VAERS ID: 1535066

AGE: 64| SEX: M|STATE: CT (United States)

Description

Perforated bowel that was sudden and caused sepsis.

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Symptoms

Sepsis, Intestinal perforation, Death

Vaccines

VAX DATE: 03-13-2021| ONSET DATE: 07-04-2021| DAYS TO ONSET: 113
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 2 COVID19 MODERNA IM Unknown

RECVDATE:08-07-2021
RPT_DATE:
CAGE_YR:64
CAGE_MO:
DIED:Y
DATEDIED:07-27-2021
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:
V_ADMINBY:
OTHER_MEDS:None
CUR_ILL:None
HISTORY:None known at the time of vaccination but he had a sudden and violent bowel perforation leading to sepsis and death.
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:08-07-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:None
V_FUNDBY:

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