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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1670758



Case Details

VAERS ID: 1670758 (history)  
Form: Version 2.0  
Age: 81.0  
Sex: Male  
Location: California  
Vaccinated:2021-08-06
Onset:2021-08-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 078C21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Death, Drain placement, Gait inability, Incisional drainage, Joint effusion, Joint fluid drainage, Malaise, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-23
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: Zithromax
Diagnostic Lab Data: Hospital august 15th to August 19th
CDC Split Type:

Write-up: Patient got his modern shot on August 6th, 2021 between the time of 11:00-11:15 at Pharmacy. Less than 22 hours later he was violently ill, and started vomiting. He also had joint pain in his right hip and was unable to walk. For one week he stayed at home and was weak and was unable to walk. On August 15th, Patient was brought to Hospital with c/o right hip pain. At ER, he was diagnosed with fluid collection on right hip. It was a rule out septic joint. The next day he went to IR where he had 150 ml of fluid drained off his hip. At this time they placed a drain and it was draining fluid. The next day he was brought to OR with Orthopedic surgeon and he had more fluid drained off his right thigh. They said the procedure was a incision and drainage. They pulled the old drain and placed a new drain. He stayed in hospital 2 more days with the drain and received Rocephin and Vancomycin via IV catheter. While he was in hospital they were treating him with lovenox SQ injection because patient kept telling everyone he was not sick or had not fallen prior to receiving his vaccination. On Thursday he was discharged to home after the drain was pulled on just Cephalexin, and no lovenox. On Monday August 23rd 17 days after his moderna vaccination patient died at home by what was said by the coroner as "Natural Causes" . patient had not been to the Dr since 2016.


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