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This is VAERS ID 956966

History of Changes from the VAERS Wayback Machine

First Appeared on 1/22/2021

VAERS ID: 956966
VAERS Form:2
Age:86.0
Sex:Male
Location:Unknown
Vaccinated:2020-12-25
Onset:2020-12-25
Submitted:0000-00-00
Entered:2021-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Body temperature increased, Cough, Dyspnoea, Hypoxia, Secretion discharge, Complication associated with device

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-12-25
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: hypoxia, secretions,cough, dyspnea Narrative: ALS patient on hospice with ongoing history of aspiration pna, receiving tube feeds. Developed incr in secretions, hypoxeia, temp and with recently noted clogged feeding tube.


Changed on 5/7/2021

VAERS ID: 956966 Before After
VAERS Form:2
Age:86.0
Sex:Male
Location:Unknown
Vaccinated:2020-12-25
Onset:2020-12-25
Submitted:0000-00-00
Entered:2021-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Body temperature increased, Cough, Dyspnoea, Hypoxia, Secretion discharge, Complication associated with device

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-12-25
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: hypoxia, secretions,cough, dyspnea Narrative: ALS patient on hospice with ongoing history of aspiration pna, receiving tube feeds. Developed incr in secretions, hypoxeia, temp and with recently noted clogged feeding tube.


Changed on 5/14/2021

VAERS ID: 956966 Before After
VAERS Form:2
Age:86.0
Sex:Male
Location:Unknown
Vaccinated:2020-12-25
Onset:2020-12-25
Submitted:0000-00-00
Entered:2021-01-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Body temperature increased, Cough, Dyspnoea, Hypoxia, Secretion discharge, Complication associated with device

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-12-25
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: hypoxia, secretions,cough, dyspnea Narrative: ALS patient on hospice with ongoing history of aspiration pna, receiving tube feeds. Developed incr in secretions, hypoxeia, temp and with recently noted clogged feeding tube.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=956966&WAYBACKHISTORY=ON


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