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This is VAERS ID 1463986

History of Changes from the VAERS Wayback Machine

First Appeared on 7/16/2021

VAERS ID: 1463986
VAERS Form:2
Age:48.0
Sex:Male
Location:Michigan
Vaccinated:2021-06-15
Onset:2021-07-01
Submitted:0000-00-00
Entered:2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 050C21A / 2 UN / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Hypoxia, Pneumonia, Pyelonephritis, Sepsis, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? No
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: 13     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: COVID19 Negative test 6/30/21
CDC 'Split Type':

Write-up: Patient admitted for sepsis/pyelonephritis/pneumonia/hypoxemia. COVID 19 negative.

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