Adverse Event Reporting
| VAERS ID | 2331916 |
|---|---|
| Gender | Male |
| Age | 86 |
| StateCode | |
| Pharmaceutical Company | MODERNA |
| Lot Number | 030L20A |
| Number of vaccinations | 2 |
| Vaccinated | 2021-01-30 |
| Onset | 2022-01-18 |
| Condition | Died |
Symptoms
- SARS-CoV-2 test positive
- COVID-19
- Death
Current Illness
Preexisting Conditions
Other Medications
Previous Vaccinations
Allergies
Laboratory Data
Write-up
1/18/22 pt had a positive COVID test ordered by a local HCF; per death certificate, the manner of death was natural, the cause of death was COVID 19; the pt died at his residence