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This is VAERS ID 1369968

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1369968
VAERS Form:2
Age:73.0
Sex:Male
Location:New Jersey
Vaccinated:2021-06-01
Onset:2021-06-02
Submitted:0000-00-00
Entered:2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Cardiac arrest, Death, Fatigue

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-06-02
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: multiple
Current Illness: CKD on HD, +
Preexisting Conditions: Hemodialysis
Allergies: none
Diagnostic Lab Data: ED record
CDC 'Split Type':

Write-up: Fatigue on 6/2/21 followed by cardiac arrest & death

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1369968&WAYBACKHISTORY=ON

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