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This is VAERS ID 994309

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 994309
VAERS Form:2
Age:87.0
Sex:Male
Location:New York
Vaccinated:2021-01-15
Onset:2021-01-16
Submitted:0000-00-00
Entered:2021-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Private      Purchased by: ??
Symptoms: Death, Dyspnoea, Fatigue, Bedridden

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-30
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: 13     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine, 5 mg; Metformin, 500mg (twice a day); Simvastatin, 20mg; Omeprazol Dr, 40mg.
Current Illness:
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Got vaccine on 1/15/21. He was tired right away, bedridden the next 3 days. He couldn''t breathe so he was taken by ambulance on 1/18/21. He was in hospital for several days. put on remdesivir cocktail for 10 days. Slowly getting worse and died in hospital on 1/30/21.

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