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This is VAERS ID 1745292

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/1/2021

VAERS ID: 1745292
VAERS Form:2
Age:67.0
Sex:Male
Location:Kentucky
Vaccinated:2021-03-27
Onset:2021-03-27
Submitted:0000-00-00
Entered:2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006B21A / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: COVID-19

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-09-28
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: Leukemia
Preexisting Conditions: Leukemia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt. contracted COVID several months after receiving vaccine.

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