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This is VAERS ID 974960

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 974960
VAERS Form:2
Age:53.0
Sex:Male
Location:Michigan
Vaccinated:2021-01-05
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Condition aggravated, Culture urine, Full blood count, Muscle rigidity, Pyrexia, Urinary tract infection, Urine analysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-20
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: JEVITY, FAMOTIDINE, VALIUM, ATROPINE, LABETALOL, PROSCAR, LASIX, DUONEB, KEPPRA, GUIAFENESIN, ERYTHROMYCIN ETHYLSUCCINATE
Current Illness: UTI
Preexisting Conditions: TRAUMATIC BRAIN INJURY, VEGETATIVE STATE, HYPERTENSION, HEART FAILURE, POST TRAUMATIC SEIZURES, CHRONIC RESPIRATORY FAILURE, FLACCID HEMIPLEGIA, GASTROPARESIS, APHASIA
Allergies: AMOXIL
Diagnostic Lab Data: 1/14/2021- URINALYSIS WITH CULTURE, CBC
CDC 'Split Type':

Write-up: ON 1/14/2021 TYPICAL UTI SYMPTOMS FOR RESIDENT DEVELOPED INCLUDING FEVER AND RIGIDITY. RESIDENT IS NON-VERBAL. IV ANTIBIOTICS WERE STARTED. FREQUENT UTI''S ARE COMMON FOR THIS RESIDENT.


Changed on 5/7/2021

VAERS ID: 974960 Before After
VAERS Form:2
Age:53.0
Sex:Male
Location:Michigan
Vaccinated:2021-01-05
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Condition aggravated, Culture urine, Full blood count, Muscle rigidity, Pyrexia, Urinary tract infection, Urine analysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-20
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: JEVITY, FAMOTIDINE, VALIUM, ATROPINE, LABETALOL, PROSCAR, LASIX, DUONEB, KEPPRA, GUIAFENESIN, ERYTHROMYCIN ETHYLSUCCINATE
Current Illness: UTI
Preexisting Conditions: TRAUMATIC BRAIN INJURY, VEGETATIVE STATE, HYPERTENSION, HEART FAILURE, POST TRAUMATIC SEIZURES, CHRONIC RESPIRATORY FAILURE, FLACCID HEMIPLEGIA, GASTROPARESIS, APHASIA
Allergies: AMOXIL AMOXIL
Diagnostic Lab Data: 1/14/2021- URINALYSIS WITH CULTURE, CBC
CDC 'Split Type':

Write-up: ON 1/14/2021 TYPICAL UTI SYMPTOMS FOR RESIDENT DEVELOPED INCLUDING FEVER AND RIGIDITY. RESIDENT IS NON-VERBAL. IV ANTIBIOTICS WERE STARTED. FREQUENT UTI''S ARE COMMON FOR THIS RESIDENT.


Changed on 5/14/2021

VAERS ID: 974960 Before After
VAERS Form:2
Age:53.0
Sex:Male
Location:Michigan
Vaccinated:2021-01-05
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Condition aggravated, Culture urine, Full blood count, Muscle rigidity, Pyrexia, Urinary tract infection, Urine analysis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-20
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: JEVITY, FAMOTIDINE, VALIUM, ATROPINE, LABETALOL, PROSCAR, LASIX, DUONEB, KEPPRA, GUIAFENESIN, ERYTHROMYCIN ETHYLSUCCINATE
Current Illness: UTI
Preexisting Conditions: TRAUMATIC BRAIN INJURY, VEGETATIVE STATE, HYPERTENSION, HEART FAILURE, POST TRAUMATIC SEIZURES, CHRONIC RESPIRATORY FAILURE, FLACCID HEMIPLEGIA, GASTROPARESIS, APHASIA
Allergies: AMOXIL AMOXIL
Diagnostic Lab Data: 1/14/2021- URINALYSIS WITH CULTURE, CBC
CDC 'Split Type':

Write-up: ON 1/14/2021 TYPICAL UTI SYMPTOMS FOR RESIDENT DEVELOPED INCLUDING FEVER AND RIGIDITY. RESIDENT IS NON-VERBAL. IV ANTIBIOTICS WERE STARTED. FREQUENT UTI''S ARE COMMON FOR THIS RESIDENT.

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