National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1761871

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1761871
VAERS Form:2
Age:78.0
Sex:Male
Location:Illinois
Vaccinated:2021-03-10
Onset:2021-09-02
Submitted:0000-00-00
Entered:2021-10-05
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:
Allergies:
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

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1761871&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166