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This is VAERS ID 1085788

History of Changes from the VAERS Wayback Machine

First Appeared on 3/11/2021

VAERS ID: 1085788
VAERS Form:2
Age:96.0
Sex:Male
Location:Michigan
Vaccinated:2021-02-22
Onset:2021-02-24
Submitted:0000-00-00
Entered:2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001A21A / 2 LA / IM

Administered by: Military      Purchased by: ??
Symptoms: Death, Dyspnoea, Lethargy, Respiration abnormal

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: Vitamin D 10mcg, , Simvistatin 20mg, ferrous sulfate 325 mg, Novolin 20 units a day, Lisinopril 2.5mg
Current Illness: No
Preexisting Conditions: diabetes, hypertension
Allergies: No allergies
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: My grandpa was very lethargic after his 2nd vaccine. The following day he started acting more awake, he had a better appetite but seemed to be breathing a little funny. He was labored a bit. He went to sleep on 2/24/21 and at 230 am was dead.


Changed on 5/7/2021

VAERS ID: 1085788 Before After
VAERS Form:2
Age:96.0
Sex:Male
Location:Michigan
Vaccinated:2021-02-22
Onset:2021-02-24
Submitted:0000-00-00
Entered:2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001A21A / 2 LA / IM

Administered by: Military      Purchased by: ??
Symptoms: Death, Dyspnoea, Lethargy, Respiration abnormal

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: Vitamin D 10mcg, , Simvistatin 20mg, ferrous sulfate 325 mg, Novolin 20 units a day, Lisinopril 2.5mg
Current Illness: No
Preexisting Conditions: diabetes, hypertension
Allergies: No allergies allergies
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: My grandpa was very lethargic after his 2nd vaccine. The following day he started acting more awake, he had a better appetite but seemed to be breathing a little funny. He was labored a bit. He went to sleep on 2/24/21 and at 230 am was dead.


Changed on 5/14/2021

VAERS ID: 1085788 Before After
VAERS Form:2
Age:96.0
Sex:Male
Location:Michigan
Vaccinated:2021-02-22
Onset:2021-02-24
Submitted:0000-00-00
Entered:2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001A21A / 2 LA / IM

Administered by: Military      Purchased by: ??
Symptoms: Death, Dyspnoea, Lethargy, Respiration abnormal

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: Vitamin D 10mcg, , Simvistatin 20mg, ferrous sulfate 325 mg, Novolin 20 units a day, Lisinopril 2.5mg
Current Illness: No
Preexisting Conditions: diabetes, hypertension
Allergies: No allergies allergies
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: My grandpa was very lethargic after his 2nd vaccine. The following day he started acting more awake, he had a better appetite but seemed to be breathing a little funny. He was labored a bit. He went to sleep on 2/24/21 and at 230 am was dead.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1085788&WAYBACKHISTORY=ON

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