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This is VAERS ID 1094197

History of Changes from the VAERS Wayback Machine

First Appeared on 3/19/2021

VAERS ID: 1094197
VAERS Form:2
Age:83.0
Sex:Male
Location:Alabama
Vaccinated:2021-02-26
Onset:2021-03-11
Submitted:0000-00-00
Entered:2021-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 1 LA / IM
FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR UJ500AB / 1 LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. T033663 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Feeling abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-11
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: ELIQUIS, LASIX, PROTONIX,ALTACE, TRADJENTA, LUMIGAN, AMIODARONE, METOPROLOL
Current Illness: UNKNOWN
Preexisting Conditions: HBP, DIABETES, MAY BE OTHERS
Allergies: UNKNOWN
Diagnostic Lab Data: UNKNOWN - CONTACT PHYSICIAN OR HOSPITAL I AM NOT AWARE IF HE WAS TAKEN TO HOSPITAL OR DR''S OFFICE YESTERDAY OR NOT.
CDC 'Split Type':

Write-up: DEATH - PT''S WIFE CALLED 3-11 TO TELL US PATIENT WAS FEELING BAD, AND TO ASK WHAT TO DO. WE SENT A PULSEOXIMETER, AND ADVISED TO CONTACT DR. - ON MORNING OF 3-12, PT''S WIFE CALLED TO TELL US HE HAD PASSED AWAY DURING THE NIGHT.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1094197&WAYBACKHISTORY=ON


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