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|History of Changes from the VAERS Wayback Machine|
|Vaccination / Manufacturer||Lot / Dose||Site / Route|
|COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA||016B21A / 2||RA / IM|
Administered by: Other Purchased by: ??
Symptoms: Death, Nausea, Unresponsive to stimuli, Vomiting
Life Threatening? No
Birth Defect? No
Permanent Disability? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Preexisting Conditions: ESRD, Type II DM with diabetic CKD, Long term use of insulin, Iron deficiency anemia, unspecified, Anemia in CKD, unspecified protein-calorie malnutrition, Other disorders of phosphorus metabolism, Unspecified amyloidosis, Blindness both eyes, Hypertensive CKD with stage 5 CKD, renal osteodystrophy, secondary hyperparathyroidism of renal origin, dependence on renal dialysis, renal osteodystrophy
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Per family patient reported c/o nausea and vomiting at home post treatment on 3/30/2021, he went to bed and was found unresponsive on 3/31, EMS was contacted and pronounced deceased at home on 3/31/2021. (exact time unknown).
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