| Days after vaccination:||6
|Vaccination / Manufacturer
||Lot / Dose
||Site / Route|
|COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA
||- / 1
||- / -
Administered by: Other Purchased by: ?
Symptoms: Cardiac failure congestive,
SMQs:, Cardiac failure (narrow), Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow)
Life Threatening? No
Birth Defect? No
Date died: 2021-03-11
Days after onset: 0
Permanent Disability? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Other Medications: My Father had heart and lung issues and was 96. He was doing well until getting vaccine. He died 5 days after receiving covid vaccine.
Current Illness: had heart and lung issues for many years but was stable on his medications and routine
Preexisting Conditions: Heart and Lung
Diagnostic Lab Data:
CDC Split Type:
Write-up: a few days after his congestive heart failure got worse and continued on a down ward spiral. He refused to go to hospital and last few days hospice was brought in. He died not being able to breath. Autopsy was not done.