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This is VAERS ID 965860

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 965860
VAERS Form:2
Age:84.0
Sex:Male
Location:Ohio
Vaccinated:2021-01-21
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Cardio-respiratory arrest, Dyspnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-21
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had increased SOB while at home. EMS was called. Patient coded in the squad


Changed on 5/7/2021

VAERS ID: 965860 Before After
VAERS Form:2
Age:84.0
Sex:Male
Location:Ohio
Vaccinated:2021-01-21
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Cardio-respiratory arrest, Dyspnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-21
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had increased SOB while at home. EMS was called. Patient coded in the squad


Changed on 5/14/2021

VAERS ID: 965860 Before After
VAERS Form:2
Age:84.0
Sex:Male
Location:Ohio
Vaccinated:2021-01-21
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Cardio-respiratory arrest, Dyspnoea

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-21
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had increased SOB while at home. EMS was called. Patient coded in the squad

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=965860&WAYBACKHISTORY=ON


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