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This is VAERS ID 1490511

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1490511
VAERS Form:2
Age:58.0
Sex:Male
Location:Alabama
Vaccinated:2021-07-01
Onset:2021-07-21
Submitted:0000-00-00
Entered:2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Blood glucose increased, Cardiac arrest, Condition aggravated, Diabetes mellitus, Syncope

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-07-21
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: Metformin
Current Illness: None known
Preexisting Conditions: CHF, NIDDM
Allergies: NKDA
Diagnostic Lab Data: BGL 600
CDC 'Split Type':

Write-up: Family notes patient started to have issues controlling blood glucose levels, prior to day of event patient had syncope episodes. 7/21/2021 patient had sudden cardiac arrest.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1490511&WAYBACKHISTORY=ON

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