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|History of Changes from the VAERS Wayback Machine|
|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
Permanent Disability? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Other Medications: HTN meds
Current Illness: NA
Preexisting Conditions: HYPERTENSION
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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