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This is VAERS ID 1371594

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1371594
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Private      Purchased by: ??
Symptoms: Cardiac arrest, Death, Ventricular fibrillation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-11
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: atorvastatin 10 mg, vitamin D3 50 mcg, hydrochlorothiazide 25 mg, multivitamin, potassium 99 mg, vitamin E 1200 mg
Current Illness:
Preexisting Conditions:
Allergies: oxycodone
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: cardiac arrest (V fib) treated: with amiodarone, magnesium, 6 doses of epi, calcium, bicarb. Achieved ROSC. outcome: withdrawal of care

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