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This is VAERS ID 1273804

History of Changes from the VAERS Wayback Machine

First Appeared on 5/7/2021

VAERS ID: 1273804
VAERS Form:2
Age:68.0
Sex:Unknown
Location:Michigan
Vaccinated:2021-03-31
Onset:2021-04-10
Submitted:0000-00-00
Entered:2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / 2 - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Death, Gastrointestinal haemorrhage, Respiratory failure, COVID-19

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-29
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: Cardizem Norco Neurontin banophen Plavix
Current Illness: None known
Preexisting Conditions: HTN S/P Heart Transplant Hyperparathyroidism Reflux End stage renal disease
Allergies: Aspirin Atrorvastatin Crestor Haldol Haloperidol Lipitor Lisinopril Oxycodone Aldactone Hydralazine
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: GI Hemorrhage Covid + Respiratory Failure


Changed on 5/14/2021

VAERS ID: 1273804 Before After
VAERS Form:2
Age:68.0
Sex:Unknown
Location:Michigan
Vaccinated:2021-03-31
Onset:2021-04-10
Submitted:0000-00-00
Entered:2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / 2 - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Death, Gastrointestinal haemorrhage, Respiratory failure, COVID-19

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-29
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: Cardizem Norco Neurontin banophen Plavix
Current Illness: None known
Preexisting Conditions: HTN S/P Heart Transplant Hyperparathyroidism Reflux End stage renal disease
Allergies: Aspirin Atrorvastatin Crestor Haldol Haloperidol Lipitor Lisinopril Oxycodone Aldactone Hydralazine Hydralazine
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: GI Hemorrhage Covid + Respiratory Failure

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1273804&WAYBACKHISTORY=ON

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