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This is VAERS ID 1172648

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1172648
VAERS Form:2
Age:47.0
Sex:Male
Location:California
Vaccinated:2021-03-16
Onset:2021-03-23
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Cardiac arrest, Cardio-respiratory arrest, Death, Fibrin D dimer increased, Life support, Chest tube insertion, Pulseless electrical activity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-23
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? No
Previous Vaccinations:
Other Medications: unk
Current Illness: no
Preexisting Conditions: NIDDM, HTN, CKD, obesity, lymphedema, chronic non pressure ulcer
Allergies: Erythromycin
Diagnostic Lab Data: DDimer 55, 000 thouand
CDC 'Split Type':

Write-up: Cardiopulmonary arrest, D-Dimer 55,000, TNKase administered, ACLS, needle thoracostomy, persistent PEA arrest, decompensated into asystole , pronounced


Changed on 5/7/2021

VAERS ID: 1172648 Before After
VAERS Form:2
Age:47.0
Sex:Male
Location:California
Vaccinated:2021-03-16
Onset:2021-03-23
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Cardiac arrest, Cardio-respiratory arrest, Death, Fibrin D dimer increased, Life support, Chest tube insertion, Pulseless electrical activity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-23
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? No
Previous Vaccinations:
Other Medications: unk
Current Illness: no
Preexisting Conditions: NIDDM, HTN, CKD, obesity, lymphedema, chronic non pressure ulcer
Allergies: Erythromycin Erythromycin
Diagnostic Lab Data: DDimer 55, 000 thouand
CDC 'Split Type':

Write-up: Cardiopulmonary arrest, D-Dimer 55,000, TNKase administered, ACLS, needle thoracostomy, persistent PEA arrest, decompensated into asystole , pronounced


Changed on 5/14/2021

VAERS ID: 1172648 Before After
VAERS Form:2
Age:47.0
Sex:Male
Location:California
Vaccinated:2021-03-16
Onset:2021-03-23
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Cardiac arrest, Cardio-respiratory arrest, Death, Fibrin D dimer increased, Life support, Chest tube insertion, Pulseless electrical activity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-23
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? No
Previous Vaccinations:
Other Medications: unk
Current Illness: no
Preexisting Conditions: NIDDM, HTN, CKD, obesity, lymphedema, chronic non pressure ulcer
Allergies: Erythromycin Erythromycin
Diagnostic Lab Data: DDimer 55, 000 thouand
CDC 'Split Type':

Write-up: Cardiopulmonary arrest, D-Dimer 55,000, TNKase administered, ACLS, needle thoracostomy, persistent PEA arrest, decompensated into asystole , pronounced

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1172648&WAYBACKHISTORY=ON

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