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This is VAERS ID 1106834

History of Changes from the VAERS Wayback Machine

First Appeared on 3/19/2021

VAERS ID: 1106834
VAERS Form:2
Age:70.0
Sex:Male
Location:Nebraska
Vaccinated:2021-03-05
Onset:2021-03-09
Submitted:0000-00-00
Entered:2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-09
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: "ASA" was noted on pre-screen; patient apparently also on oxygen per friend and POD staff due to COPD
Current Illness: COPD; recently began oxygen therapy
Preexisting Conditions: COPD; unknown others
Allergies: None reported on prescreen
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Patient apparently expired 3/09/2021, no other information known, unknown if linked.


Changed on 5/7/2021

VAERS ID: 1106834 Before After
VAERS Form:2
Age:70.0
Sex:Male
Location:Nebraska
Vaccinated:2021-03-05
Onset:2021-03-09
Submitted:0000-00-00
Entered:2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-09
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: "ASA" was noted on pre-screen; patient apparently also on oxygen per friend and POD staff due to COPD
Current Illness: COPD; recently began oxygen therapy
Preexisting Conditions: COPD; unknown others
Allergies: None reported on prescreen prescreen
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Patient apparently expired 3/09/2021, no other information known, unknown if linked.


Changed on 5/14/2021

VAERS ID: 1106834 Before After
VAERS Form:2
Age:70.0
Sex:Male
Location:Nebraska
Vaccinated:2021-03-05
Onset:2021-03-09
Submitted:0000-00-00
Entered:2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-09
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: "ASA" was noted on pre-screen; patient apparently also on oxygen per friend and POD staff due to COPD
Current Illness: COPD; recently began oxygen therapy
Preexisting Conditions: COPD; unknown others
Allergies: None reported on prescreen prescreen
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Patient apparently expired 3/09/2021, no other information known, unknown if linked.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1106834&WAYBACKHISTORY=ON

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