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This is VAERS ID 1509547

History of Changes from the VAERS Wayback Machine

First Appeared on 7/30/2021

VAERS ID: 1509547
VAERS Form:2
Age:73.0
Sex:Male
Location:Unknown
Vaccinated:2021-04-22
Onset:2021-05-25
Submitted:0000-00-00
Entered:2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA N/A / 2 UN / UN

Administered by: Unknown      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-06-26
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 21     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had an ED visit and/or hospitalization within 6 weeks of receiving COVID vaccine.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1509547&WAYBACKHISTORY=ON

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