National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1360114

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1360114
VAERS Form:2
Age:42.0
Sex:Male
Location:California
Vaccinated:2021-04-11
Onset:2021-04-13
Submitted:0000-00-00
Entered:2021-05-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / SYR

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Hypotension, Pain

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-17
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: None
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Soarness, low blood pressure and then death.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1360114&WAYBACKHISTORY=ON

Government Disclaimer on use of this data


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166