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This is VAERS ID 1229917

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1229917
VAERS Form:2
Age:69.0
Sex:Male
Location:California
Vaccinated:2021-03-25
Onset:2021-04-02
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 AR / IM

Administered by: Private      Purchased by: ??
Symptoms: Body temperature decreased, Cardiac arrest, Chest X-ray abnormal, Death, Lung infiltration, Myocardial infarction, Pneumonia, Resuscitation, General physical health deterioration, Coronary arterial stent insertion, Troponin increased, Mechanical ventilation, Endotracheal intubation, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-06
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: aripiprazole 400mg IMQ4 weeks (last dose 3/24/21), cholecalciferol 25mcg daily, fluphenazine 5mg daily
Current Illness:
Preexisting Conditions: elevated prostate specific antigen of 4.18 on admission (9/10/19) vitamin D deficiency elevated BMI of 26.5 schozophrenia anxiety disorder alcohol use disorder, severe, in institutional remission ex-smoker, patient unable to detail per admission history and physical
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 4/3/21 at 0052 during Q15 rounds the patient was found laying awake on the floor next to his bed. He denied falling. Vitals showed BP 95/57, Temp 96, O2 sat 77%. He was evaluated and transferred to an acute care hospital with cardiac specialty. He was found to have elevated triponin and chest x-ray showed lung infiltrates; COVID test was negative. Diagnosis was MI and pnuemonia. He received a right coronary artery stent. The patient was intubated on full ventilation support. On 4/4/21 the patient went into cardiac arrest 3 times and was resuscitated. On 4/5/21 his condition declined and he went into cardiac arrest again and was resuscitated around noon. The patient died in acute care on 4/7/21 at 0608.


Changed on 5/7/2021

VAERS ID: 1229917 Before After
VAERS Form:2
Age:69.0
Sex:Male
Location:California
Vaccinated:2021-03-25
Onset:2021-04-02
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 AR / IM

Administered by: Private      Purchased by: ??
Symptoms: Body temperature decreased, Cardiac arrest, Chest X-ray abnormal, Death, Lung infiltration, Myocardial infarction, Pneumonia, Resuscitation, General physical health deterioration, Coronary arterial stent insertion, Troponin increased, Mechanical ventilation, Endotracheal intubation, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-06
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: aripiprazole 400mg IMQ4 weeks (last dose 3/24/21), cholecalciferol 25mcg daily, fluphenazine 5mg daily
Current Illness:
Preexisting Conditions: elevated prostate specific antigen of 4.18 on admission (9/10/19) vitamin D deficiency elevated BMI of 26.5 schozophrenia anxiety disorder alcohol use disorder, severe, in institutional remission ex-smoker, patient unable to detail per admission history and physical
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 4/3/21 at 0052 during Q15 rounds the patient was found laying awake on the floor next to his bed. He denied falling. Vitals showed BP 95/57, Temp 96, O2 sat 77%. He was evaluated and transferred to an acute care hospital with cardiac specialty. He was found to have elevated triponin and chest x-ray showed lung infiltrates; COVID test was negative. Diagnosis was MI and pnuemonia. He received a right coronary artery stent. The patient was intubated on full ventilation support. On 4/4/21 the patient went into cardiac arrest 3 times and was resuscitated. On 4/5/21 his condition declined and he went into cardiac arrest again and was resuscitated around noon. The patient died in acute care on 4/7/21 at 0608.


Changed on 5/14/2021

VAERS ID: 1229917 Before After
VAERS Form:2
Age:69.0
Sex:Male
Location:California
Vaccinated:2021-03-25
Onset:2021-04-02
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 AR / IM

Administered by: Private      Purchased by: ??
Symptoms: Body temperature decreased, Cardiac arrest, Chest X-ray abnormal, Death, Lung infiltration, Myocardial infarction, Pneumonia, Resuscitation, General physical health deterioration, Coronary arterial stent insertion, Troponin increased, Mechanical ventilation, Endotracheal intubation, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-06
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: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: aripiprazole 400mg IMQ4 weeks (last dose 3/24/21), cholecalciferol 25mcg daily, fluphenazine 5mg daily
Current Illness:
Preexisting Conditions: elevated prostate specific antigen of 4.18 on admission (9/10/19) vitamin D deficiency elevated BMI of 26.5 schozophrenia anxiety disorder alcohol use disorder, severe, in institutional remission ex-smoker, patient unable to detail per admission history and physical
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 4/3/21 at 0052 during Q15 rounds the patient was found laying awake on the floor next to his bed. He denied falling. Vitals showed BP 95/57, Temp 96, O2 sat 77%. He was evaluated and transferred to an acute care hospital with cardiac specialty. He was found to have elevated triponin and chest x-ray showed lung infiltrates; COVID test was negative. Diagnosis was MI and pnuemonia. He received a right coronary artery stent. The patient was intubated on full ventilation support. On 4/4/21 the patient went into cardiac arrest 3 times and was resuscitated. On 4/5/21 his condition declined and he went into cardiac arrest again and was resuscitated around noon. The patient died in acute care on 4/7/21 at 0608.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1229917&WAYBACKHISTORY=ON

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