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This is VAERS ID 992154

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 992154
VAERS Form:2
Age:100.0
Sex:Male
Location:Minnesota
Vaccinated:2021-01-11
Onset:2021-01-25
Submitted:0000-00-00
Entered:2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

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? No
Previous Vaccinations:
Other Medications: duo neb, lasix, protonix, prednisone, apap , dulcolax, cough syryp, levsin, MOM, morphine, tums, ativan, flomax, aquaiphor oint, senna, muscle rub
Current Illness: None
Preexisting Conditions: Alzheimers Dementia late onset without behavioral disturbance, Hypotension, benign prostatic hyperplasia, Left inguinal hernia found 2016, Left shoulder lesions, Hypothyroidism, GERD (gastroesophageal reflux disease), Mixed hyperlipidemia, Basal Cell Carcinoma, Kyphosis, Hx of shingles, dysphagia, Legally blind LEFT eye, cataracts both eyes, frality, hard of hearing Hospice- general decline in the past year.
Allergies: NKA
Diagnostic Lab Data: none, pt on hospice, comfort cares
CDC 'Split Type':

Write-up: No adverse events reported post vaccine. 1 st dose on 1/11/21 by public health. Death 1/31/21 Patient was on hospice for gradual decline.

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