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This is VAERS ID 1222901

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1222901
VAERS Form:2
Age:90.0
Sex:Male
Location:New York
Vaccinated:2021-03-18
Onset:2021-03-18
Submitted:0000-00-00
Entered:2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Dyspnoea, Injection site pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-19
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: Crestor, Levoxyl, Isosorbide mononitrate, Finasteride, Calcitriol, Aspirin, Alfuzosin, Aranesp, Carvidilol, Eliquis, Breo Ellipta
Current Illness: Coronary artery disease, End Stage Renal Disease, COPD
Preexisting Conditions: see above # 11
Allergies: None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had started peritoneal dialysis at home with me, his wife, 8 days before the second shot. All was going well. We got his second shot on the morig of March 18. His only reaction seemed to be soreness at injection site. At 11 pm we started dialysis as usual, with the cycler. At 12 pm he was having trouble breathing after just having been filled with 1500 ml of dialysate. This was the first time this happened. I gave hi nitro glycerine and had the cycler take out the 1500 ml of dialysate, and stopped the therapy for the night. He then felt better, and apologized for waking me up. In the morning he was dead. I believe it is possible that the vaccine tipped the balance of patients already taxed system. As I know that people who have serious diseases and are older are encouraged to take the vaccine, this outcome should be known to the CDC.


Changed on 5/7/2021

VAERS ID: 1222901 Before After
VAERS Form:2
Age:90.0
Sex:Male
Location:New York
Vaccinated:2021-03-18
Onset:2021-03-18
Submitted:0000-00-00
Entered:2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Dyspnoea, Injection site pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-19
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: Crestor, Levoxyl, Isosorbide mononitrate, Finasteride, Calcitriol, Aspirin, Alfuzosin, Aranesp, Carvidilol, Eliquis, Breo Ellipta
Current Illness: Coronary artery disease, End Stage Renal Disease, COPD
Preexisting Conditions: see above # 11
Allergies: None None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had started peritoneal dialysis at home with me, his wife, 8 days before the second shot. All was going well. We got his second shot on the morig of March 18. His only reaction seemed to be soreness at injection site. At 11 pm we started dialysis as usual, with the cycler. At 12 pm he was having trouble breathing after just having been filled with 1500 ml of dialysate. This was the first time this happened. I gave hi nitro glycerine and had the cycler take out the 1500 ml of dialysate, and stopped the therapy for the night. He then felt better, and apologized for waking me up. In the morning he was dead. I believe it is possible that the vaccine tipped the balance of patients already taxed system. As I know that people who have serious diseases and are older are encouraged to take the vaccine, this outcome should be known to the CDC.


Changed on 5/14/2021

VAERS ID: 1222901 Before After
VAERS Form:2
Age:90.0
Sex:Male
Location:New York
Vaccinated:2021-03-18
Onset:2021-03-18
Submitted:0000-00-00
Entered:2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Dyspnoea, Injection site pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-19
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: Crestor, Levoxyl, Isosorbide mononitrate, Finasteride, Calcitriol, Aspirin, Alfuzosin, Aranesp, Carvidilol, Eliquis, Breo Ellipta
Current Illness: Coronary artery disease, End Stage Renal Disease, COPD
Preexisting Conditions: see above # 11
Allergies: None None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had started peritoneal dialysis at home with me, his wife, 8 days before the second shot. All was going well. We got his second shot on the morig of March 18. His only reaction seemed to be soreness at injection site. At 11 pm we started dialysis as usual, with the cycler. At 12 pm he was having trouble breathing after just having been filled with 1500 ml of dialysate. This was the first time this happened. I gave hi nitro glycerine and had the cycler take out the 1500 ml of dialysate, and stopped the therapy for the night. He then felt better, and apologized for waking me up. In the morning he was dead. I believe it is possible that the vaccine tipped the balance of patients already taxed system. As I know that people who have serious diseases and are older are encouraged to take the vaccine, this outcome should be known to the CDC.

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