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This is VAERS ID 1229390

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1229390
VAERS Form:2
Age:61.0
Sex:Male
Location:Nebraska
Vaccinated:2021-03-18
Onset:2021-04-18
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 1 - / -

Administered by: Private      Purchased by: ??
Symptoms: Blood lactic acid increased, Cardiac arrest, Death, Hypoxia, Pneumonia, Pneumonia aspiration, Sinus tachycardia, Supraventricular tachycardia, Unresponsive to stimuli, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-18
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: Levaquin, Lovenox, ertapenem, prednisone, pantoprazole, potassium chloride, magnesium oxide, montelukast
Current Illness: Was currently admitted in the hospital for pneumonia. Initial presentation was vomiting for 3-4 days prior. Had an episode of SVT vs sinus tachycardia on admit. Pt had elevated lactate on admission which had normalized to 0.6 on 04/13.
Preexisting Conditions:
Allergies: amoxicillin, naproxen, cefdinir, ketorolac, aspirin, celecoxib, sulfa abx, glucosamine
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt found unresponsive in hospital room with large amount of vomit. Patient pronounced dead shortly after with cause of death noted to be aspiration pneumonia with hypoxemia leading to cardiac arrest. Pt received vaccine 1 month prior so I wanted to report this.


Changed on 5/7/2021

VAERS ID: 1229390 Before After
VAERS Form:2
Age:61.0
Sex:Male
Location:Nebraska
Vaccinated:2021-03-18
Onset:2021-04-18
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 1 - / -

Administered by: Private      Purchased by: ??
Symptoms: Blood lactic acid increased, Cardiac arrest, Death, Hypoxia, Pneumonia, Pneumonia aspiration, Sinus tachycardia, Supraventricular tachycardia, Unresponsive to stimuli, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-18
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: Levaquin, Lovenox, ertapenem, prednisone, pantoprazole, potassium chloride, magnesium oxide, montelukast
Current Illness: Was currently admitted in the hospital for pneumonia. Initial presentation was vomiting for 3-4 days prior. Had an episode of SVT vs sinus tachycardia on admit. Pt had elevated lactate on admission which had normalized to 0.6 on 04/13.
Preexisting Conditions:
Allergies: amoxicillin, naproxen, cefdinir, ketorolac, aspirin, celecoxib, sulfa abx, glucosamine glucosamine
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt found unresponsive in hospital room with large amount of vomit. Patient pronounced dead shortly after with cause of death noted to be aspiration pneumonia with hypoxemia leading to cardiac arrest. Pt received vaccine 1 month prior so I wanted to report this.


Changed on 5/14/2021

VAERS ID: 1229390 Before After
VAERS Form:2
Age:61.0
Sex:Male
Location:Nebraska
Vaccinated:2021-03-18
Onset:2021-04-18
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 1 - / -

Administered by: Private      Purchased by: ??
Symptoms: Blood lactic acid increased, Cardiac arrest, Death, Hypoxia, Pneumonia, Pneumonia aspiration, Sinus tachycardia, Supraventricular tachycardia, Unresponsive to stimuli, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-18
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: Levaquin, Lovenox, ertapenem, prednisone, pantoprazole, potassium chloride, magnesium oxide, montelukast
Current Illness: Was currently admitted in the hospital for pneumonia. Initial presentation was vomiting for 3-4 days prior. Had an episode of SVT vs sinus tachycardia on admit. Pt had elevated lactate on admission which had normalized to 0.6 on 04/13.
Preexisting Conditions:
Allergies: amoxicillin, naproxen, cefdinir, ketorolac, aspirin, celecoxib, sulfa abx, glucosamine glucosamine
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt found unresponsive in hospital room with large amount of vomit. Patient pronounced dead shortly after with cause of death noted to be aspiration pneumonia with hypoxemia leading to cardiac arrest. Pt received vaccine 1 month prior so I wanted to report this.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1229390&WAYBACKHISTORY=ON

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