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This is VAERS ID 1744331

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First Appeared on 10/1/2021

VAERS ID: 1744331
VAERS Form:2
Age:77.0
Sex:Male
Location:North Carolina
Vaccinated:2021-03-29
Onset:2021-04-01
Submitted:0000-00-00
Entered:2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0421321A / 2 RA / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Ageusia, Anosmia, Death, Dizziness, Dyspnoea, Fatigue, Headache, Nausea, Pericardial effusion, Laboratory test, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-06-09
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: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amiodarone 200 MG Tablet, Atorvastatin 20 MG Tablet, Furosemide 40 MG Tablet, Gabapentin 300 MG Capsule, Glipizide 10 MG Tablet, Magnesium Oxide 400 MG, Metolazone, 2.5 M Tablet, Metoprolol Succinate 100 MG, Nexium 40 MG Capsule, SitaGlipti
Current Illness:
Preexisting Conditions: Congestive Heart Failure, Hypertension, Coronary Artery Disease and Atrial Fibrillation
Allergies: Latex
Diagnostic Lab Data: Too many test and laboratory results to list as my father had extensive list of health issues.
CDC 'Split Type':

Write-up: Fatigue, Dizzy, Nausea, Loss of taste, Loss of smell (lasted about a week, then disappeared) Fatigue, Dizzy, Nausea, Loss of taste, Loss of smell, trouble breathing, headaches, loss of appetite(05/09/2021, went to hospital twice, was discharged too early the first time; 11 May 2021; returned to the hospital 21 May 2021 due to shortness of breath, fatigue, dizzy, nausea, loss of appetite, which the trouble breathing and shortness of breath was due to fluid build-up around the heart and his lungs). Admitted approximately late afternoon 21 May 2021 and did not get discharged, died on 9 June 2021 in the Hospice house.

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