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This is VAERS ID 979223

History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 979223
VAERS Form:2
Age:77.0
Sex:Male
Location:California
Vaccinated:2021-01-05
Onset:2021-01-12
Submitted:0000-00-00
Entered:2021-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-22
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: Pravastatin 40 mg, KCL ER 10meq, Metoprolol 25 mg, losartan 100 mg, glyburide 2.5 mg, furosemide 40 mg, ASA 81 mg, amlopidine 10 mg, allopurinol 300 mg
Current Illness: CHF, hypertension, type 2 DM
Preexisting Conditions: same as 11
Allergies: NKA
Diagnostic Lab Data: (ER event)
CDC 'Split Type':

Write-up: Patient developed SOB but reported good O2Sats. Instructed on going to ER if worsening symptoms. Patient eventually expired on 1/22/21


Changed on 5/7/2021

VAERS ID: 979223 Before After
VAERS Form:2
Age:77.0
Sex:Male
Location:California
Vaccinated:2021-01-05
Onset:2021-01-12
Submitted:0000-00-00
Entered:2021-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-22
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: Pravastatin 40 mg, KCL ER 10meq, Metoprolol 25 mg, losartan 100 mg, glyburide 2.5 mg, furosemide 40 mg, ASA 81 mg, amlopidine 10 mg, allopurinol 300 mg
Current Illness: CHF, hypertension, type 2 DM
Preexisting Conditions: same as 11
Allergies: NKA NKA
Diagnostic Lab Data: (ER event)
CDC 'Split Type':

Write-up: Patient developed SOB but reported good O2Sats. Instructed on going to ER if worsening symptoms. Patient eventually expired on 1/22/21


Changed on 5/14/2021

VAERS ID: 979223 Before After
VAERS Form:2
Age:77.0
Sex:Male
Location:California
Vaccinated:2021-01-05
Onset:2021-01-12
Submitted:0000-00-00
Entered:2021-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-22
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: Pravastatin 40 mg, KCL ER 10meq, Metoprolol 25 mg, losartan 100 mg, glyburide 2.5 mg, furosemide 40 mg, ASA 81 mg, amlopidine 10 mg, allopurinol 300 mg
Current Illness: CHF, hypertension, type 2 DM
Preexisting Conditions: same as 11
Allergies: NKA NKA
Diagnostic Lab Data: (ER event)
CDC 'Split Type':

Write-up: Patient developed SOB but reported good O2Sats. Instructed on going to ER if worsening symptoms. Patient eventually expired on 1/22/21

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=979223&WAYBACKHISTORY=ON

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