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This is VAERS ID 1232799

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1232799
VAERS Form:2
Age:56.0
Sex:Male
Location:Kentucky
Vaccinated:2021-04-06
Onset:2021-04-09
Submitted:0000-00-00
Entered:2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-09
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: citalopram 20mg, Lyrica 200mg, oxycodone 15mg, Xanax 1mg
Current Illness: none
Preexisting Conditions: Charcot-Marie Tooth Disease, Anxiety
Allergies: none
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: No information really known. Office was notified yesterday by county coroner that patient was found deceased in his home on 4/9/19. Coroner was requesting patient records. Unknown if death related to the Moderna Covie-19 vaccine but reporting this as death occurred 3 days after the vaccine and coroner gave office no information. You can contact the coroner involved with this case.


Changed on 5/7/2021

VAERS ID: 1232799 Before After
VAERS Form:2
Age:56.0
Sex:Male
Location:Kentucky
Vaccinated:2021-04-06
Onset:2021-04-09
Submitted:0000-00-00
Entered:2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-09
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: citalopram 20mg, Lyrica 200mg, oxycodone 15mg, Xanax 1mg
Current Illness: none
Preexisting Conditions: Charcot-Marie Tooth Disease, Anxiety
Allergies: none none
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: No information really known. Office was notified yesterday by county coroner that patient was found deceased in his home on 4/9/19. Coroner was requesting patient records. Unknown if death related to the Moderna Covie-19 vaccine but reporting this as death occurred 3 days after the vaccine and coroner gave office no information. You can contact the coroner involved with this case.


Changed on 5/14/2021

VAERS ID: 1232799 Before After
VAERS Form:2
Age:56.0
Sex:Male
Location:Kentucky
Vaccinated:2021-04-06
Onset:2021-04-09
Submitted:0000-00-00
Entered:2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 020B21A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-09
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: citalopram 20mg, Lyrica 200mg, oxycodone 15mg, Xanax 1mg
Current Illness: none
Preexisting Conditions: Charcot-Marie Tooth Disease, Anxiety
Allergies: none none
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: No information really known. Office was notified yesterday by county coroner that patient was found deceased in his home on 4/9/19. Coroner was requesting patient records. Unknown if death related to the Moderna Covie-19 vaccine but reporting this as death occurred 3 days after the vaccine and coroner gave office no information. You can contact the coroner involved with this case.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1232799&WAYBACKHISTORY=ON

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