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This is VAERS ID 1155829

History of Changes from the VAERS Wayback Machine

First Appeared on 4/1/2021

VAERS ID: 1155829
VAERS Form:2
Age:51.0
Sex:Male
Location:Nevada
Vaccinated:2021-03-24
Onset:2021-03-24
Submitted:0000-00-00
Entered:2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 041L20A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Cardio-respiratory arrest, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-01
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: Regular Humulin insulin, NPH insulin, Naprosyn, Creon, omeprazole, Allerchlor, Montelukast, metformin, lovastatin, glipizide, losartan
Current Illness: CAD, obesity, Diabetes, cellulitis
Preexisting Conditions: Diabetes, CAD
Allergies: NKA
Diagnostic Lab Data: FSBS 415
CDC 'Split Type':

Write-up: Cardiopulmonary arrest and death at 0822 4/1/21

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