National Vaccine Information Center Your Health. Your Family. Your Choice. |
MedAlerts.org |
History of Changes from the VAERS Wayback Machine |
VAERS ID: | 956966 |
VAERS Form: | 2 |
Age: | 86.0 |
Sex: | Male |
Location: | Unknown |
Vaccinated: | 2020-12-25 |
Onset: | 2020-12-25 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-09 |
Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 011J20A / 1 | LA / IM |
Administered by: Other Purchased by: ??
Symptoms: Body temperature increased, Cough, Dyspnoea, Hypoxia, Secretion discharge, Complication associated with device
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:2020-12-25
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: hypoxia, secretions,cough, dyspnea Narrative: ALS patient on hospice with ongoing history of aspiration pna, receiving tube feeds. Developed incr in secretions, hypoxeia, temp and with recently noted clogged feeding tube.
Copyright ©
2024 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166