Adverse Event Reporting
| VAERS ID | 1433503 |
|---|---|
| Gender | Male |
| Age | 81 |
| StateCode | MN |
| Pharmaceutical Company | MODERNA |
| Lot Number | 041L20A |
| Number of vaccinations | 1 |
| Vaccinated | 2021-01-29 |
| Onset | 2021-03-14 |
| Condition | Died |
Symptoms
- Death
Current Illness
Preexisting Conditions
Hypertension, AFib, CHF, Type 2 diabetes, chronic lymphocytic leukemia
Other Medications
Tylenol, Ativan, GenTeal Tears, Haldol, Roxanol, Triple antibiotic ointment, Aspercreme
Previous Vaccinations
Allergies
Penicillins
Laboratory Data
Write-up
Patient passed away on 03/14/2021