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This is VAERS ID 992342

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 992342
VAERS Form:2
Age:77.0
Sex:Male
Location:Alabama
Vaccinated:2021-01-21
Onset:2021-01-30
Submitted:0000-00-00
Entered:2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Arrhythmia, Dyspnoea, Hypertension, Oxygen saturation decreased, Pneumonia, SARS-CoV-2 test positive

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)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Baby Aspirin
Current Illness: none
Preexisting Conditions: Diabetes Type 2
Allergies: NKDA
Diagnostic Lab Data: unknown
CDC 'Split Type':

Write-up: Shortness of Breath, decreased oxygen saturation, irregular heart rhythm, hypertension, Positive for COVID, bilateral pneumonia


Changed on 5/7/2021

VAERS ID: 992342 Before After
VAERS Form:2
Age:77.0
Sex:Male
Location:Alabama
Vaccinated:2021-01-21
Onset:2021-01-30
Submitted:0000-00-00
Entered:2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Arrhythmia, Dyspnoea, Hypertension, Oxygen saturation decreased, Pneumonia, SARS-CoV-2 test positive

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)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Baby Aspirin
Current Illness: none
Preexisting Conditions: Diabetes Type 2
Allergies: NKDA NKDA
Diagnostic Lab Data: unknown
CDC 'Split Type':

Write-up: Shortness of Breath, decreased oxygen saturation, irregular heart rhythm, hypertension, Positive for COVID, bilateral pneumonia


Changed on 5/14/2021

VAERS ID: 992342 Before After
VAERS Form:2
Age:77.0
Sex:Male
Location:Alabama
Vaccinated:2021-01-21
Onset:2021-01-30
Submitted:0000-00-00
Entered:2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032L20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Arrhythmia, Dyspnoea, Hypertension, Oxygen saturation decreased, Pneumonia, SARS-CoV-2 test positive

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)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Baby Aspirin
Current Illness: none
Preexisting Conditions: Diabetes Type 2
Allergies: NKDA NKDA
Diagnostic Lab Data: unknown
CDC 'Split Type':

Write-up: Shortness of Breath, decreased oxygen saturation, irregular heart rhythm, hypertension, Positive for COVID, bilateral pneumonia

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=992342&WAYBACKHISTORY=ON


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