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This is VAERS ID 1454388

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1454388
VAERS Form:2
Age:84.0
Sex:Male
Location:California
Vaccinated:2021-04-23
Onset:2021-04-01
Submitted:0000-00-00
Entered:2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037A21B / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Computerised tomogram, Death, Herpes zoster, X-ray, Laboratory test, Magnetic resonance imaging

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-06-04
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 18     Extended hospital stay? No
Previous Vaccinations:
Other Medications: High Blood Pressure, Cholesterol, Diabetes, anti-depressants medications (known)
Current Illness: none (known)
Preexisting Conditions: high blood pressure, cholesterol, type 2 diabetes
Allergies: unknown
Diagnostic Lab Data: labs, cat scans, MRIs, X-rays.
CDC 'Split Type':

Write-up: Singles virus broke out within one week of receiving the 2nd COVID-19 vaccination shot. The patient reported to Dr who was then given 400 mg of anti-virals medication. Patient did not improve and was taken to Hospital on 5/17/2021. The Patient was transferred to Hospital on 5/26/2021 and then died on 6/4/2021.

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