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This is VAERS ID 1672341

History of Changes from the VAERS Wayback Machine

First Appeared on 9/10/2021

VAERS ID: 1672341
VAERS Form:2
Age:80.0
Sex:Male
Location:New York
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-09-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20212

Write-up: passed away; bubbles like blisters in the face/neck /back /arms / legs; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (passed away) and BLISTER (bubbles like blisters in the face/neck /back /arms /legs) in an 80-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced DEATH (passed away) (seriousness criteria death and medically significant) and BLISTER (bubbles like blisters in the face/neck /back /arms / legs) (seriousness criterion death). The reported cause of death was bubbles like blisters in the face/neck /back /arms / legs. It is unknown if an autopsy was performed. Concomitant products were not provided. Treatment medication were not reported. Patient was healthy in his 80s. The patient had bubbles like blisters in the face and in the back of the neck, back and arms, and legs. This is a case of death in a 80-year-old male patient after receiving vaccine. The patient also experienced blisters in the face and in the back of the neck, back and arms, and legs. Very limited information has been provided at this time.; Sender''s Comments: This is a case of death in a 80-year-old male patient after receiving vaccine. The patient also experienced blisters in the face and in the back of the neck, back and arms, and legs.Very limited information has been provided at this time.; Reported Cause(s) of Death: passed away; bubbles like blisters in the face/neck /back /arms / legs

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1672341&WAYBACKHISTORY=ON

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