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This is VAERS ID 982472

History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 982472
VAERS Form:2
Age:72.0
Sex:Male
Location:New Jersey
Vaccinated:2021-01-19
Onset:2021-01-20
Submitted:0000-00-00
Entered:2021-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Respiratory failure

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2021-01-27
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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Eliquis, Lasix, metoprolol
Current Illness: Chf, CKD
Preexisting Conditions: CHF, CKD, DM
Allergies: None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Worsening respiratory failure 1/20/2021 death 1/27/2021

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