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This is VAERS ID 1302844

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History of Changes from the VAERS Wayback Machine

First Appeared on 5/14/2021

VAERS ID: 1302844
VAERS Form:2
Age:29.0
Sex:Male
Location:Texas
Vaccinated:2021-05-06
Onset:2021-05-07
Submitted:0000-00-00
Entered:2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 2 - / SYR

Administered by: Private      Purchased by: ??
Symptoms: Abdominal pain, Chest pain, Death, Dyspnoea, Lethargy, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-09
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: Hydroxyzine pamoate
Current Illness:
Preexisting Conditions: Hypertension, non-insulin dependent diabetes
Allergies: None
Diagnostic Lab Data: Autopsy on May 10, 2021. Results pending.
CDC 'Split Type':

Write-up: Lethargy began the day of vaccine and shortness of breath along with abdominal and chest pain followed the next day. Decedent was found deceased the next evening.

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