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This is VAERS ID 930611

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/22/2021

VAERS ID: 930611
VAERS Form:2
Age:71.0
Sex:Male
Location:Massachusetts
Vaccinated:2021-01-06
Onset:2021-01-07
Submitted:0000-00-00
Entered:2021-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Cardiac failure congestive, Condition aggravated, Intensive care, Respiratory failure, Bilevel positive airway pressure

Life Threatening? Yes
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: Albuterol, metoprolol, fish oil, apixiban, insulin
Current Illness: Advanced diastolic heart failure and CKD. Returned from hospitalization one week prior for CHF exacerbation treated with BIPAP, IV diuresis
Preexisting Conditions: oxygen dependent COPD, type II DM, diastolic CHF, stage IV renal failure, personality disorder
Allergies: statin, PCN
Diagnostic Lab Data: unknonw
CDC 'Split Type':

Write-up: Developed hypercapnic respiratory failure, CHF exacerbation - readmitted to Hospital. In ICU with BIPAP


Changed on 5/7/2021

VAERS ID: 930611 Before After
VAERS Form:2
Age:71.0
Sex:Male
Location:Massachusetts
Vaccinated:2021-01-06
Onset:2021-01-07
Submitted:0000-00-00
Entered:2021-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Cardiac failure congestive, Condition aggravated, Intensive care, Respiratory failure, Bilevel positive airway pressure

Life Threatening? Yes
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: Albuterol, metoprolol, fish oil, apixiban, insulin
Current Illness: Advanced diastolic heart failure and CKD. Returned from hospitalization one week prior for CHF exacerbation treated with BIPAP, IV diuresis
Preexisting Conditions: oxygen dependent COPD, type II DM, diastolic CHF, stage IV renal failure, personality disorder
Allergies: statin, PCN PCN
Diagnostic Lab Data: unknonw
CDC 'Split Type':

Write-up: Developed hypercapnic respiratory failure, CHF exacerbation - readmitted to Hospital. In ICU with BIPAP


Changed on 5/21/2021

VAERS ID: 930611 Before After
VAERS Form:2
Age:71.0
Sex:Male
Location:Massachusetts
Vaccinated:2021-01-06
Onset:2021-01-07
Submitted:0000-00-00
Entered:2021-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Cardiac failure congestive, Condition aggravated, Intensive care, Respiratory failure, Bilevel positive airway pressure

Life Threatening? Yes
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: Albuterol, metoprolol, fish oil, apixiban, insulin
Current Illness: Advanced diastolic heart failure and CKD. Returned from hospitalization one week prior for CHF exacerbation treated with BIPAP, IV diuresis
Preexisting Conditions: oxygen dependent COPD, type II DM, diastolic CHF, stage IV renal failure, personality disorder
Allergies: statin, PCN PCN
Diagnostic Lab Data: unknonw
CDC 'Split Type':

Write-up: Developed hypercapnic respiratory failure, CHF exacerbation - readmitted to Hospital. In ICU with BIPAP

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