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This is VAERS ID 1343543

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1343543
VAERS Form:2
Age:84.0
Sex:Male
Location:Illinois
Vaccinated:2021-02-23
Onset:2021-04-13
Submitted:0000-00-00
Entered:2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011M20A / 2 AR / IM

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-13
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: Anemia, Asthma, diabetes, dyslipidemia, Heart Disease, HTN, Open Heart Surgery, Stroke, Thyroid dysfunction, Dementia, Afib, CKD stage 4, infrarenal AAA, chronic hyponatremia, TIA
Allergies: Beta-blockers; Cipro; Hydrochlorothiazide; Rubella Vaccine; Tetanus Toxoid
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Death within 90 Days

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1343543&WAYBACKHISTORY=ON

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