National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1371740

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1371740
VAERS Form:2
Age:87.0
Sex:Male
Location:Minnesota
Vaccinated:2021-05-04
Onset:2021-05-20
Submitted:0000-00-00
Entered:2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0146214 / 1 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

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? No
Previous Vaccinations:
Other Medications: Remeron, Tylenol, Abilify, Senna, Polyethylene Glycol, Vitamin D3, Flomax, Mirabegron, Morphine Sulfate
Current Illness: HTN
Preexisting Conditions: Vascular Dementia, Depression, HTN, BPH, History of COVID-19
Allergies: Lisinopril, Hydrochlorothiazide
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Resident was found in his bed to be passed away. He had been on Hospice.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1371740&WAYBACKHISTORY=ON

Government Disclaimer on use of this data


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166