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This is VAERS ID 1176010

History of Changes from the VAERS Wayback Machine

First Appeared on 4/8/2021

VAERS ID: 1176010
VAERS Form:2
Age:36.0
Sex:Male
Location:New York
Vaccinated:2021-03-10
Onset:2021-03-18
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Abdominal pain upper, Death, Haematemesis, Pain in extremity, Autopsy, Internal haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-21
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: Two different insulin''s.
Current Illness: None.
Preexisting Conditions: Diabetes, type I.
Allergies: None.
Diagnostic Lab Data: None.
CDC 'Split Type':

Write-up: He got his vaccine, and mother had talked to his girlfriend said that he felt fine other than a sore arm. He called his mother and told her that he was sick to his stomach with cramps and that he was throwing up blood. The girlfriend found him on the floor on the 21st dead on the floor in his hotel room at 8:00 AM. The girlfriend said she had spoken with him around 10:00 PM and that he said he was going to sleep on the floor in the bathroom as he was throwing up and the floor was cool. She subsequently found out that he was throwing up blood, and autopsy report showed that his stomach was full of blood and further testing is being done to see what has caused the bleeding.


Changed on 5/7/2021

VAERS ID: 1176010 Before After
VAERS Form:2
Age:36.0
Sex:Male
Location:New York
Vaccinated:2021-03-10
Onset:2021-03-18
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Abdominal pain upper, Death, Haematemesis, Pain in extremity, Autopsy, Internal haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-21
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: Two different insulin''s.
Current Illness: None.
Preexisting Conditions: Diabetes, type I.
Allergies: None. None.
Diagnostic Lab Data: None.
CDC 'Split Type':

Write-up: He got his vaccine, and mother had talked to his girlfriend said that he felt fine other than a sore arm. He called his mother and told her that he was sick to his stomach with cramps and that he was throwing up blood. The girlfriend found him on the floor on the 21st dead on the floor in his hotel room at 8:00 AM. The girlfriend said she had spoken with him around 10:00 PM and that he said he was going to sleep on the floor in the bathroom as he was throwing up and the floor was cool. She subsequently found out that he was throwing up blood, and autopsy report showed that his stomach was full of blood and further testing is being done to see what has caused the bleeding.


Changed on 5/14/2021

VAERS ID: 1176010 Before After
VAERS Form:2
Age:36.0
Sex:Male
Location:New York
Vaccinated:2021-03-10
Onset:2021-03-18
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032M20A / 2 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Abdominal pain upper, Death, Haematemesis, Pain in extremity, Autopsy, Internal haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-21
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: Two different insulin''s.
Current Illness: None.
Preexisting Conditions: Diabetes, type I.
Allergies: None. None.
Diagnostic Lab Data: None.
CDC 'Split Type':

Write-up: He got his vaccine, and mother had talked to his girlfriend said that he felt fine other than a sore arm. He called his mother and told her that he was sick to his stomach with cramps and that he was throwing up blood. The girlfriend found him on the floor on the 21st dead on the floor in his hotel room at 8:00 AM. The girlfriend said she had spoken with him around 10:00 PM and that he said he was going to sleep on the floor in the bathroom as he was throwing up and the floor was cool. She subsequently found out that he was throwing up blood, and autopsy report showed that his stomach was full of blood and further testing is being done to see what has caused the bleeding.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1176010&WAYBACKHISTORY=ON

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