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This is VAERS ID 1365007

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History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1365007
VAERS Form:2
Age:27.0
Sex:Male
Location:Connecticut
Vaccinated:2021-01-18
Onset:2021-01-23
Submitted:0000-00-00
Entered:2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Cardiac arrest

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-25
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unk
Current Illness: unk
Preexisting Conditions: weakened immune system
Allergies: no
Diagnostic Lab Data: unknown
CDC 'Split Type':

Write-up: I do not know the individuals medical hx or illness/complications. Due to new information circulating related to mRNA vaccines and myocarditis/pericarditis and being made aware that this person had suffered cardiac arrest after being admit to the hospital following complications with their health it warrants being reported regardless of prior health conditions.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=1365007&WAYBACKHISTORY=ON


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