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This is VAERS ID 1088956

History of Changes from the VAERS Wayback Machine

First Appeared on 3/11/2021

VAERS ID: 1088956
VAERS Form:2
Age:74.0
Sex:Male
Location:New York
Vaccinated:2021-02-03
Onset:2021-02-14
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 UN / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Intensive care, COVID-19, SARS-CoV-2 test positive

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)? Yes
Hospitalized? Yes, days: 15     Extended hospital stay? No
Previous Vaccinations:
Other Medications: No
Current Illness: No
Preexisting Conditions: Diabetes
Allergies: No
Diagnostic Lab Data: 02/14/2021: Covid-19 test positive and hospitalized hospital
CDC 'Split Type':

Write-up: Tested positive and had symptoms for Covid-19 . Admitted to hospital on 2/14/21 in the icu and died in 2/28/21


Changed on 5/7/2021

VAERS ID: 1088956 Before After
VAERS Form:2
Age:74.0
Sex:Male
Location:New York
Vaccinated:2021-02-03
Onset:2021-02-14
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 UN / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Intensive care, COVID-19, SARS-CoV-2 test positive

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)? Yes
Hospitalized? Yes, days: 15     Extended hospital stay? No
Previous Vaccinations:
Other Medications: No
Current Illness: No
Preexisting Conditions: Diabetes
Allergies: No No
Diagnostic Lab Data: 02/14/2021: Covid-19 test positive and hospitalized hospital
CDC 'Split Type':

Write-up: Tested positive and had symptoms for Covid-19 . Admitted to hospital on 2/14/21 in the icu and died in 2/28/21


Changed on 5/14/2021

VAERS ID: 1088956 Before After
VAERS Form:2
Age:74.0
Sex:Male
Location:New York
Vaccinated:2021-02-03
Onset:2021-02-14
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 UN / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Intensive care, COVID-19, SARS-CoV-2 test positive

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)? Yes
Hospitalized? Yes, days: 15     Extended hospital stay? No
Previous Vaccinations:
Other Medications: No
Current Illness: No
Preexisting Conditions: Diabetes
Allergies: No No
Diagnostic Lab Data: 02/14/2021: Covid-19 test positive and hospitalized hospital
CDC 'Split Type':

Write-up: Tested positive and had symptoms for Covid-19 . Admitted to hospital on 2/14/21 in the icu and died in 2/28/21

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1088956&WAYBACKHISTORY=ON

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