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This is VAERS ID 958971

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/22/2021

VAERS ID: 958971
VAERS Form:2
Age:84.0
Sex:Male
Location:Florida
Vaccinated:2021-01-13
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Computerised tomogram, Haemorrhagic stroke, Basal ganglia stroke

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)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Simvastatin
Current Illness:
Preexisting Conditions: Aortic Insuf Dyslipidemia h/o prostate CA
Allergies: NKDA
Diagnostic Lab Data: CT scan
CDC 'Split Type':

Write-up: Hemorrhagic Stroke, Right Basal Ganglion


Changed on 5/7/2021

VAERS ID: 958971 Before After
VAERS Form:2
Age:84.0
Sex:Male
Location:Florida
Vaccinated:2021-01-13
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Computerised tomogram, Haemorrhagic stroke, Basal ganglia stroke

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)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Simvastatin
Current Illness:
Preexisting Conditions: Aortic Insuf Dyslipidemia h/o prostate CA
Allergies: NKDA NKDA
Diagnostic Lab Data: CT scan
CDC 'Split Type':

Write-up: Hemorrhagic Stroke, Right Basal Ganglion


Changed on 5/14/2021

VAERS ID: 958971 Before After
VAERS Form:2
Age:84.0
Sex:Male
Location:Florida
Vaccinated:2021-01-13
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Computerised tomogram, Haemorrhagic stroke, Basal ganglia stroke

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)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Simvastatin
Current Illness:
Preexisting Conditions: Aortic Insuf Dyslipidemia h/o prostate CA
Allergies: NKDA NKDA
Diagnostic Lab Data: CT scan
CDC 'Split Type':

Write-up: Hemorrhagic Stroke, Right Basal Ganglion

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