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This is VAERS ID 1362518

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1362518
VAERS Form:2
Age:89.0
Sex:Male
Location:New Mexico
Vaccinated:2021-01-27
Onset:2021-01-28
Submitted:0000-00-00
Entered:2021-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-28
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: zyrtec, allegra, montelukast, simvastatin, myrbetriq, tolterodine, tamsulosin, finasteride, promethazine
Current Illness:
Preexisting Conditions: hypothyroidism, HTN, osteoarthritis, BPH, secundum atrial sept def, CKD stage 3, hyperlipidemia, CVA, cerebral infarction,
Allergies: NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death (found down in home ) having died the night before, and he received his COVID vaccine <24 hours before his death.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1362518&WAYBACKHISTORY=ON

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