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This is VAERS ID 1006416

History of Changes from the VAERS Wayback Machine

First Appeared on 2/12/2021

VAERS ID: 1006416
VAERS Form:2
Age:53.0
Sex:Male
Location:California
Vaccinated:2021-01-13
Onset:2021-01-31
Submitted:0000-00-00
Entered:2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Myocardial infarction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-31
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:
Current Illness:
Preexisting Conditions: diabetes
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died of a heart attack on 1/31/21, 2.5 weeks after vaccination


Changed on 5/7/2021

VAERS ID: 1006416 Before After
VAERS Form:2
Age:53.0
Sex:Male
Location:California
Vaccinated:2021-01-13
Onset:2021-01-31
Submitted:0000-00-00
Entered:2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Myocardial infarction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-31
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:
Current Illness:
Preexisting Conditions: diabetes
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died of a heart attack on 1/31/21, 2.5 weeks after vaccination


Changed on 5/14/2021

VAERS ID: 1006416 Before After
VAERS Form:2
Age:53.0
Sex:Male
Location:California
Vaccinated:2021-01-13
Onset:2021-01-31
Submitted:0000-00-00
Entered:2021-02-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Myocardial infarction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-31
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:
Current Illness:
Preexisting Conditions: diabetes
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died of a heart attack on 1/31/21, 2.5 weeks after vaccination

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=1006416&WAYBACKHISTORY=ON


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