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This is VAERS ID 991216

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 991216
VAERS Form:2
Age:70.0
Sex:Male
Location:Kansas
Vaccinated:2021-01-26
Onset:2021-01-28
Submitted:0000-00-00
Entered:2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J202A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-28
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: Unknown
Current Illness:
Preexisting Conditions: History of Heart Condition
Allergies: NKDA
Diagnostic Lab Data: Unknown
CDC 'Split Type': 921134 WebIZ #

Write-up: Vaccine given on 01-25-2021. Wife reported on 01-29-2021 that patient had a ran a fever on 01-26-2021, Was better on 01-27-2021. She found him dead when she came home work on the evening of 01-28-2021.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=991216&WAYBACKHISTORY=ON


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