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This is VAERS ID 1355831

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1355831
VAERS Form:2
Age:87.0
Sex:Male
Location:California
Vaccinated:2021-04-09
Onset:2021-04-10
Submitted:0000-00-00
Entered:2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038B21A / 2 - / SYR

Administered by: Private      Purchased by: ??
Symptoms: Death, Injection site pain, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-10
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: Metformin
Current Illness:
Preexisting Conditions: Arthritis
Allergies: Nkda
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Site pain Vomiting fever death

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1355831&WAYBACKHISTORY=ON

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