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This is VAERS ID 966844

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 966844
VAERS Form:2
Age:76.0
Sex:Male
Location:New Mexico
Vaccinated:2021-01-13
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Feeling abnormal, Palpitations

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: Unknown
Current Illness: DM II
Preexisting Conditions: DM II
Allergies: KNA
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient is reported to have died at home, the day after his COVID test. Family member states that he did good the afternoon and evening after his COVID-19 injection, but that he started not feeling good the next day. The patient "was having palpitations". The family tried to convince him to go to the Emergency Room, but he refused. Patient died at home.


Changed on 5/7/2021

VAERS ID: 966844 Before After
VAERS Form:2
Age:76.0
Sex:Male
Location:New Mexico
Vaccinated:2021-01-13
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Feeling abnormal, Palpitations

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: Unknown
Current Illness: DM II
Preexisting Conditions: DM II
Allergies: KNA KNA
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient is reported to have died at home, the day after his COVID test. Family member states that he did good the afternoon and evening after his COVID-19 injection, but that he started not feeling good the next day. The patient "was having palpitations". The family tried to convince him to go to the Emergency Room, but he refused. Patient died at home.


Changed on 5/14/2021

VAERS ID: 966844 Before After
VAERS Form:2
Age:76.0
Sex:Male
Location:New Mexico
Vaccinated:2021-01-13
Onset:2021-01-14
Submitted:0000-00-00
Entered:2021-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Feeling abnormal, Palpitations

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: Unknown
Current Illness: DM II
Preexisting Conditions: DM II
Allergies: KNA KNA
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient is reported to have died at home, the day after his COVID test. Family member states that he did good the afternoon and evening after his COVID-19 injection, but that he started not feeling good the next day. The patient "was having palpitations". The family tried to convince him to go to the Emergency Room, but he refused. Patient died at home.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=966844&WAYBACKHISTORY=ON


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