From the 6/11/2021 release of VAERS data:
This is VAERS ID 1027141
| Days after vaccination:||0
|Vaccination / Manufacturer
||Lot / Dose
||Site / Route|
|COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA
||037K20A / 1
||LA / IM
Administered by: Senior Living Purchased by: ?
Life Threatening? No
Birth Defect? No
Date died: 2021-02-12
Days after onset: 14
Permanent Disability? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Other Medications: Acidophilus Capsule BID, Metamucil (Generic) 1 packet/day, Metformin HCL 500 Generic BID, Omeprazole 20 mg Daily, Potassium Cloride ER 20 MEQ tablet PO daily with breakfast, Prenatal Vitamin plus low iron daily with breakfast, Tamsulosin Hc
Current Illness: None, Last prior illness was November 2020 he had Cdiff and was at Hospital but per facility the patient was fully recovered from this.
Preexisting Conditions: Forgetfulness/Mild Dementia, Diabetes, Obese, Urinary Flow Issues all per facility and MAR
Diagnostic Lab Data: None
CDC Split Type:
Write-up: The patient reported feeling well. I discussed with him the Covid-19 vaccine and he was able to state that he wanted it and to sign his consent form. The facility reported they had discussed this with him and he had agreed prior to my visit.
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21525 Ridgetop Circle, Suite 100, Sterling, VA 20166