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This is VAERS ID 1108959

History of Changes from the VAERS Wayback Machine

First Appeared on 3/19/2021

VAERS ID: 1108959
VAERS Form:2
Age:73.0
Sex:Male
Location:California
Vaccinated:2021-02-18
Onset:2021-02-21
Submitted:0000-00-00
Entered:2021-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / UNK LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Cerebral artery occlusion, Death, Respiratory distress, Syncope, Thrombectomy, Angiogram cerebral, Computerised tomogram head, Haemorrhagic transformation stroke, Endotracheal intubation, Neurological decompensation, Magnetic resonance imaging head

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-01
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: metoprolol XL, Rivaroxaban
Current Illness: Atrial fibrillation Alcoholism
Preexisting Conditions: Atrial fibrillation Alcoholism
Allergies: NKDA
Diagnostic Lab Data: CTA Brain, Cerebral angiogram, MRI Brain
CDC 'Split Type':

Write-up: Stroke resulting in death. Admitted to hospital 2/21/21 as transfer from first Hospital after found collapsed in his hotel room. Left M1 occlusion, thrombectomy performed, then had hemorrhagic trnasformation. Developed worsening respiratory status after extubation, was reintubated. Given poor neurologic status, was extubated and started on palliative morphine drip. Pt died 0100 3/1/21.


Changed on 5/7/2021

VAERS ID: 1108959 Before After
VAERS Form:2
Age:73.0
Sex:Male
Location:California
Vaccinated:2021-02-18
Onset:2021-02-21
Submitted:0000-00-00
Entered:2021-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / UNK LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Cerebral artery occlusion, Death, Respiratory distress, Syncope, Thrombectomy, Angiogram cerebral, Computerised tomogram head, Haemorrhagic transformation stroke, Endotracheal intubation, Neurological decompensation, Magnetic resonance imaging head

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-01
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: metoprolol XL, Rivaroxaban
Current Illness: Atrial fibrillation Alcoholism
Preexisting Conditions: Atrial fibrillation Alcoholism
Allergies: NKDA NKDA
Diagnostic Lab Data: CTA Brain, Cerebral angiogram, MRI Brain
CDC 'Split Type':

Write-up: Stroke resulting in death. Admitted to hospital 2/21/21 as transfer from first Hospital after found collapsed in his hotel room. Left M1 occlusion, thrombectomy performed, then had hemorrhagic trnasformation. Developed worsening respiratory status after extubation, was reintubated. Given poor neurologic status, was extubated and started on palliative morphine drip. Pt died 0100 3/1/21.


Changed on 5/14/2021

VAERS ID: 1108959 Before After
VAERS Form:2
Age:73.0
Sex:Male
Location:California
Vaccinated:2021-02-18
Onset:2021-02-21
Submitted:0000-00-00
Entered:2021-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / UNK LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Cerebral artery occlusion, Death, Respiratory distress, Syncope, Thrombectomy, Angiogram cerebral, Computerised tomogram head, Haemorrhagic transformation stroke, Endotracheal intubation, Neurological decompensation, Magnetic resonance imaging head

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-01
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: metoprolol XL, Rivaroxaban
Current Illness: Atrial fibrillation Alcoholism
Preexisting Conditions: Atrial fibrillation Alcoholism
Allergies: NKDA NKDA
Diagnostic Lab Data: CTA Brain, Cerebral angiogram, MRI Brain
CDC 'Split Type':

Write-up: Stroke resulting in death. Admitted to hospital 2/21/21 as transfer from first Hospital after found collapsed in his hotel room. Left M1 occlusion, thrombectomy performed, then had hemorrhagic trnasformation. Developed worsening respiratory status after extubation, was reintubated. Given poor neurologic status, was extubated and started on palliative morphine drip. Pt died 0100 3/1/21.

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