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This is VAERS ID 1339062

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1339062
VAERS Form:2
Age:85.0
Sex:Male
Location:South Carolina
Vaccinated:2021-04-15
Onset:2021-05-04
Submitted:0000-00-00
Entered:2021-05-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Computerised tomogram, Death, Electrocardiogram, Pneumonia, Sepsis, Inflammation, Blood test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-17
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: Insulin, Aricept, KLONopin, Trazodone, Zoloft, Depakote, Hytrin
Current Illness:
Preexisting Conditions: Diabetes, dementia
Allergies: Penicillin, anti-psychotics
Diagnostic Lab Data: Bloodwork, CT, EKG
CDC 'Split Type':

Write-up: Patient appeared to have had suffered a stroke. Admitted to hospital, tests determined no stroke. Patient had pneumonia, and severe inflammatory response. Sepsis.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1339062&WAYBACKHISTORY=ON

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