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This is VAERS ID 1238316

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1238316
VAERS Form:2
Age:85.0
Sex:Male
Location:Puerto Rico
Vaccinated:2021-01-12
Onset:2021-02-28
Submitted:0000-00-00
Entered:2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037KZOA / 1 UN / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Fall, Decreased appetite, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-28
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: Furosemide, Dipyramid, Losartan, Simvastatin.
Current Illness: Unknown.
Preexisting Conditions: Dementia, Cholesterol, Depression, Osteoarthritis.
Allergies: Unknown.
Diagnostic Lab Data: COVID-19 PCR test result negative.
CDC 'Split Type':

Write-up: Suffered a fall, stopped eating, on February 28, 2021 was found without vital signs.


Changed on 5/7/2021

VAERS ID: 1238316 Before After
VAERS Form:2
Age:85.0
Sex:Male
Location:Puerto Rico
Vaccinated:2021-01-12
Onset:2021-02-28
Submitted:0000-00-00
Entered:2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037KZOA / 1 UN / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Fall, Decreased appetite, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-28
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: Furosemide, Dipyramid, Losartan, Simvastatin.
Current Illness: Unknown.
Preexisting Conditions: Dementia, Cholesterol, Depression, Osteoarthritis.
Allergies: Unknown. Unknown.
Diagnostic Lab Data: COVID-19 PCR test result negative.
CDC 'Split Type':

Write-up: Suffered a fall, stopped eating, on February 28, 2021 was found without vital signs.


Changed on 5/14/2021

VAERS ID: 1238316 Before After
VAERS Form:2
Age:85.0
Sex:Male
Location:Puerto Rico
Vaccinated:2021-01-12
Onset:2021-02-28
Submitted:0000-00-00
Entered:2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037KZOA / 1 UN / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Fall, Decreased appetite, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-28
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: Furosemide, Dipyramid, Losartan, Simvastatin.
Current Illness: Unknown.
Preexisting Conditions: Dementia, Cholesterol, Depression, Osteoarthritis.
Allergies: Unknown. Unknown.
Diagnostic Lab Data: COVID-19 PCR test result negative.
CDC 'Split Type':

Write-up: Suffered a fall, stopped eating, on February 28, 2021 was found without vital signs.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1238316&WAYBACKHISTORY=ON


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