National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 10/15/2021 release of VAERS data:

This is VAERS ID 996259



Case Details

VAERS ID: 996259 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-01-19
Onset:2021-01-25
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death, SARS-CoV-2 test negative
SMQs:, COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-29
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluoxetine HCL, 20 mg, Magnesium Oxide, 400 mg, Atrovastatin/Calcium, 10 mg, Omprazole, 20 mg, Lisinoprilm 2.5.mg, Lyrica, 200mg, Metoprolol Tartrate, 25 mg , Potassium Chloride 20 meq,
Current Illness: COPD, Chronic Hypoxemic respiratory failure, Chronic bronchitis, Atrial Fibrillation, OSA on CPAP
Preexisting Conditions: COPD, Chronic Hypoxemic respiratory failure, Chronic bronchitis, Atrial Fibrillation,
Allergies: Wellbutrin, Niaspan
Diagnostic Lab Data: Reported by hospital patient was COVID negative. Dr. office did not receive any additional lab information or treatment to her office.
CDC Split Type:

Write-up: Unknown. Was informed that the patient went to E/R on 1/25/21 (6 days after receiving vaccine. Died 1/29/21 ( 10 days after receiving vaccine).


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=996259

Government Disclaimer on use of this data


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