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This is VAERS ID 1371420

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1371420
VAERS Form:2
Age:58.0
Sex:Male
Location:Arizona
Vaccinated:2021-02-17
Onset:2021-02-20
Submitted:0000-00-00
Entered:2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-20
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: unknown
Current Illness: unknown
Preexisting Conditions: gastroesophageal reflux disease degenerative joint disease hepatitis C scoliosis ulnar neuropathy reactive airway disease seasonal allergies chronic pain alcohol abuse hypertension
Allergies: NKA
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: patient expired 3 days after first vaccination. Did not present to our facility for care after vaccination; did not have any adverse reactions during vaccination waiting period. Per the Medical examiner, patient passed away at his residence, and his death was not related to the COVID vaccine.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1371420&WAYBACKHISTORY=ON

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