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This is VAERS ID 992846

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 992846
VAERS Form:2
Age:82.0
Sex:Male
Location:Montana
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 042L20A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Malaise

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-29
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: Coreg 12.5 mg tablet: 12.5 mg PO BID; Hytrin 10 mg capsule po daily; Lasix 20 mg tablet po daily; Lipitor 40 mg tablet daily; Phenobarbital 30 mg tablet po BID; Levothyroxine 100 mcg tablet daily; lisinopril 2.5 mg tablet po daily; pantopra
Current Illness: CRT-P upgrade on 1/7/2021 Pacemaker 0107 on 1/7/2021
Preexisting Conditions: Acute MI; arthritis; atrial fibrillation; bleeding; bronchitis; bypass; cholecystitis; chronic anemia; COPD; CKD; CAD; Heart block Hypercholesteremia; HTN; hypothyroidism; MI
Allergies: CeleBREX-GI Bleed Morphine-urticaria
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient complained to wife of not feeling well in evening after the vaccination and expired at home during the night.

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