National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 5/14/2021 release of VAERS data (an older release, current is 11/26/2021):

This is VAERS ID 1088184

Government Disclaimer on use of this data



Case Details

VAERS ID: 1088184 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-06
Onset:2021-03-09
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-09
   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: Furosemide, Omeprazole, Xarelto, Vitamin D3, Propranolol, Sucralfate, Spironolactone
Current Illness: Unknown
Preexisting Conditions: Seizures, unknown
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pronounced dead on 3/9/21 approximately 72 hours after receiving vaccination. Unknown symptoms prior.


New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210514&IDNUMBER=1088184


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