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This is VAERS ID 1493712

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1493712
VAERS Form:2
Age:90.0
Sex:Male
Location:Michigan
Vaccinated:2021-01-26
Onset:2021-02-07
Submitted:0000-00-00
Entered:2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004MZ0A / 2 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Atelectasis, Cardiomegaly, Chest X-ray abnormal, Death, Dyspnoea, Hypoxia, Oedema, Pleural effusion, Pneumonia, Pulmonary congestion, Lung opacity

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-07
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: Bumex, Eliquis, Flonase nasal spray, Miralax, Nitro PRN, Potassium, Requip, Synthroid, Tramadal, Trazodone, Zoloft, Tylenol
Current Illness: Oxygen dependent CHF with gradual declining course
Preexisting Conditions: CHF, Cataract Right Eye, Restless Leg Syndrome, Abdominal Hernia, Vit D Deficiency, Long Term use Anticoagulants, Urge incontinence, Bilat Artificial Knee joint, Atherosclerotic heart disease of native coronary Artery with unstable angina, Essential (Primary) Hypertension, A-Fib, Ischemic Cardiomypathy, Chronic Kidney disease-Stage 3, Anemia in Chronic Kidney Disease, Alzheimers, Major Depressive disorder, Constipation, Hypothyroidism, Osteoarthritis, Hyperlipidemia
Allergies: NKA
Diagnostic Lab Data: Chest XRay on 202/01/2021 showed: 1. Cardiomegaly with pulmonary vascular congestion 2. Nonspecific bibasilar opacities, favoring atelectasis and edema. An underlying pneumonia cannot be excluded. 3. There is a moderate right pleural effusion
CDC 'Split Type':

Write-up: 90 y.o. Nursing home resident with comorbidities including oxygen dependent CHF with gradual declining course prior to 1st dose of COVID 19 Moderna vaccine died 12 days after receiving 2nd dose. Resident experienced increased dyspnea and hypoxia 5 days after receiving 2nd dose.

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