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This is VAERS ID 1761871

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First Appeared on 10/8/2021

VAERS ID: 1761871
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032B21A / 2 - / -

Administered by: Private      Purchased by: ??
Symptoms: Death, Dyspnoea, Septic shock, Syncope, Endotracheal intubation, COVID-19, SARS-CoV-2 test positive, Positive airway pressure therapy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-09-12
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: antigen Covid test positive on 9/2
CDC 'Split Type':

Write-up: pt admitted on 9/2 syncopy and sob, pt placed on cpap in er condition continued to worse, pt intubated pt went into septic shock and expired on 9/12/21

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