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This is VAERS ID 943889

History of Changes from the VAERS Wayback Machine

First Appeared on 1/15/2021

VAERS ID: 943889
VAERS Form:2
Age:75.0
Sex:Male
Location:Virginia
Vaccinated:2021-01-08
Onset:2021-01-09
Submitted:0000-00-00
Entered:2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death, Dyspnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Alvesco, Amiodarone, Lipitor, Atrovent, Coreg, Cymbalta, Guaifenesin, Keppra, Levothroid, Megace, Protonix, Potassium, Prednisone, Rifampin, Carafate, Bactrim, Flomax
Current Illness: Rigth femur fracture, GI bleed
Preexisting Conditions: Hypertension, seizure, hypothyroidism, CHF
Allergies: No known allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: No adverse reactions observed after administration of medication. Patient starting complaining of shortness of breath around 0500 the following morning. SP02 checked in the 80s. Patient expired 01/09/2021;


Changed on 5/7/2021

VAERS ID: 943889 Before After
VAERS Form:2
Age:75.0
Sex:Male
Location:Virginia
Vaccinated:2021-01-08
Onset:2021-01-09
Submitted:0000-00-00
Entered:2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death, Dyspnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Alvesco, Amiodarone, Lipitor, Atrovent, Coreg, Cymbalta, Guaifenesin, Keppra, Levothroid, Megace, Protonix, Potassium, Prednisone, Rifampin, Carafate, Bactrim, Flomax
Current Illness: Rigth femur fracture, GI bleed
Preexisting Conditions: Hypertension, seizure, hypothyroidism, CHF
Allergies: No known allergies allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: No adverse reactions observed after administration of medication. Patient starting complaining of shortness of breath around 0500 the following morning. SP02 checked in the 80s. Patient expired 01/09/2021;


Changed on 5/14/2021

VAERS ID: 943889 Before After
VAERS Form:2
Age:75.0
Sex:Male
Location:Virginia
Vaccinated:2021-01-08
Onset:2021-01-09
Submitted:0000-00-00
Entered:2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death, Dyspnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Alvesco, Amiodarone, Lipitor, Atrovent, Coreg, Cymbalta, Guaifenesin, Keppra, Levothroid, Megace, Protonix, Potassium, Prednisone, Rifampin, Carafate, Bactrim, Flomax
Current Illness: Rigth femur fracture, GI bleed
Preexisting Conditions: Hypertension, seizure, hypothyroidism, CHF
Allergies: No known allergies allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: No adverse reactions observed after administration of medication. Patient starting complaining of shortness of breath around 0500 the following morning. SP02 checked in the 80s. Patient expired 01/09/2021;

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=943889&WAYBACKHISTORY=ON

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