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This is VAERS ID 1762046

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1762046
VAERS Form:2
Age:69.0
Sex:Male
Location:Hawaii
Vaccinated:2021-04-01
Onset:2021-09-22
Submitted:0000-00-00
Entered:2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Death, COVID-19

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-09-22
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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: COVID illness and death.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1762046&WAYBACKHISTORY=ON


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