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This is VAERS ID 1231694

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1231694
VAERS Form:2
Age:71.0
Sex:Male
Location:Florida
Vaccinated:2021-01-20
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Death, Myocardial infarction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-11
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: Multivitamin, Vitamin D, vitamin C, Vitamin B12
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Extensive testing/procedures were performed too numerous to list.
CDC 'Split Type':

Write-up: suffered a massive heart attack the morning following his first dose of Moderna vaccine. He was hospitalized for 21 days, first at Hospital and then . He passed away on February 11, 2021, at .


Changed on 5/7/2021

VAERS ID: 1231694 Before After
VAERS Form:2
Age:71.0
Sex:Male
Location:Florida
Vaccinated:2021-01-20
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Death, Myocardial infarction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-11
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: Multivitamin, Vitamin D, vitamin C, Vitamin B12
Current Illness: None
Preexisting Conditions: None
Allergies: None None
Diagnostic Lab Data: Extensive testing/procedures were performed too numerous to list.
CDC 'Split Type':

Write-up: suffered a massive heart attack the morning following his first dose of Moderna vaccine. He was hospitalized for 21 days, first at Hospital and then . He passed away on February 11, 2021, at .


Changed on 5/14/2021

VAERS ID: 1231694 Before After
VAERS Form:2
Age:71.0
Sex:Male
Location:Florida
Vaccinated:2021-01-20
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Death, Myocardial infarction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-11
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: Multivitamin, Vitamin D, vitamin C, Vitamin B12
Current Illness: None
Preexisting Conditions: None
Allergies: None None
Diagnostic Lab Data: Extensive testing/procedures were performed too numerous to list.
CDC 'Split Type':

Write-up: suffered a massive heart attack the morning following his first dose of Moderna vaccine. He was hospitalized for 21 days, first at Hospital and then . He passed away on February 11, 2021, at .

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1231694&WAYBACKHISTORY=ON

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