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This is VAERS ID 941561

History of Changes from the VAERS Wayback Machine

First Appeared on 1/15/2021

VAERS ID: 941561
VAERS Form:2
Age:91.0
Sex:Male
Location:Minnesota
Vaccinated:2021-01-07
Onset:2021-01-08
Submitted:0000-00-00
Entered:2021-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / UNK LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Cerebrovascular accident, Death, Hemiplegia, Hypotonia, Speech disorder, Weight decreased, Decreased appetite, Grip strength decreased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-11
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: Escitalopram Oxalate, Metformin ER, Systane balance, Colace, Refresh tears, Milk of Magnesia, Diltiazem
Current Illness: Resident was on hospice for Alzheimer''s disease.
Preexisting Conditions: Alzheimer''s Disease, Type II diabetes, Major depression disorder, Elevated B/P readings with Hypertension, history of stroke (7/22/2019 - Acute Lacunar Stroke)
Allergies: No known Allergies
Diagnostic Lab Data: Resident was declining for some time. He normally had a high heart rate. Appetite was poor with a significant weight loss noted.
CDC 'Split Type':

Write-up: Staff walked into resident''s room around 10:00am and noted resident''s left side of his face was flaccid. Nurse was called and upon assessment resident noted to have an unequal hand grasp with left worse. He was able to talk but was mumbled and hard to understand. Physician, hospice, and family were notified. Resident had a stroke at 10:06 am on 1/8/2020. He lost all ability to use his left side. Resident passed away on 1/11/2020.


Changed on 5/7/2021

VAERS ID: 941561 Before After
VAERS Form:2
Age:91.0
Sex:Male
Location:Minnesota
Vaccinated:2021-01-07
Onset:2021-01-08
Submitted:0000-00-00
Entered:2021-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / UNK LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Cerebrovascular accident, Death, Hemiplegia, Hypotonia, Speech disorder, Weight decreased, Decreased appetite, Grip strength decreased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-11
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: Escitalopram Oxalate, Metformin ER, Systane balance, Colace, Refresh tears, Milk of Magnesia, Diltiazem
Current Illness: Resident was on hospice for Alzheimer''s disease.
Preexisting Conditions: Alzheimer''s Disease, Type II diabetes, Major depression disorder, Elevated B/P readings with Hypertension, history of stroke (7/22/2019 - Acute Lacunar Stroke)
Allergies: No known Allergies Allergies
Diagnostic Lab Data: Resident was declining for some time. He normally had a high heart rate. Appetite was poor with a significant weight loss noted.
CDC 'Split Type':

Write-up: Staff walked into resident''s room around 10:00am and noted resident''s left side of his face was flaccid. Nurse was called and upon assessment resident noted to have an unequal hand grasp with left worse. He was able to talk but was mumbled and hard to understand. Physician, hospice, and family were notified. Resident had a stroke at 10:06 am on 1/8/2020. He lost all ability to use his left side. Resident passed away on 1/11/2020.


Changed on 5/14/2021

VAERS ID: 941561 Before After
VAERS Form:2
Age:91.0
Sex:Male
Location:Minnesota
Vaccinated:2021-01-07
Onset:2021-01-08
Submitted:0000-00-00
Entered:2021-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / UNK LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Cerebrovascular accident, Death, Hemiplegia, Hypotonia, Speech disorder, Weight decreased, Decreased appetite, Grip strength decreased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-11
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: Escitalopram Oxalate, Metformin ER, Systane balance, Colace, Refresh tears, Milk of Magnesia, Diltiazem
Current Illness: Resident was on hospice for Alzheimer''s disease.
Preexisting Conditions: Alzheimer''s Disease, Type II diabetes, Major depression disorder, Elevated B/P readings with Hypertension, history of stroke (7/22/2019 - Acute Lacunar Stroke)
Allergies: No known Allergies Allergies
Diagnostic Lab Data: Resident was declining for some time. He normally had a high heart rate. Appetite was poor with a significant weight loss noted.
CDC 'Split Type':

Write-up: Staff walked into resident''s room around 10:00am and noted resident''s left side of his face was flaccid. Nurse was called and upon assessment resident noted to have an unequal hand grasp with left worse. He was able to talk but was mumbled and hard to understand. Physician, hospice, and family were notified. Resident had a stroke at 10:06 am on 1/8/2020. He lost all ability to use his left side. Resident passed away on 1/11/2020.

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