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This is VAERS ID 1176374

History of Changes from the VAERS Wayback Machine

First Appeared on 4/8/2021

VAERS ID: 1176374
VAERS Form:2
Age:58.0
Sex:Male
Location:Hawaii
Vaccinated:2021-02-24
Onset:2021-03-04
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Military      Purchased by: ??
Symptoms: Cardiac arrest, Death, Dyspnoea, Fatigue, Heart rate increased, Lethargy, Oxygen saturation decreased, Pain in extremity, Pulmonary oedema, Pyrexia, Respiratory failure, Transfusion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-12
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vancomycin, ertapenum, voriconazole, acyclovir, omeprazole
Current Illness: MDS, CIDP, hemochromatosis, pancytopenia, chronic Thrombocytop
Preexisting Conditions: NDS, CIDP, pancytopenia, thrombocytopenia, hemochromatosis
Allergies: Tomatoes
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: sore arm, lethargy, chronic fatigue, fever, fluid on lungs, lack of oxygen, death Husband received first dose of MODERNA vaccine on 1/30/21. Mild side effects. Received second dose on 2/24/21. For the first week after the second dose, the side effects seemed normal. By the second week he was gasping for air. Rused to ER via ambulance on 3/9/21. High heart rate, poor oxygen. Received numerous blood transfusions over 3-days (typical treatment for his blood disorder), yet body would not retain the transfused products. Died on 3/12/21 at 4:35 am from cardia arrest caused by respiratory failure.


Changed on 5/7/2021

VAERS ID: 1176374 Before After
VAERS Form:2
Age:58.0
Sex:Male
Location:Hawaii
Vaccinated:2021-02-24
Onset:2021-03-04
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Military      Purchased by: ??
Symptoms: Cardiac arrest, Death, Dyspnoea, Fatigue, Heart rate increased, Lethargy, Oxygen saturation decreased, Pain in extremity, Pulmonary oedema, Pyrexia, Respiratory failure, Transfusion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-12
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vancomycin, ertapenum, voriconazole, acyclovir, omeprazole
Current Illness: MDS, CIDP, hemochromatosis, pancytopenia, chronic Thrombocytop
Preexisting Conditions: NDS, CIDP, pancytopenia, thrombocytopenia, hemochromatosis
Allergies: Tomatoes Tomatoes
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: sore arm, lethargy, chronic fatigue, fever, fluid on lungs, lack of oxygen, death Husband received first dose of MODERNA vaccine on 1/30/21. Mild side effects. Received second dose on 2/24/21. For the first week after the second dose, the side effects seemed normal. By the second week he was gasping for air. Rused to ER via ambulance on 3/9/21. High heart rate, poor oxygen. Received numerous blood transfusions over 3-days (typical treatment for his blood disorder), yet body would not retain the transfused products. Died on 3/12/21 at 4:35 am from cardia arrest caused by respiratory failure.


Changed on 5/14/2021

VAERS ID: 1176374 Before After
VAERS Form:2
Age:58.0
Sex:Male
Location:Hawaii
Vaccinated:2021-02-24
Onset:2021-03-04
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Military      Purchased by: ??
Symptoms: Cardiac arrest, Death, Dyspnoea, Fatigue, Heart rate increased, Lethargy, Oxygen saturation decreased, Pain in extremity, Pulmonary oedema, Pyrexia, Respiratory failure, Transfusion

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-12
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Vancomycin, ertapenum, voriconazole, acyclovir, omeprazole
Current Illness: MDS, CIDP, hemochromatosis, pancytopenia, chronic Thrombocytop
Preexisting Conditions: NDS, CIDP, pancytopenia, thrombocytopenia, hemochromatosis
Allergies: Tomatoes Tomatoes
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: sore arm, lethargy, chronic fatigue, fever, fluid on lungs, lack of oxygen, death Husband received first dose of MODERNA vaccine on 1/30/21. Mild side effects. Received second dose on 2/24/21. For the first week after the second dose, the side effects seemed normal. By the second week he was gasping for air. Rused to ER via ambulance on 3/9/21. High heart rate, poor oxygen. Received numerous blood transfusions over 3-days (typical treatment for his blood disorder), yet body would not retain the transfused products. Died on 3/12/21 at 4:35 am from cardia arrest caused by respiratory failure.

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