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This is VAERS ID 988369

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 988369
VAERS Form:2
Age:82.0
Sex:Male
Location:Illinois
Vaccinated:2021-01-19
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 LA / -

Administered by: Unknown      Purchased by: ??
Symptoms: Death, Pneumonia aspiration

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-22
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? No
Previous Vaccinations:
Other Medications: Carvedilol Citalopram Phenytion Olanzapine
Current Illness:
Preexisting Conditions: diabetes gastroparesis MitraClip
Allergies: Penicillin
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: aspiration pneumonia/death

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=988369&WAYBACKHISTORY=ON


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