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This is VAERS ID 1369287

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History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1369287
VAERS Form:2
Age:26.0
Sex:Male
Location:Minnesota
Vaccinated:2021-03-31
Onset:2021-04-03
Submitted:0000-00-00
Entered:2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027D21A / 2 AR / IM

Administered by: School      Purchased by: ??
Symptoms: Cardiac arrest, Chest pain, Chills, Fatigue, Headache, Vaccination complication, Sudden cardiac death, Autopsy, Toxicologic test normal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-03
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: None.
Current Illness: None.
Preexisting Conditions: None.
Allergies: None known.
Diagnostic Lab Data: Autopsy showed no anatomic cause of death; toxicology non-contributory. Suspect possible undiagnosed underlying genetic arrhythmia syndrome. Parents suspect a vaccine-related death.
CDC 'Split Type':

Write-up: Sudden cardiac death. After vaccine patient experienced headache, chills, fatigue, chest pain and did not seek medical care. He had a witnessed cardiac arrest less than 3 days after vaccine #2.

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