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This is VAERS ID 1753844

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1753844
VAERS Form:2
Age:67.0
Sex:Male
Location:New York
Vaccinated:2021-03-04
Onset:2021-03-09
Submitted:0000-00-00
Entered:2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001A21A / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-09
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: No
Current Illness: Diabetes, Type II, Uncontrolled - 1995 HTN/Hyperlipidemia-2002 Coronary Artery Disease (CAD) - 2002 Cerebrovascular Accident (CVA) - Lt Post Medullary Infarct 5/2008. Left leg is more weaker than right. moderate persistent asthma, Peripheral Vascular Disease (PVD) Retinopathy - (2005) 2015: proliferative retinopathy OU Neuropathy - 2002 Kidney Stones, GERD/HH/Dysphagia Prostate cancer - (7/26/2016) Tx: Radical prostatectomy 9/16/2016 Urinary incontinence - (2016) Acute renal failure - (1/24/2017) GB stone - (5/7/2017) Sleep apnea on Cpap - (2001) Influenza B infection - (11/23/2017) Lumbar epidural fibrosis s/p spine stimulator trial - (11/28/2017)
Preexisting Conditions: Above
Allergies: No
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Death

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