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This is VAERS ID 991859

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 991859
VAERS Form:2
Age:89.0
Sex:Male
Location:Illinois
Vaccinated:2021-01-29
Onset:2021-01-29
Submitted:0000-00-00
Entered:2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Asthenia, Death, Memory impairment, Somnolence, Visual impairment, Mobility decreased, Urine output decreased, Decreased appetite, Food refusal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-01
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: hospice patient for 1 year
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Per granddaughter''s report, pt became very weak within hours of receiving the first dose of the Moderna COVID-19 vaccine and could not get out of bed the next morning without assistance, reported difficulty seeing, and did not recognize some family members. By Sunday, 1/31, pt was unable to be awakened, would not eat, and had low urinary output. Granddaughter reports that the morning of 2/1 he was awake and ate a small amount and seemed to be improving although still weak and unable to get out of bed. Granddaughter reported he died 2/1 around 10am in the morning.

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