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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 930487 |
VAERS Form: | 2 |
Age: | 86.0 |
Sex: | Male |
Location: | North Carolina |
Vaccinated: | 2021-01-08 |
Onset: | 2021-01-08 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-08 |
Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 037K20A / UNK | - / - |
Administered by: Senior Living Purchased by: ??
Symptoms: Myocardial infarction
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:2021-01-08
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: calcium-D tablet, cholecalciferol, fish oil, melatonin, tylenol,
Current Illness: na
Preexisting Conditions: bph, apraxia, , dysphagia, muscle weakness, alzheimers disease
Allergies: cephalexin
Diagnostic Lab Data: na
CDC 'Split Type':
Write-up: Medical docter state patient has a acute cardiac attack
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