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This is VAERS ID 1244990

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1244990
VAERS Form:2
Age:38.0
Sex:Male
Location:Arizona
Vaccinated:2021-03-19
Onset:2021-03-19
Submitted:0000-00-00
Entered:2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Catheterisation cardiac abnormal, Chest pain, Death, Injection site pain, Myocardial infarction, Laboratory test, Echocardiogram abnormal

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2021-04-15
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: He had lab work, cardiac cath and an echo
CDC 'Split Type':

Write-up: After receiving the second dose of the vaccine, my husband experienced left arm pain which he thought was from the injection. About a week later, the pain got worse and moved toward his chest. It got so bad, he had to be taken by ambulance to the hospital to find out he had been having a heart attack. He spent nearly three weeks in the hospital before he died on 4/15/21


Changed on 5/7/2021

VAERS ID: 1244990 Before After
VAERS Form:2
Age:38.0
Sex:Male
Location:Arizona
Vaccinated:2021-03-19
Onset:2021-03-19
Submitted:0000-00-00
Entered:2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Catheterisation cardiac abnormal, Chest pain, Death, Injection site pain, Myocardial infarction, Laboratory test, Echocardiogram abnormal

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2021-04-15
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None None
Diagnostic Lab Data: He had lab work, cardiac cath and an echo
CDC 'Split Type':

Write-up: After receiving the second dose of the vaccine, my husband experienced left arm pain which he thought was from the injection. About a week later, the pain got worse and moved toward his chest. It got so bad, he had to be taken by ambulance to the hospital to find out he had been having a heart attack. He spent nearly three weeks in the hospital before he died on 4/15/21


Changed on 5/14/2021

VAERS ID: 1244990 Before After
VAERS Form:2
Age:38.0
Sex:Male
Location:Arizona
Vaccinated:2021-03-19
Onset:2021-03-19
Submitted:0000-00-00
Entered:2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Catheterisation cardiac abnormal, Chest pain, Death, Injection site pain, Myocardial infarction, Laboratory test, Echocardiogram abnormal

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2021-04-15
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None None
Diagnostic Lab Data: He had lab work, cardiac cath and an echo
CDC 'Split Type':

Write-up: After receiving the second dose of the vaccine, my husband experienced left arm pain which he thought was from the injection. About a week later, the pain got worse and moved toward his chest. It got so bad, he had to be taken by ambulance to the hospital to find out he had been having a heart attack. He spent nearly three weeks in the hospital before he died on 4/15/21

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1244990&WAYBACKHISTORY=ON


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