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This is VAERS ID 1592763

History of Changes from the VAERS Wayback Machine

First Appeared on 8/27/2021

VAERS ID: 1592763
VAERS Form:2
Age:86.0
Sex:Male
Location:Michigan
Vaccinated:2021-08-18
Onset:2021-08-19
Submitted:0000-00-00
Entered:2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052C21A / 2 LA / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Myocardial infarction, Laboratory test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-08-20
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Progressive dementia
Allergies: None
Diagnostic Lab Data: Contact Hospital. They confirmed all tests and cause of death.
CDC 'Split Type':

Write-up: Patient suffered a heart attack 18 hours later, and died less than 50 hours after 2nd vaccine injection.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1592763&WAYBACKHISTORY=ON

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