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This is VAERS ID 1228010

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1228010
VAERS Form:2
Age:33.0
Sex:Male
Location:Unknown
Vaccinated:2021-03-08
Onset:2021-03-17
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death, High risk sexual behaviour, Overdose, Drug screen positive, Chlamydial infection, Chlamydia test negative, Substance use disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-17
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death Narrative: Patient was not previously Covid positive and did not have any predisposing factors(PMH, allergies, etc.) for experiencing an adverse drug event. The ADR did not occur at the time of administration of the vaccine nor was there an ADR that occurred between the observation period and the date of death. Patient died of a drug overdose and had a UDS positive for fentanyl and alcohol on 3/8/21 patient tested positive for Chlamydia due to high risk sexual behavior and substance use disorder. Patient was admitted to facility on 2/26/21 to detox from alcohol.


Changed on 5/7/2021

VAERS ID: 1228010 Before After
VAERS Form:2
Age:33.0
Sex:Male
Location:Unknown
Vaccinated:2021-03-08
Onset:2021-03-17
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death, High risk sexual behaviour, Overdose, Drug screen positive, Chlamydial infection, Chlamydia test negative, Substance use disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-17
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death Narrative: Patient was not previously Covid positive and did not have any predisposing factors(PMH, allergies, etc.) for experiencing an adverse drug event. The ADR did not occur at the time of administration of the vaccine nor was there an ADR that occurred between the observation period and the date of death. Patient died of a drug overdose and had a UDS positive for fentanyl and alcohol on 3/8/21 patient tested positive for Chlamydia due to high risk sexual behavior and substance use disorder. Patient was admitted to facility on 2/26/21 to detox from alcohol.


Changed on 5/14/2021

VAERS ID: 1228010 Before After
VAERS Form:2
Age:33.0
Sex:Male
Location:Unknown
Vaccinated:2021-03-08
Onset:2021-03-17
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death, High risk sexual behaviour, Overdose, Drug screen positive, Chlamydial infection, Chlamydia test negative, Substance use disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-17
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death Narrative: Patient was not previously Covid positive and did not have any predisposing factors(PMH, allergies, etc.) for experiencing an adverse drug event. The ADR did not occur at the time of administration of the vaccine nor was there an ADR that occurred between the observation period and the date of death. Patient died of a drug overdose and had a UDS positive for fentanyl and alcohol on 3/8/21 patient tested positive for Chlamydia due to high risk sexual behavior and substance use disorder. Patient was admitted to facility on 2/26/21 to detox from alcohol.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1228010&WAYBACKHISTORY=ON

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