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This is VAERS ID 1371446

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1371446
VAERS Form:2
Age:67.0
Sex:Male
Location:Michigan
Vaccinated:2021-03-08
Onset:2021-05-14
Submitted:0000-00-00
Entered:2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 015M20A / 2 UN / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Lung disorder, Pneumonitis, Pulmonary granuloma, Syncope

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-20
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? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Admitted for syncopal episode on 5/14/21, found to have lung lesion with necrotizing granulomatous inflammation, deceased 5/20/21

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1371446&WAYBACKHISTORY=ON

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