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This is VAERS ID 1368553

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1368553
VAERS Form:2
Age:60.0
Sex:Male
Location:Texas
Vaccinated:2021-02-08
Onset:2021-05-16
Submitted:0000-00-00
Entered:2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 2 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Cardio-respiratory arrest, Cough, Dyspnoea, Fibrin D dimer increased, Intensive care, Life support, Oxygen saturation decreased, Pain, Pyrexia, Serum ferritin increased, General physical health deterioration, Pulseless electrical activity, Bilevel positive airway pressure, Procalcitonin increased, Endotracheal intubation, COVID-19 pneumonia, Agonal respiration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-27
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? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications: lyrica, ASA, sertraline, Sevelamer, insulin Lispro, insulin lantus, lipitor,
Current Illness: unknown
Preexisting Conditions: cardiac stent x3, CHF, HTN, ESRD, neuropathy, Diabetes mellitus
Allergies: Actos- diarrhea tramadol-hallucinations Tape- rash
Diagnostic Lab Data: 5/27- PCT 8.22 ng/ml, Ddimer 5227, ferrit $g1500.
CDC 'Split Type':

Write-up: 5/16- symptoms started- cough, fever body aches. admitted 5/19 with SOB in addition. COVID pnuemonitis, 5/23-sudden decrease in saturation - placed on BiPAP and transferred to the ICU. further decline and arrested on 5/27. PEA and agonal breathing. intubated and ACLS meds given. Coded a second time and family elected to halt heroic measures.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1368553&WAYBACKHISTORY=ON

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