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This is VAERS ID 1156328

History of Changes from the VAERS Wayback Machine

First Appeared on 4/1/2021

VAERS ID: 1156328
VAERS Form:2
Age:72.0
Sex:Male
Location:Puerto Rico
Vaccinated:2021-03-03
Onset:2021-03-29
Submitted:0000-00-00
Entered:2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-29
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
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death on 03/29/2021

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1156328&WAYBACKHISTORY=ON


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