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This is VAERS ID 979990

History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 979990
VAERS Form:2
Age:63.0
Sex:Male
Location:Ohio
Vaccinated:2021-01-07
Onset:2021-01-09
Submitted:0000-00-00
Entered:2021-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-09
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: none
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: sudden cardiac arrest


Changed on 5/7/2021

VAERS ID: 979990 Before After
VAERS Form:2
Age:63.0
Sex:Male
Location:Ohio
Vaccinated:2021-01-07
Onset:2021-01-09
Submitted:0000-00-00
Entered:2021-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-09
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: none
Preexisting Conditions:
Allergies: NKDA NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: sudden cardiac arrest


Changed on 5/14/2021

VAERS ID: 979990 Before After
VAERS Form:2
Age:63.0
Sex:Male
Location:Ohio
Vaccinated:2021-01-07
Onset:2021-01-09
Submitted:0000-00-00
Entered:2021-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-09
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: none
Preexisting Conditions:
Allergies: NKDA NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: sudden cardiac arrest

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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=979990&WAYBACKHISTORY=ON


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