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This is VAERS ID 1430978

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1430978
VAERS Form:2
Age:40.0
Sex:Male
Location:Texas
Vaccinated:2021-03-31
Onset:2021-04-04
Submitted:0000-00-00
Entered:2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / IM

Administered by: Other      Purchased by: ??
Symptoms: Death, Dizziness, Nausea, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-04
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: Received COVID-19 monoclonal antibodies 02/2021
Current Illness: tested positive for COVID-19 on 01/28/2021 via PCR testing
Preexisting Conditions: Obesity
Allergies:
Diagnostic Lab Data: 01/28/2021 COVID-19 PCR test positive
CDC 'Split Type':

Write-up: 03/31/2021 received 1st dose of Moderna COVID-19 vaccine 04/01/2021 104 F fever, dizziness, nausea 04/03/2021 symptoms subsided 04/04/2021 case expired as a result of undetermined natural causes per medical examiner final report

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1430978&WAYBACKHISTORY=ON

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