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This is VAERS ID 1271898

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1271898
VAERS Form:2
Age:52.0
Sex:Male
Location:Alabama
Vaccinated:2021-04-12
Onset:2021-04-15
Submitted:0000-00-00
Entered:2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Myocardial infarction, Unresponsive to stimuli

Life Threatening? No
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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prescriptions: oxymorphone 10mg, lyrica 150mg, metoprolol ER 100mg, Novolog 100units/ml, tresiba flextouch 200units/ml, metformin 1000mg, furosemide 40mg, spironolactone 100mg, famotidine 40mg, omeprazole 40mg, lactulose 10gram/15ml, trazod
Current Illness: NA
Preexisting Conditions: diabetes, hypertension, cirrhosis of liver, high cholesterol, sleep apnea
Allergies: No known Drug allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was found unresponsive on 4/15/2021. Patient seemed to pass in his sleep per family member. The coroner deemed myocardial infarction. No autopsy completed.


Changed on 5/7/2021

VAERS ID: 1271898 Before After
VAERS Form:2
Age:52.0
Sex:Male
Location:Alabama
Vaccinated:2021-04-12
Onset:2021-04-15
Submitted:0000-00-00
Entered:2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Myocardial infarction, Unresponsive to stimuli

Life Threatening? No
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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prescriptions: oxymorphone 10mg, lyrica 150mg, metoprolol ER 100mg, Novolog 100units/ml, tresiba flextouch 200units/ml, metformin 1000mg, furosemide 40mg, spironolactone 100mg, famotidine 40mg, omeprazole 40mg, lactulose 10gram/15ml, trazod
Current Illness: NA
Preexisting Conditions: diabetes, hypertension, cirrhosis of liver, high cholesterol, sleep apnea
Allergies: No known Drug allergies allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was found unresponsive on 4/15/2021. Patient seemed to pass in his sleep per family member. The coroner deemed myocardial infarction. No autopsy completed.


Changed on 5/14/2021

VAERS ID: 1271898 Before After
VAERS Form:2
Age:52.0
Sex:Male
Location:Alabama
Vaccinated:2021-04-12
Onset:2021-04-15
Submitted:0000-00-00
Entered:2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002B21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Myocardial infarction, Unresponsive to stimuli

Life Threatening? No
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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prescriptions: oxymorphone 10mg, lyrica 150mg, metoprolol ER 100mg, Novolog 100units/ml, tresiba flextouch 200units/ml, metformin 1000mg, furosemide 40mg, spironolactone 100mg, famotidine 40mg, omeprazole 40mg, lactulose 10gram/15ml, trazod
Current Illness: NA
Preexisting Conditions: diabetes, hypertension, cirrhosis of liver, high cholesterol, sleep apnea
Allergies: No known Drug allergies allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was found unresponsive on 4/15/2021. Patient seemed to pass in his sleep per family member. The coroner deemed myocardial infarction. No autopsy completed.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1271898&WAYBACKHISTORY=ON

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