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This is VAERS ID 948164

History of Changes from the VAERS Wayback Machine

First Appeared on 1/22/2021

VAERS ID: 948164
VAERS Form:2
Age:77.0
Sex:Male
Location:Michigan
Vaccinated:2021-01-06
Onset:2021-01-08
Submitted:0000-00-00
Entered:2021-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 02SL20A / 1 - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Abdominal pain, Chest pain, Chest X-ray, Computerised tomogram, Confusional state, Full blood count, Headache, Computerised tomogram abdomen, Hepatic enzyme increased, Decreased appetite, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-15
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Multivitamin, Zinc, Doxycycline, Ultram, Xanax, Pepcid, Nitroglycerin, Tylenol, Simethicone, Metoprolol Succinate ER, Loperamide, Levothyroxine,
Current Illness: UTI and Sinus infection
Preexisting Conditions: Encephalopathy, Type 2 diabetes, Morbid obesity, hypothyroidism, CKD, HTN, iron deficiency anemia, Atrial fibrillation, IBS,
Allergies:
Diagnostic Lab Data: CT- 1/14/21, chest x-ray 1/14/21 & 1/15/21, abdomen CT 1/14/21; CBC, CMP, Liver panel 1/14/21
CDC 'Split Type':

Write-up: Abdominal pain, Headaches, chest pain, loss of appetite, confusion, elevated liver enzymes 1/8-1/15/21


Changed on 5/7/2021

VAERS ID: 948164 Before After
VAERS Form:2
Age:77.0
Sex:Male
Location:Michigan
Vaccinated:2021-01-06
Onset:2021-01-08
Submitted:0000-00-00
Entered:2021-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 02SL20A / 1 - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Abdominal pain, Chest pain, Chest X-ray, Computerised tomogram, Confusional state, Full blood count, Headache, Computerised tomogram abdomen, Hepatic enzyme increased, Decreased appetite, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-15
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Multivitamin, Zinc, Doxycycline, Ultram, Xanax, Pepcid, Nitroglycerin, Tylenol, Simethicone, Metoprolol Succinate ER, Loperamide, Levothyroxine,
Current Illness: UTI and Sinus infection
Preexisting Conditions: Encephalopathy, Type 2 diabetes, Morbid obesity, hypothyroidism, CKD, HTN, iron deficiency anemia, Atrial fibrillation, IBS,
Allergies:
Diagnostic Lab Data: CT- 1/14/21, chest x-ray 1/14/21 & 1/15/21, abdomen CT 1/14/21; CBC, CMP, Liver panel 1/14/21
CDC 'Split Type':

Write-up: Abdominal pain, Headaches, chest pain, loss of appetite, confusion, elevated liver enzymes 1/8-1/15/21


Changed on 5/14/2021

VAERS ID: 948164 Before After
VAERS Form:2
Age:77.0
Sex:Male
Location:Michigan
Vaccinated:2021-01-06
Onset:2021-01-08
Submitted:0000-00-00
Entered:2021-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 02SL20A / 1 - / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Abdominal pain, Chest pain, Chest X-ray, Computerised tomogram, Confusional state, Full blood count, Headache, Computerised tomogram abdomen, Hepatic enzyme increased, Decreased appetite, Metabolic function test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-15
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Multivitamin, Zinc, Doxycycline, Ultram, Xanax, Pepcid, Nitroglycerin, Tylenol, Simethicone, Metoprolol Succinate ER, Loperamide, Levothyroxine,
Current Illness: UTI and Sinus infection
Preexisting Conditions: Encephalopathy, Type 2 diabetes, Morbid obesity, hypothyroidism, CKD, HTN, iron deficiency anemia, Atrial fibrillation, IBS,
Allergies:
Diagnostic Lab Data: CT- 1/14/21, chest x-ray 1/14/21 & 1/15/21, abdomen CT 1/14/21; CBC, CMP, Liver panel 1/14/21
CDC 'Split Type':

Write-up: Abdominal pain, Headaches, chest pain, loss of appetite, confusion, elevated liver enzymes 1/8-1/15/21

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