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This is VAERS ID 952713

History of Changes from the VAERS Wayback Machine

First Appeared on 1/22/2021

VAERS ID: 952713
VAERS Form:2
Age:64.0
Sex:Male
Location:Missouri
Vaccinated:2020-12-30
Onset:2021-01-12
Submitted:0000-00-00
Entered:2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / UNK AR / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Asthenia, Death, Oxygen saturation decreased, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-16
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes, Parkinson Disease
Allergies: PCN, Zithromax, Flomax
Diagnostic Lab Data: PCR and antigen test
CDC 'Split Type':

Write-up: Weakness, Low O2, death. Positive for COVID on 1/12/21, dies on 1/16/21

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=952713&WAYBACKHISTORY=ON


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