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This is VAERS ID 1776827

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/15/2021

VAERS ID: 1776827
VAERS Form:2
Age:84.0
Sex:Male
Location:Minnesota
Vaccinated:2021-01-28
Onset:2021-10-10
Submitted:0000-00-00
Entered:2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0112M0A / 2 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Blood glucose abnormal, Unresponsive to stimuli, Decreased appetite, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? No
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Allopurinol (Zyloprim) 300 Mg Oral Tablet Amlodipine (Norvasc) 10 Mg Oral Tablet Apixaban (Eliquis) 2.5 Mg Oral Tablet Aspirin 81 Mg Oral Enteric Coated Tablet Bumetanide (Bumex) 1 Mg Oral Tablet Chole
Current Illness:
Preexisting Conditions: Essential hypertension, benign Hypercholesterolemia Diabetes mellitus Acute pulmonary embolism Chronic pulmonary embolism without acute cor pulmonale Right upper quadrant abdominal pain Acute GI bleeding Acute kidney injury superimposed on chronic kidney disease Acute blood loss anemia Gastrointestinal hemorrhage with melena Hypotension due to hypovolemia Polymyalgia rheumatica Benign prostatic hyperplasia CKD stage 4 Gout Dyslipidemia Upper GI bleed
Allergies: Colchicine Simvastatin
Diagnostic Lab Data: Positive COVID test 10/10/21
CDC 'Split Type':

Write-up: Pt became unresponsive. Upon arrival EMS blood sugar was 29. loss of appetite.

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