VAERS ID: 1052226

AGE: 62| SEX: M|STATE: MS (United States)

Description

Patient discovered unresponsive in cell, blue coloration to skin, vital signs, undetectable. CPR initiated, Ambulance summoned. Following EMS arrival with additional unsuccessful attempts to revive patient, patient was determined to have expired.

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Symptoms

Cyanosis, Unresponsive to stimuli, Death, Resuscitation

Vaccines

VAX DATE: 02-11-2021| ONSET DATE: 02-13-2021| DAYS TO ONSET: 2
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 1 COVID19 MODERNA 015M20A IM AR

RECVDATE:02-24-2021
RPT_DATE:
CAGE_YR:62
CAGE_MO:
DIED:Y
DATEDIED:02-13-2021
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:
V_ADMINBY:OTH
OTHER_MEDS:Alveso, Xopenex, Aspirin, Atorvastatin, Cetirizine, Fiber, Hydralazine, Hydrochlorothiazide, Levothyroxine, Lisinopril, Meloxicam, Metformin, Metoprolol, Novolin,
CUR_ILL:
HISTORY:Arthritis, Diabetes Mellitus, Diabetic Neuropathy, Venous Insufficiency in Lower Extremity, Hypothyroidism, Chronic Obstructive Pulmonary Disease, Hypothyroidism, Obesity
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:02-24-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:Bactrim
V_FUNDBY:

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