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This is VAERS ID 1586936

History of Changes from the VAERS Wayback Machine

First Appeared on 8/20/2021

VAERS ID: 1586936
VAERS Form:2
Age:22.0
Sex:Male
Location:Louisiana
Vaccinated:2021-08-18
Onset:2021-08-18
Submitted:0000-00-00
Entered:2021-08-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Aphasia, Blood pressure immeasurable, Death, Hypopnoea, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-08-18
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? No
Previous Vaccinations:
Other Medications: ASA BUMETANIDE CARVEDILOL ENTRESTO FERROUS SULFATE LEVSIN SPIRONOLACTONE
Current Illness: ENCOUNTER FOR AUTISM SCREENING ACUTE EMBOLISM & THROMBOSIS OF OTHER SPECIFIED VEINS OBESITY IRON DEFICIENT ANEMIA ACUTE ON CHRONIC COMBINED SYSTOLIC & DIASTOLIC CONGESTIVE HEART FAILURE HEART FAILURE DUCHENNE OR BECKER MUSCULAR DYSTROPHY PULMONARY HTN MILD PROTEIN-CALORIE MALNUTRITION
Preexisting Conditions: SEE ABOVE
Allergies: NKDA
Diagnostic Lab Data: UNKNOWN
CDC 'Split Type':

Write-up: RESIDENT REC''D FIRST DOSE MODERNA VACCINE LEFT DELTOID AT 1334. PROGRESS NOTE FROM FACILITY READS: 8/18/21 @ 15:11- "RESIDENT IS ALERT AND WATCHES TV IN HIS (?) FOR ENTERTAINMENT. RESIDENT RECEIVES ROOM VISITS AND MONITORING NEEDS AND INTEREST." 8/18/21 @ 20:50- "RESIDENT WAS UNRESPONSIVE WITH SHALLOW BREATHING, EYES OPEN BUT VERBALLY NO SOUND, PLACED RESIDENT ON 02 @ 3 LITERS PER NASAL CANNULA, NOTIFIED NP OF RESIDENTS STATUS RECEIVED ORDERS TO SEND RESIDENT TO HOSPITAL VIA 911, NOTIFIED 911, 911 UNABLE TO GET A BP ON RESIDENT, RESIDENT SAFELY TRANSFERRED TO STRETCHER FOR TRANSPORT TO ER, RESIDENT FAMILY NOTIFIED, RN NOTIFIED." RN STATES THEY REC''D WORD THAT PT HAD EXPIRED BETWEEN 8:50 AND 10:14PM.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1586936&WAYBACKHISTORY=ON

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