National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/26/2021 release of VAERS data:

This is VAERS ID 1346657

Government Disclaimer on use of this data



Case Details

VAERS ID: 1346657 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-02-18
Onset:2021-02-19
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031M20A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Arrhythmia, Autopsy, Blood immunoglobulin E increased, Death, Histology, SARS-CoV-2 test negative, Seizure, Toxicologic test, Tryptase
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Clonidine, Vyvanse, Vraylor
Current Illness: none
Preexisting Conditions: Autism and ADHD
Allergies:
Diagnostic Lab Data: Autopsy with histology, toxicology, postmortem Covid-19 PCR test negative, post mortem Tryptase normal and elevated elevated IgE, cause and manner of death undetermined, Covid-19 not suspected cause, suspected cause heart arrhythmia (family history, history of chest pain, and medications) or seizure.
CDC Split Type:

Write-up: Found deceased in bed, no known symptoms, undetermined cause and manner of death


New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=1346657


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