National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 937434

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 1/15/2021

VAERS ID: 937434
VAERS Form:2
Age:70.0
Sex:Male
Location:Montana
Vaccinated:2021-01-07
Onset:2021-01-11
Submitted:0000-00-00
Entered:2021-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-12
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: None known
Preexisting Conditions: only had 1 lung
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt expired due to possible cardiac arrest. Unsure if this was vaccine related.


Changed on 5/7/2021

VAERS ID: 937434 Before After
VAERS Form:2
Age:70.0
Sex:Male
Location:Montana
Vaccinated:2021-01-07
Onset:2021-01-11
Submitted:0000-00-00
Entered:2021-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-12
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: None known
Preexisting Conditions: only had 1 lung
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt expired due to possible cardiac arrest. Unsure if this was vaccine related.


Changed on 5/14/2021

VAERS ID: 937434 Before After
VAERS Form:2
Age:70.0
Sex:Male
Location:Montana
Vaccinated:2021-01-07
Onset:2021-01-11
Submitted:0000-00-00
Entered:2021-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20 / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-12
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: None known
Preexisting Conditions: only had 1 lung
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt expired due to possible cardiac arrest. Unsure if this was vaccine related.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=937434&WAYBACKHISTORY=ON


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