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This is VAERS ID 1242160

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1242160
VAERS Form:2
Age:78.0
Sex:Male
Location:New York
Vaccinated:2021-04-01
Onset:2021-04-01
Submitted:0000-00-00
Entered:2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Senior Living      Purchased by: ??
Symptoms: Cardio-respiratory arrest, Death, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-01
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:
Current Illness: AICD ,FAILURE TO THRIVE ,AFIB ,SEVERE CARDIOMYOPATHY DEMENTIA
Preexisting Conditions: AICD ,FAILURE TO THRIVE ,AFIB ,SEVERE CARDIOMYOPATHY DEMENTIA
Allergies:
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: CALLED TO TRANSFER PATIENT FROM 2C ADMITTING AREA TO ENDOSCOPY UNIT AROUND 1410. UPON ARRIVAL IN 2C TO TRANSFER PATIENT, PATIENT WAS ALERT AND RESPONSIVE TO NAME. WHEN WHEELED TO BEDSIDE IN ENDOSCOPY UNIT PATIENTS RIGHT ARM SLUMPED AND HE BECAME UNRESPONSIVE. RAPID RESPONSE CALLED. PATIENT TRANSFERRED TO STRETCHER, CODE BLUE CALLED, AND CPR STARTED. DR. ANESTHESIA AT BEDSIDE MANAGING AIRWAY. CODE TEAM RESPONDED. REFER TO ARREST RECORD.


Changed on 5/7/2021

VAERS ID: 1242160 Before After
VAERS Form:2
Age:78.0
Sex:Male
Location:New York
Vaccinated:2021-04-01
Onset:2021-04-01
Submitted:0000-00-00
Entered:2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Senior Living      Purchased by: ??
Symptoms: Cardio-respiratory arrest, Death, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-01
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:
Current Illness: AICD ,FAILURE TO THRIVE ,AFIB ,SEVERE CARDIOMYOPATHY DEMENTIA
Preexisting Conditions: AICD ,FAILURE TO THRIVE ,AFIB ,SEVERE CARDIOMYOPATHY DEMENTIA
Allergies:
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: CALLED TO TRANSFER PATIENT FROM 2C ADMITTING AREA TO ENDOSCOPY UNIT AROUND 1410. UPON ARRIVAL IN 2C TO TRANSFER PATIENT, PATIENT WAS ALERT AND RESPONSIVE TO NAME. WHEN WHEELED TO BEDSIDE IN ENDOSCOPY UNIT PATIENTS RIGHT ARM SLUMPED AND HE BECAME UNRESPONSIVE. RAPID RESPONSE CALLED. PATIENT TRANSFERRED TO STRETCHER, CODE BLUE CALLED, AND CPR STARTED. DR. ANESTHESIA AT BEDSIDE MANAGING AIRWAY. CODE TEAM RESPONDED. REFER TO ARREST RECORD.


Changed on 5/14/2021

VAERS ID: 1242160 Before After
VAERS Form:2
Age:78.0
Sex:Male
Location:New York
Vaccinated:2021-04-01
Onset:2021-04-01
Submitted:0000-00-00
Entered:2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Senior Living      Purchased by: ??
Symptoms: Cardio-respiratory arrest, Death, Resuscitation, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-01
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:
Current Illness: AICD ,FAILURE TO THRIVE ,AFIB ,SEVERE CARDIOMYOPATHY DEMENTIA
Preexisting Conditions: AICD ,FAILURE TO THRIVE ,AFIB ,SEVERE CARDIOMYOPATHY DEMENTIA
Allergies:
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: CALLED TO TRANSFER PATIENT FROM 2C ADMITTING AREA TO ENDOSCOPY UNIT AROUND 1410. UPON ARRIVAL IN 2C TO TRANSFER PATIENT, PATIENT WAS ALERT AND RESPONSIVE TO NAME. WHEN WHEELED TO BEDSIDE IN ENDOSCOPY UNIT PATIENTS RIGHT ARM SLUMPED AND HE BECAME UNRESPONSIVE. RAPID RESPONSE CALLED. PATIENT TRANSFERRED TO STRETCHER, CODE BLUE CALLED, AND CPR STARTED. DR. ANESTHESIA AT BEDSIDE MANAGING AIRWAY. CODE TEAM RESPONDED. REFER TO ARREST RECORD.

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