National Vaccine Information Center Your Health. Your Family. Your Choice. |
MedAlerts.org |
History of Changes from the VAERS Wayback Machine |
VAERS ID: | 925264 |
VAERS Form: | 2 |
Age: | 77.0 |
Sex: | Male |
Location: | Oklahoma |
Vaccinated: | 2020-12-31 |
Onset: | 0000-00-00 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-07 |
Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 025L20A / 1 | LA / IM |
Administered by: Other Purchased by: ??
Symptoms: Death
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:2021-01-07
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: Norco 5/325 1 tablet every 6 hours as needed. Warfarin 4mg , 2 tablets orally Monday and Friday Torsemide 100mg, 1/2 tablet orally once a day Sabcubitril-Valsartan 24/26mg 1/4 tablet orally twice a day Gabapentin 300mg, tablet once daily Ca
Current Illness: CHF HTN DM 2 CKD Obesity DDD
Preexisting Conditions: CHF HTN DM 2 CKD Obesity DDD
Allergies: NKDA
Diagnostic Lab Data: None
CDC 'Split Type':
Write-up: PT was found deceased in his home on 1/5/2021
Copyright ©
2024 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166