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This is VAERS ID 1454319

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1454319
VAERS Form:2
Age:64.0
Sex:Male
Location:Delaware
Vaccinated:2021-02-20
Onset:2021-06-05
Submitted:0000-00-00
Entered:2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 2 - / SYR

Administered by: Work      Purchased by: ??
Symptoms: Death, Vaccine breakthrough infection, COVID-19

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-06-22
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: 12     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Diabetes; Cholesterol; Hypertension
Allergies: Unknown
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Breakthrough COVID related death

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