National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1229797

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1229797
VAERS Form:2
Age:72.0
Sex:Male
Location:Georgia
Vaccinated:2021-03-29
Onset:2021-04-04
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death, COVID-19

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-16
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: Had pneumonia in Feb 2021. Lives at a LTCF that developed an outbreak just after his first vaccination. Patient contracted COVID after his first Moderna vaccine and passed away on 4/16/2021.
Preexisting Conditions: sendss reports cardiovascular and renal disease
Allergies: unknown
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Paient was vaccinated on 3/29/2021 with dose 1 of Moderna. Patient developed COVID symptoms on 4/4/2021 and passed away on 4/16/2021.


Changed on 5/7/2021

VAERS ID: 1229797 Before After
VAERS Form:2
Age:72.0
Sex:Male
Location:Georgia
Vaccinated:2021-03-29
Onset:2021-04-04
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death, COVID-19

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-16
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: Had pneumonia in Feb 2021. Lives at a LTCF that developed an outbreak just after his first vaccination. Patient contracted COVID after his first Moderna vaccine and passed away on 4/16/2021.
Preexisting Conditions: sendss reports cardiovascular and renal disease
Allergies: unknown unknown
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Paient was vaccinated on 3/29/2021 with dose 1 of Moderna. Patient developed COVID symptoms on 4/4/2021 and passed away on 4/16/2021.


Changed on 5/14/2021

VAERS ID: 1229797 Before After
VAERS Form:2
Age:72.0
Sex:Male
Location:Georgia
Vaccinated:2021-03-29
Onset:2021-04-04
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 021B21A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death, COVID-19

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-16
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: Had pneumonia in Feb 2021. Lives at a LTCF that developed an outbreak just after his first vaccination. Patient contracted COVID after his first Moderna vaccine and passed away on 4/16/2021.
Preexisting Conditions: sendss reports cardiovascular and renal disease
Allergies: unknown unknown
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Paient was vaccinated on 3/29/2021 with dose 1 of Moderna. Patient developed COVID symptoms on 4/4/2021 and passed away on 4/16/2021.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1229797&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166