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This is VAERS ID 1365485

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1365485
VAERS Form:2
Age:30.0
Sex:Male
Location:California
Vaccinated:2021-05-26
Onset:2021-05-27
Submitted:0000-00-00
Entered:2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Chills, Cough, Death, Dyspnoea, Injection site pain, Pyrexia, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-28
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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Coroner''s autopsy
CDC 'Split Type':

Write-up: On 05/27/2021 the decedent began complaining of shortness of breath, cough, fever, chills, and pain at the injection site. On 05/28/2021 the decedent complained of the same symptoms.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1365485&WAYBACKHISTORY=ON

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