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This is VAERS ID 1228448

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1228448
VAERS Form:2
Age:67.0
Sex:Male
Location:Kentucky
Vaccinated:2021-04-08
Onset:2021-04-09
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Cardiac arrest, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-09
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: 1. CITALOPRAM 2. FLUTICASONE 3. MOMETASONE 4. LANSOPRAZOLE 5. NIACIN 6. EZETIMIBE 7. RANOLAZINE 8. ROSUVASTATIN 9. MONTELUKAST 10. LANTUS 11. REGULAR INSULIN 12. ELIQUIS 13. COREG 14. ENTRESTO 15. BRILINTA
Current Illness: Was admitted to hospital records 4/5 to 4/7 with c/o chest pain and GI bleed. Hgb was 6.7. Received 2 units of packed red clood cells.
Preexisting Conditions: History of COPD and Emphysema, type 2 diabetes, CKD stage 2, atrial fib, hypertension, CVA, and seizure disorder.
Allergies: NONE
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Received vaccine 04/08/2021. Was admitted to the hospital later in the day with cardiac arrest. Deceased 4/9/2021


Changed on 5/7/2021

VAERS ID: 1228448 Before After
VAERS Form:2
Age:67.0
Sex:Male
Location:Kentucky
Vaccinated:2021-04-08
Onset:2021-04-09
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Cardiac arrest, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-09
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: 1. CITALOPRAM 2. FLUTICASONE 3. MOMETASONE 4. LANSOPRAZOLE 5. NIACIN 6. EZETIMIBE 7. RANOLAZINE 8. ROSUVASTATIN 9. MONTELUKAST 10. LANTUS 11. REGULAR INSULIN 12. ELIQUIS 13. COREG 14. ENTRESTO 15. BRILINTA
Current Illness: Was admitted to hospital records 4/5 to 4/7 with c/o chest pain and GI bleed. Hgb was 6.7. Received 2 units of packed red clood cells.
Preexisting Conditions: History of COPD and Emphysema, type 2 diabetes, CKD stage 2, atrial fib, hypertension, CVA, and seizure disorder.
Allergies: NONE NONE
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Received vaccine 04/08/2021. Was admitted to the hospital later in the day with cardiac arrest. Deceased 4/9/2021


Changed on 5/14/2021

VAERS ID: 1228448 Before After
VAERS Form:2
Age:67.0
Sex:Male
Location:Kentucky
Vaccinated:2021-04-08
Onset:2021-04-09
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 2 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Cardiac arrest, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-09
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: 1. CITALOPRAM 2. FLUTICASONE 3. MOMETASONE 4. LANSOPRAZOLE 5. NIACIN 6. EZETIMIBE 7. RANOLAZINE 8. ROSUVASTATIN 9. MONTELUKAST 10. LANTUS 11. REGULAR INSULIN 12. ELIQUIS 13. COREG 14. ENTRESTO 15. BRILINTA
Current Illness: Was admitted to hospital records 4/5 to 4/7 with c/o chest pain and GI bleed. Hgb was 6.7. Received 2 units of packed red clood cells.
Preexisting Conditions: History of COPD and Emphysema, type 2 diabetes, CKD stage 2, atrial fib, hypertension, CVA, and seizure disorder.
Allergies: NONE NONE
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Received vaccine 04/08/2021. Was admitted to the hospital later in the day with cardiac arrest. Deceased 4/9/2021

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1228448&WAYBACKHISTORY=ON

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