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This is VAERS ID 992571

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 992571
VAERS Form:2
Age:75.0
Sex:Male
Location:Pennsylvania
Vaccinated:2021-01-29
Onset:2021-01-30
Submitted:0000-00-00
Entered:2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Condition aggravated, Death, Dyspnoea, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-30
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: He stated he was experiencing some shortness of breath with cold and walking up the steps. The patient did report that they had some bloody stool early in the week but that had resolved.
Preexisting Conditions: PMH: DM, HTN, Obesity, hyperlipidemia, Chronic kidney Disease, polyp?s removal. History of Angioedema secondary Ace Inhibitor
Allergies: ACE inhibitor
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: Patient''s wife called the physician''s office with increasing SOB. MD advised that the patient go to the ED. While dressing, the patient became unresponsive, 911 called. Patient expired in ED.


Changed on 5/7/2021

VAERS ID: 992571 Before After
VAERS Form:2
Age:75.0
Sex:Male
Location:Pennsylvania
Vaccinated:2021-01-29
Onset:2021-01-30
Submitted:0000-00-00
Entered:2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Condition aggravated, Death, Dyspnoea, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-30
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: He stated he was experiencing some shortness of breath with cold and walking up the steps. The patient did report that they had some bloody stool early in the week but that had resolved.
Preexisting Conditions: PMH: DM, HTN, Obesity, hyperlipidemia, Chronic kidney Disease, polyp?s removal. History of Angioedema secondary Ace Inhibitor
Allergies: ACE inhibitor inhibitor
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: Patient''s wife called the physician''s office with increasing SOB. MD advised that the patient go to the ED. While dressing, the patient became unresponsive, 911 called. Patient expired in ED.


Changed on 5/14/2021

VAERS ID: 992571 Before After
VAERS Form:2
Age:75.0
Sex:Male
Location:Pennsylvania
Vaccinated:2021-01-29
Onset:2021-01-30
Submitted:0000-00-00
Entered:2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Condition aggravated, Death, Dyspnoea, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-30
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: He stated he was experiencing some shortness of breath with cold and walking up the steps. The patient did report that they had some bloody stool early in the week but that had resolved.
Preexisting Conditions: PMH: DM, HTN, Obesity, hyperlipidemia, Chronic kidney Disease, polyp?s removal. History of Angioedema secondary Ace Inhibitor
Allergies: ACE inhibitor inhibitor
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: Patient''s wife called the physician''s office with increasing SOB. MD advised that the patient go to the ED. While dressing, the patient became unresponsive, 911 called. Patient expired in ED.

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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=992571&WAYBACKHISTORY=ON


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