National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1759418

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1759418
VAERS Form:2
Age:79.0
Sex:Male
Location:Michigan
Vaccinated:2021-02-19
Onset:2021-10-02
Submitted:0000-00-00
Entered:2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Death, Intensive care, Respiratory failure, COVID-19, SARS-CoV-2 test positive, Positive airway pressure therapy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-10-02
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: Aspirin, lipitor, calcium carbonate, Zyrtec, temovate, vitamin B12, Avodart, Ferocon, Flonase, Neurontin, Zestril, Glucophage, Aleve, Saw Palmetto, Flomax, ultram, kenalog cream.
Current Illness:
Preexisting Conditions: Chronic back pain, HTN, DM2, extracranial carotid artery stenosis, arthritis, hyperlipidemia, B12 deficiency, cerebral thrombosis with cerebral infarction, vitiligo, obstructive pattern present on pulmonary function testing, aortic extasia (abdominal), monoclonal gammopathy of unknown significance, spinal stenosis, neuropathy, anemia, history of cerebrovascular accident, benign prostatic hyperplasia.
Allergies: "Seasonal allergies"
Diagnostic Lab Data: COVID positive swab on 09/19/21.
CDC 'Split Type':

Write-up: Fully COVID vaccinated patient who admitted through emergency department with COVID positive test on 09/19/21. Patients respiratory status continued to decline, he required CCU admission high flow oxygen, and subsquently BiPAP. Medical team reviewed ongoing respiratory decline and grave status with patient and family who declined intubation. Patient moved to comfort care and died on 10/02/21.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1759418&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166