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This is VAERS ID 1347105

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History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1347105
VAERS Form:2
Age:26.0
Sex:Male
Location:California
Vaccinated:2021-04-20
Onset:2021-05-01
Submitted:0000-00-00
Entered:2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001C21A / 1 - / IM

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-01
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: Lamictal, zestoretic
Current Illness: Had seizure 3.5 years prior, had "night time seizure in mid march.
Preexisting Conditions: elevated BP, seizures
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Found dead on May 3, 2021. Question day of death 05/01/2021. Medical examiners case. Cause pending, possible SUDEP.

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