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This is VAERS ID 998421

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 998421
VAERS Form:2
Age:91.0
Sex:Male
Location:North Carolina
Vaccinated:2021-01-06
Onset:2021-01-27
Submitted:0000-00-00
Entered:2021-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Sudden cardiac death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-27
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: acetaminophen aspirin- 81mg calcium carbonate carbidopa-levodopa cholecalciferol fenofibrate fluorouracil cream fluticasone nasal spray folic acid nitroglycerin PRN miralax
Current Illness: Basal cell carcinoma of right ear
Preexisting Conditions: Parkinson''s CAD Labile HTN Renal artery stenosis HLD Basal cell carcinoma Squamous cell carcinoma BPH Prostate CA Urge incontinence Mild cognitive impairment
Allergies: Verapamil Amlodipine Morphine Penicillins
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Resident passed away unexpectedly on 1/27/21 from presumed sudden cardiac death.

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