National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 992137

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 992137
VAERS Form:2
Age:74.0
Sex:Male
Location:South Carolina
Vaccinated:2021-01-19
Onset:2021-01-25
Submitted:0000-00-00
Entered:2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Bradycardia, Cardio-respiratory arrest, Death, Diarrhoea haemorrhagic, Hypotension, Mechanical ventilation, Hyporesponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-31
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? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: oxymorphone ,mertazapine,medical marijuana , duloxetine , lisinopril , monolucast, hydocortisone, simvastatin amlodipine famotidine
Current Illness:
Preexisting Conditions: pan-hypo pituitarism, hypertension, hyperlipidemia chronic pain sleep apnea
Allergies:
Diagnostic Lab Data: See hospital record
CDC 'Split Type':

Write-up: 6 days after vaccine developed bloody diarrhea. Thought to have ischemic colitis but negative evaluation. became hypotensive bradycardic placed on ventilator. Subsequently was poorly responsive and eventually coded once more and succumbed

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=992137&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166