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This is VAERS ID 1365410

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1365410
VAERS Form:2
Age:52.0
Sex:Male
Location:Maryland
Vaccinated:2021-02-28
Onset:2021-03-15
Submitted:0000-00-00
Entered:2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026A21A / 1 UN / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Cardiac arrest, Cardioversion, Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-15
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: HTN meds
Current Illness: NA
Preexisting Conditions: HYPERTENSION
Allergies: Penicillin
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: ON 3/15/21 patient was found unresponsive by spouse. EMS was called. Patient was found to have cardiac arrest Was given Epinephrine, Amiodarone and External Ventricular defibrillation Patient passed away on 3/15/21

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1365410&WAYBACKHISTORY=ON

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