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This is VAERS ID 1355128

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1355128
VAERS Form:2
Age:70.0
Sex:Male
Location:Massachusetts
Vaccinated:2021-04-01
Onset:2021-04-03
Submitted:0000-00-00
Entered:2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038A21A / 2 UN / UN

Administered by: Senior Living      Purchased by: ??
Symptoms: Aspiration, Colonoscopy, Coma, Confusional state, Cough, Death, Dysphagia, Dyspnoea, Oxygen saturation decreased, Pneumonia, Syncope, Blood test abnormal, Transfusion, Internal haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-22
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Omeprazole 20mg, 1 cap 2X/day; Furosemide 20mg, 1 tab/day; Folic Acid 1MG, 1 tab/day; Amlodipine Besylate 5MG 1 tab/day; Amitriptyline HCL 50MG, 1 tab/day; Aripiprazole 20 mg, 1 tab/day; Daily-vite, 1 tab/day; Ventolin HFA albuterol sulfate
Current Illness:
Preexisting Conditions: COPD, Parkinsons, High Blood Pressure, Schizophrenia
Allergies: penicillin
Diagnostic Lab Data: Blood work at Hospital (found to be abnormal), and internal bleeding. Two blood transfusions given as well a colonoscopy. Trouble breathing, low oxygen, mental confusion. Transferred Transported to ER Hospital on April 11. Trouble breathing and swallowing. Discovered food was going into his lungs. Diagnosed with pneumonia. Went into coma on April 18. Passed away on April 22.
CDC 'Split Type':

Write-up: Fainted in apartment parking lot, on morning of April 3; transported to ER,, via ambulance. Hospital stay for several days, moved to Rehab, sent back to ER with a cough, trouble breathing, and swallowing. Diagnosed with pneumonia. Went into coma on 4/18. Passed away on 4/22/2021.

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