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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 935350 |
VAERS Form: | 2 |
Age: | 81.0 |
Sex: | Male |
Location: | Texas |
Vaccinated: | 2020-12-31 |
Onset: | 2021-01-02 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-11 |
Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 037K20A / 1 | LA / IM |
Administered by: Private Purchased by: ??
Symptoms: Unresponsive to stimuli
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:2021-01-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 4
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Symbicort 160/4.5 mcg/act inhaler Dilitiazem ER 360mg PO daily Eliquis 5mg PO twice a day Furosemide 20mg PO daily Losartan 100mg PO daily KCL 10mEq ER PO daily Ranitidine 150mg PO Ventolin HFA 0.09mg/1ACT 2 puffs every 4 hours as needed Me
Current Illness: Dyspnea, Shortness of breath
Preexisting Conditions: Paroxysmal atrial fibrillation Hypertension Chronic iron deficiency anemia Congestive heart failure with chronic diastolic
Allergies: No known allergies
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Patient was found unresponsive at home with SpO2 20% 1/2/2021
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