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This is VAERS ID 944732

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/22/2021

VAERS ID: 944732
VAERS Form:2
Age:92.0
Sex:Male
Location:Wisconsin
Vaccinated:2021-01-13
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K2OA / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Pulse absent, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-14
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: Cholecalciferol, furosemide, metoprolol tartrate, tamsulosin, amlodipine, finasteride
Current Illness: Covid-19 infection from 12/31-01/10/2021
Preexisting Conditions: CHF, atrial fibrilation, Dysphagia, macular degeneration, Vitamin D deficiency, impaired fasting glucose, benign prostatic hyperplasia, osteoporosis, retention of urine, anemia
Allergies: hydrocodone
Diagnostic Lab Data: None.
CDC 'Split Type':

Write-up: Resident found unresponsive and without pulse at 05:45am.


Changed on 5/7/2021

VAERS ID: 944732 Before After
VAERS Form:2
Age:92.0
Sex:Male
Location:Wisconsin
Vaccinated:2021-01-13
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K2OA / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Pulse absent, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-14
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: Cholecalciferol, furosemide, metoprolol tartrate, tamsulosin, amlodipine, finasteride
Current Illness: Covid-19 infection from 12/31-01/10/2021
Preexisting Conditions: CHF, atrial fibrilation, Dysphagia, macular degeneration, Vitamin D deficiency, impaired fasting glucose, benign prostatic hyperplasia, osteoporosis, retention of urine, anemia
Allergies: hydrocodone hydrocodone
Diagnostic Lab Data: None.
CDC 'Split Type':

Write-up: Resident found unresponsive and without pulse at 05:45am.


Changed on 5/21/2021

VAERS ID: 944732 Before After
VAERS Form:2
Age:92.0
Sex:Male
Location:Wisconsin
Vaccinated:2021-01-13
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K2OA / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Pulse absent, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-14
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: Cholecalciferol, furosemide, metoprolol tartrate, tamsulosin, amlodipine, finasteride
Current Illness: Covid-19 infection from 12/31-01/10/2021
Preexisting Conditions: CHF, atrial fibrilation, Dysphagia, macular degeneration, Vitamin D deficiency, impaired fasting glucose, benign prostatic hyperplasia, osteoporosis, retention of urine, anemia
Allergies: hydrocodone hydrocodone
Diagnostic Lab Data: None.
CDC 'Split Type':

Write-up: Resident found unresponsive and without pulse at 05:45am.

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