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This is VAERS ID 1156365

History of Changes from the VAERS Wayback Machine

First Appeared on 4/1/2021

VAERS ID: 1156365
VAERS Form:2
Age:72.0
Sex:Male
Location:
Vaccinated:2021-03-01
Onset:2021-03-04
Submitted:0000-00-00
Entered:2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 16B21A / 2 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death, Dyspnoea, Resuscitation, Peripheral swelling

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-30
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: 23     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness:
Preexisting Conditions: COPD and CHF
Allergies: NKA
Diagnostic Lab Data: unknown
CDC 'Split Type': 240924872

Write-up: Client has history of COPD and CHF. Three days after the 1st COVID Vaccine, client had some SOB and he called 911. When the ambulance arrived they had to do CPR on him and got him to the hospital and at the hospital they got him breathing on his own. From the ER they transferred him to Facility. He spent 23 days in the hospital and Rehab. He was told he could take the vaccine. He was out of the hospital for one week before his 2nd COVID Vaccine. His friend/neighbor is the historian and she states that since he was out of rehab that he was having a lot of extremity swelling. He then came to the Health Services on 03/29/2021for his 2nd COVID Vaccine. On 3/30/2021 at 5:45 pm, client went to Pharmacy to pick up his medications, and after 9 pm was found by friend deceased in his car at Pharmacy. This information was received from friend/neighbor, no local family available.


Changed on 5/7/2021

VAERS ID: 1156365 Before After
VAERS Form:2
Age:72.0
Sex:Male
Location:
Vaccinated:2021-03-01
Onset:2021-03-04
Submitted:0000-00-00
Entered:2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 16B21A / 2 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death, Dyspnoea, Resuscitation, Peripheral swelling

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-30
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: 23     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness:
Preexisting Conditions: COPD and CHF
Allergies: NKA NKA
Diagnostic Lab Data: unknown
CDC 'Split Type': 240924872

Write-up: Client has history of COPD and CHF. Three days after the 1st COVID Vaccine, client had some SOB and he called 911. When the ambulance arrived they had to do CPR on him and got him to the hospital and at the hospital they got him breathing on his own. From the ER they transferred him to Facility. He spent 23 days in the hospital and Rehab. He was told he could take the vaccine. He was out of the hospital for one week before his 2nd COVID Vaccine. His friend/neighbor is the historian and she states that since he was out of rehab that he was having a lot of extremity swelling. He then came to the Health Services on 03/29/2021for his 2nd COVID Vaccine. On 3/30/2021 at 5:45 pm, client went to Pharmacy to pick up his medications, and after 9 pm was found by friend deceased in his car at Pharmacy. This information was received from friend/neighbor, no local family available.


Changed on 5/14/2021

VAERS ID: 1156365 Before After
VAERS Form:2
Age:72.0
Sex:Male
Location:
Vaccinated:2021-03-01
Onset:2021-03-04
Submitted:0000-00-00
Entered:2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 16B21A / 2 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death, Dyspnoea, Resuscitation, Peripheral swelling

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-30
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: 23     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness:
Preexisting Conditions: COPD and CHF
Allergies: NKA NKA
Diagnostic Lab Data: unknown
CDC 'Split Type': 240924872

Write-up: Client has history of COPD and CHF. Three days after the 1st COVID Vaccine, client had some SOB and he called 911. When the ambulance arrived they had to do CPR on him and got him to the hospital and at the hospital they got him breathing on his own. From the ER they transferred him to Facility. He spent 23 days in the hospital and Rehab. He was told he could take the vaccine. He was out of the hospital for one week before his 2nd COVID Vaccine. His friend/neighbor is the historian and she states that since he was out of rehab that he was having a lot of extremity swelling. He then came to the Health Services on 03/29/2021for his 2nd COVID Vaccine. On 3/30/2021 at 5:45 pm, client went to Pharmacy to pick up his medications, and after 9 pm was found by friend deceased in his car at Pharmacy. This information was received from friend/neighbor, no local family available.

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