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This is VAERS ID 985715

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 985715
VAERS Form:2
Age:80.0
Sex:Male
Location:Florida
Vaccinated:2020-12-29
Onset:2021-01-02
Submitted:0000-00-00
Entered:2021-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Malaise, General physical health deterioration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-02
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: metoprolol 25mg vitamin D3 1000IU furosemide 80mg Norvasc 5mg aspirin 81mg Renvela 800mg atorvastatin 20mg vitamin B12 1000mcg
Current Illness: high blood pressure dialysis GI bleed/ symptomatic anemia
Preexisting Conditions:
Allergies: no known allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient received the vaccine on 12/29/20 and presented at the ER at the Hospital on 12/30/20 stating that he wasn''t feeling well. It is stated that his health had declined over the past few weeks and currently on hospice. Visit was unremarkable. Patient stated that wanted to stop dialysis. Patient passed away on 01/02/2021.

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