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This is VAERS ID 1225566

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1225566
VAERS Form:2
Age:81.0
Sex:Male
Location:Wisconsin
Vaccinated:2021-02-11
Onset:2021-02-18
Submitted:0000-00-00
Entered:2021-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 38077727399 / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood pressure increased, Death, Hyperhidrosis, Pain, Tachypnoea

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2021-02-27
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: metoprolol succinate, apixaban, clopidogrel, sertraline, tamsulosin, finasteride, famotidine, senna, ducolax
Current Illness: paronychia, dental caries
Preexisting Conditions: fronto-temporal dementia with motor neuron disease, ischemic cardiomyopathy, benign prostatic hypertrophy
Allergies: quinolone antibiotics
Diagnostic Lab Data: None, due to hospice status. Received symptom management at home only.
CDC 'Split Type':

Write-up: William had a sudden change in status one week after receiving his first Moderna Covid 19 vaccine. He had sudden onset of tachypnea RR = 40/min, apparent severe pain, greatly elevated blood pressure, with normal heart rate (on beta blocker), diaphoresis. had been enrolled in hospice for 14 months prior to this episode, but had experienced only slow decline prior to this acute event. He died at home under hospice care on 2/27/2021.


Changed on 5/7/2021

VAERS ID: 1225566 Before After
VAERS Form:2
Age:81.0
Sex:Male
Location:Wisconsin
Vaccinated:2021-02-11
Onset:2021-02-18
Submitted:0000-00-00
Entered:2021-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 38077727399 / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood pressure increased, Death, Hyperhidrosis, Pain, Tachypnoea

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2021-02-27
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: metoprolol succinate, apixaban, clopidogrel, sertraline, tamsulosin, finasteride, famotidine, senna, ducolax
Current Illness: paronychia, dental caries
Preexisting Conditions: fronto-temporal dementia with motor neuron disease, ischemic cardiomyopathy, benign prostatic hypertrophy
Allergies: quinolone antibiotics antibiotics
Diagnostic Lab Data: None, due to hospice status. Received symptom management at home only.
CDC 'Split Type':

Write-up: William had a sudden change in status one week after receiving his first Moderna Covid 19 vaccine. He had sudden onset of tachypnea RR = 40/min, apparent severe pain, greatly elevated blood pressure, with normal heart rate (on beta blocker), diaphoresis. had been enrolled in hospice for 14 months prior to this episode, but had experienced only slow decline prior to this acute event. He died at home under hospice care on 2/27/2021.


Changed on 5/14/2021

VAERS ID: 1225566 Before After
VAERS Form:2
Age:81.0
Sex:Male
Location:Wisconsin
Vaccinated:2021-02-11
Onset:2021-02-18
Submitted:0000-00-00
Entered:2021-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 38077727399 / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Blood pressure increased, Death, Hyperhidrosis, Pain, Tachypnoea

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2021-02-27
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: metoprolol succinate, apixaban, clopidogrel, sertraline, tamsulosin, finasteride, famotidine, senna, ducolax
Current Illness: paronychia, dental caries
Preexisting Conditions: fronto-temporal dementia with motor neuron disease, ischemic cardiomyopathy, benign prostatic hypertrophy
Allergies: quinolone antibiotics antibiotics
Diagnostic Lab Data: None, due to hospice status. Received symptom management at home only.
CDC 'Split Type':

Write-up: William Patient had a sudden change in status one week after receiving his first Moderna Covid 19 vaccine. He had sudden onset of tachypnea RR = 40/min, apparent severe pain, greatly elevated blood pressure, with normal heart rate (on beta blocker), diaphoresis. had been enrolled in hospice for 14 months prior to this episode, but had experienced only slow decline prior to this acute event. He died at home under hospice care on 2/27/2021.

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