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This is VAERS ID 1501811

History of Changes from the VAERS Wayback Machine

First Appeared on 7/30/2021

VAERS ID: 1501811
VAERS Form:2
Age:58.0
Sex:Male
Location:Florida
Vaccinated:2021-07-22
Onset:2021-07-24
Submitted:0000-00-00
Entered:2021-07-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006D21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Chills, Death, Pain in extremity, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-07-24
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: Lisinopril 40mg daily
Current Illness: None
Preexisting Conditions: High blood pressure
Allergies: None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Day of injection patient was experiencing fever and chills, also had sore arm. 2 days after the injection the patient was found dead

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1501811&WAYBACKHISTORY=ON

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