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This is VAERS ID 930487

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/15/2021

VAERS ID: 930487
VAERS Form:2
Age:86.0
Sex:Male
Location:North Carolina
Vaccinated:2021-01-08
Onset:2021-01-08
Submitted:0000-00-00
Entered:2021-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / UNK - / -

Administered by: Senior Living      Purchased by: ??
Symptoms: Myocardial infarction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-08
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: calcium-D tablet, cholecalciferol, fish oil, melatonin, tylenol,
Current Illness: na
Preexisting Conditions: bph, apraxia, , dysphagia, muscle weakness, alzheimers disease
Allergies: cephalexin
Diagnostic Lab Data: na
CDC 'Split Type':

Write-up: Medical docter state patient has a acute cardiac attack


Changed on 5/7/2021

VAERS ID: 930487 Before After
VAERS Form:2
Age:86.0
Sex:Male
Location:North Carolina
Vaccinated:2021-01-08
Onset:2021-01-08
Submitted:0000-00-00
Entered:2021-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / UNK - / -

Administered by: Senior Living      Purchased by: ??
Symptoms: Myocardial infarction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-08
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: calcium-D tablet, cholecalciferol, fish oil, melatonin, tylenol,
Current Illness: na
Preexisting Conditions: bph, apraxia, , dysphagia, muscle weakness, alzheimers disease
Allergies: cephalexin cephalexin
Diagnostic Lab Data: na
CDC 'Split Type':

Write-up: Medical docter state patient has a acute cardiac attack


Changed on 5/14/2021

VAERS ID: 930487 Before After
VAERS Form:2
Age:86.0
Sex:Male
Location:North Carolina
Vaccinated:2021-01-08
Onset:2021-01-08
Submitted:0000-00-00
Entered:2021-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / UNK - / -

Administered by: Senior Living      Purchased by: ??
Symptoms: Myocardial infarction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-08
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: calcium-D tablet, cholecalciferol, fish oil, melatonin, tylenol,
Current Illness: na
Preexisting Conditions: bph, apraxia, , dysphagia, muscle weakness, alzheimers disease
Allergies: cephalexin cephalexin
Diagnostic Lab Data: na
CDC 'Split Type':

Write-up: Medical docter state patient has a acute cardiac attack

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=930487&WAYBACKHISTORY=ON


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