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MedAlerts.org |
History of Changes from the VAERS Wayback Machine |
VAERS ID: | 952713 |
VAERS Form: | 2 |
Age: | 64.0 |
Sex: | Male |
Location: | Missouri |
Vaccinated: | 2020-12-30 |
Onset: | 2021-01-12 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-18 |
Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 026L20A / UNK | AR / IM |
Administered by: Senior Living Purchased by: ??
Symptoms: Asthenia, Death, Oxygen saturation decreased, SARS-CoV-2 test positive
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:2021-01-16
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes, Parkinson Disease
Allergies: PCN, Zithromax, Flomax
Diagnostic Lab Data: PCR and antigen test
CDC 'Split Type':
Write-up: Weakness, Low O2, death. Positive for COVID on 1/12/21, dies on 1/16/21
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