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This is VAERS ID 1178571

History of Changes from the VAERS Wayback Machine

First Appeared on 4/8/2021

VAERS ID: 1178571
VAERS Form:2
Age:58.0
Sex:Male
Location:Massachusetts
Vaccinated:2021-03-12
Onset:2021-04-02
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Scan myocardial perfusion normal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-02
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: Amlodipine, Gabapentin, Aspirin, Ramipril, Metoprolol, Atorvastatin
Current Illness: Gout, HTN, seizure disorder.
Preexisting Conditions: See above.
Allergies: Bee stings, NKDA.
Diagnostic Lab Data: Pt had had a cardiology visit 3/22. Ramipril rx was new. Perfusion test five months prior was negative for ischemia. Plan to see him back PRN basis.
CDC 'Split Type':

Write-up: Pt was found deceased at home, 4/2/2021.


Changed on 5/7/2021

VAERS ID: 1178571 Before After
VAERS Form:2
Age:58.0
Sex:Male
Location:Massachusetts
Vaccinated:2021-03-12
Onset:2021-04-02
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Scan myocardial perfusion normal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-02
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: Amlodipine, Gabapentin, Aspirin, Ramipril, Metoprolol, Atorvastatin
Current Illness: Gout, HTN, seizure disorder.
Preexisting Conditions: See above.
Allergies: Bee stings, NKDA. NKDA.
Diagnostic Lab Data: Pt had had a cardiology visit 3/22. Ramipril rx was new. Perfusion test five months prior was negative for ischemia. Plan to see him back PRN basis.
CDC 'Split Type':

Write-up: Pt was found deceased at home, 4/2/2021.


Changed on 5/14/2021

VAERS ID: 1178571 Before After
VAERS Form:2
Age:58.0
Sex:Male
Location:Massachusetts
Vaccinated:2021-03-12
Onset:2021-04-02
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Scan myocardial perfusion normal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-02
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: Amlodipine, Gabapentin, Aspirin, Ramipril, Metoprolol, Atorvastatin
Current Illness: Gout, HTN, seizure disorder.
Preexisting Conditions: See above.
Allergies: Bee stings, NKDA. NKDA.
Diagnostic Lab Data: Pt had had a cardiology visit 3/22. Ramipril rx was new. Perfusion test five months prior was negative for ischemia. Plan to see him back PRN basis.
CDC 'Split Type':

Write-up: Pt was found deceased at home, 4/2/2021.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1178571&WAYBACKHISTORY=ON

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