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This is VAERS ID 1081305

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/11/2021

VAERS ID: 1081305
VAERS Form:2
Age:59.0
Sex:Male
Location:Nebraska
Vaccinated:2021-02-26
Onset:2021-02-27
Submitted:0000-00-00
Entered:2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 AR / IM

Administered by: Military      Purchased by: ??
Symptoms: Sudden death, Autopsy, Cardiac disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-27
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:
Current Illness:
Preexisting Conditions: Cardiac disease
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Sudden death approximately 24 hours after receiving 2nd COVID vaccine - symptoms unknown - autopsy revealed cardiac disease as the cause of death


Changed on 5/7/2021

VAERS ID: 1081305 Before After
VAERS Form:2
Age:59.0
Sex:Male
Location:Nebraska
Vaccinated:2021-02-26
Onset:2021-02-27
Submitted:0000-00-00
Entered:2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 AR / IM

Administered by: Military      Purchased by: ??
Symptoms: Sudden death, Autopsy, Cardiac disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-27
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:
Current Illness:
Preexisting Conditions: Cardiac disease
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Sudden death approximately 24 hours after receiving 2nd COVID vaccine - symptoms unknown - autopsy revealed cardiac disease as the cause of death


Changed on 5/14/2021

VAERS ID: 1081305 Before After
VAERS Form:2
Age:59.0
Sex:Male
Location:Nebraska
Vaccinated:2021-02-26
Onset:2021-02-27
Submitted:0000-00-00
Entered:2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 AR / IM

Administered by: Military      Purchased by: ??
Symptoms: Sudden death, Autopsy, Cardiac disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-27
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:
Current Illness:
Preexisting Conditions: Cardiac disease
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Sudden death approximately 24 hours after receiving 2nd COVID vaccine - symptoms unknown - autopsy revealed cardiac disease as the cause of death

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1081305&WAYBACKHISTORY=ON


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