Adverse Event Reporting
| VAERS ID | 918487 |
|---|---|
| Gender | Male |
| Age | 94 |
| StateCode | MI |
| Pharmaceutical Company | MODERNA |
| Lot Number | 011L2OA |
| Number of vaccinations | 1 |
| Vaccinated | 2020-01-02 |
| Onset | 2021-01-04 |
| Condition | Died |
Symptoms
- Death
- Cardiac arrest
Current Illness
NSTEMI, Dementia, TIA, COVID-19, HTN, CVA, PVD
Preexisting Conditions
HTN, PVD, Dementia
Other Medications
Loratadine, Plavix, flomax, Lisinopril, atrovastatin, amlodipine, Pentoxifylline, ASA, Donepezil, trazodone, Metoprolol tartrate.
Previous Vaccinations
Allergies
Beta Adrenergic Blockers
Laboratory Data
None
Write-up
Two days post vaccine patient went into cardiac arrest and passed away.