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This is VAERS ID 1231977

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1231977
VAERS Form:2
Age:96.0
Sex:Male
Location:Texas
Vaccinated:2021-04-20
Onset:2021-04-20
Submitted:0000-00-00
Entered:2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 2 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Dyspnoea, Electrocardiogram, Fall, Lethargy, Miosis, Nausea, Pallor, Unresponsive to stimuli, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
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: Plavix, warfarin, unknown others.
Current Illness: Patient denies
Preexisting Conditions: Prostate Cancer
Allergies: PCN
Diagnostic Lab Data: EKG by EMS 4/20/21
CDC 'Split Type':

Write-up: Lethargic, pale, glassy and pinpoint eyes to unresponsive, limp and falling to the right side. Client laid on ground due to unresponsiveness and unable to obtain vitals, client gasped when laid flat then reported nausea, rolled to side client started vomiting. EMS called, EKG ran, client refused services. Walked out of clinic.


Changed on 5/7/2021

VAERS ID: 1231977 Before After
VAERS Form:2
Age:96.0
Sex:Male
Location:Texas
Vaccinated:2021-04-20
Onset:2021-04-20
Submitted:0000-00-00
Entered:2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 2 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Dyspnoea, Electrocardiogram, Fall, Lethargy, Miosis, Nausea, Pallor, Unresponsive to stimuli, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
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: Plavix, warfarin, unknown others.
Current Illness: Patient denies
Preexisting Conditions: Prostate Cancer
Allergies: PCN PCN
Diagnostic Lab Data: EKG by EMS 4/20/21
CDC 'Split Type':

Write-up: Lethargic, pale, glassy and pinpoint eyes to unresponsive, limp and falling to the right side. Client laid on ground due to unresponsiveness and unable to obtain vitals, client gasped when laid flat then reported nausea, rolled to side client started vomiting. EMS called, EKG ran, client refused services. Walked out of clinic.


Changed on 5/14/2021

VAERS ID: 1231977 Before After
VAERS Form:2
Age:96.0
Sex:Male
Location:Texas
Vaccinated:2021-04-20
Onset:2021-04-20
Submitted:0000-00-00
Entered:2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 2 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Dyspnoea, Electrocardiogram, Fall, Lethargy, Miosis, Nausea, Pallor, Unresponsive to stimuli, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
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: Plavix, warfarin, unknown others.
Current Illness: Patient denies
Preexisting Conditions: Prostate Cancer
Allergies: PCN PCN
Diagnostic Lab Data: EKG by EMS 4/20/21
CDC 'Split Type':

Write-up: Lethargic, pale, glassy and pinpoint eyes to unresponsive, limp and falling to the right side. Client laid on ground due to unresponsiveness and unable to obtain vitals, client gasped when laid flat then reported nausea, rolled to side client started vomiting. EMS called, EKG ran, client refused services. Walked out of clinic.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1231977&WAYBACKHISTORY=ON


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