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This is VAERS ID 1117316

History of Changes from the VAERS Wayback Machine

First Appeared on 3/26/2021

VAERS ID: 1117316
VAERS Form:2
Age:69.0
Sex:Male
Location:Ohio
Vaccinated:2021-03-18
Onset:2021-03-19
Submitted:0000-00-00
Entered:2021-03-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-19
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: Unknown - Patient has never filled prescriptions
Current Illness: Unknown
Preexisting Conditions: Unknown - Patient did not see a health provider in the past year
Allergies: None
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Sister in law called on 3-19-2021 to report that had died a day after receiving his Moderna vaccine. She stated he was found in his driveway and was unable to be resuscitated after being rushed to the hospital.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1117316&WAYBACKHISTORY=ON


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