomen, Computerised tomogram head, Laboratory test, X-ray limb, Computerised tomogram spine

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2021-03-07
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? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin, atorvastatin, Cymbalta, lyrica, finastride, hydrochlorathiazide iron, losartan, metoprolol tamsulosin, ambien
Current Illness: none
Preexisting Conditions: psoriasis (lips), neuropathy, HTN, anxiety/depression, type 2 DM
Allergies: Penicillin, sulfa
Diagnostic Lab Data: labs, EKG, CT abd, Ct c spine, shoulder xray, CT of Head
CDC 'Split Type':

Write-up: pt became nauseated and vomiting 1 day after getting vaccine, reported on Mon 2/22/21 but states was getting better, received call from sister on 2/25/21 that pt could not get out of bed on own - was sent to ER at that time


Changed on 5/7/2021

VAERS ID: 1082850 Before After
VAERS Form:2
Age:68.0
Sex:Male
Location:Michigan
Vaccinated:2021-02-19
Onset:2021-02-20
Submitted:0000-00-00
Entered:2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Electrocardiogram, Nausea, Vomiting, Mobility decreased, Computerised tomogram abdomen, Computerised tomogram head, Laboratory test, X-ray limb, Computerised tomogram spine

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2021-03-07
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? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin, atorvastatin, Cymbalta, lyrica, finastride, hydrochlorathiazide iron, losartan, metoprolol tamsulosin, ambien
Current Illness: none
Preexisting Conditions: psoriasis (lips), neuropathy, HTN, anxiety/depression, type 2 DM
Allergies: Penicillin, sulfa sulfa
Diagnostic Lab Data: labs, EKG, CT abd, Ct c spine, shoulder xray, CT of Head
CDC 'Split Type':

Write-up: pt became nauseated and vomiting 1 day after getting vaccine, reported on Mon 2/22/21 but states was getting better, received call from sister on 2/25/21 that pt could not get out of bed on own - was sent to ER at that time


Changed on 5/14/2021

VAERS ID: 1082850 Before After
VAERS Form:2
Age:68.0
Sex:Male
Location:Michigan
Vaccinated:2021-02-19
Onset:2021-02-20
Submitted:0000-00-00
Entered:2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Electrocardiogram, Nausea, Vomiting, Mobility decreased, Computerised tomogram abdomen, Computerised tomogram head, Laboratory test, X-ray limb, Computerised tomogram spine

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2021-03-07
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? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin, atorvastatin, Cymbalta, lyrica, finastride, hydrochlorathiazide iron, losartan, metoprolol tamsulosin, ambien
Current Illness: none
Preexisting Conditions: psoriasis (lips), neuropathy, HTN, anxiety/depression, type 2 DM
Allergies: Penicillin, sulfa sulfa
Diagnostic Lab Data: labs, EKG, CT abd, Ct c spine, shoulder xray, CT of Head
CDC 'Split Type':

Write-up: pt became nauseated and vomiting 1 day after getting vaccine, reported on Mon 2/22/21 but states was getting better, received call from sister on 2/25/21 that pt could not get out of bed on own - was sent to ER at that time

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1082850&WAYBACKHISTORY=ON

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