Report #2877629

Received Dec 12, 2025

Died

A note on interpretation. VAERS reports are unverified and may be incomplete or coincidental. A report does not establish that a vaccine caused an event, and counts should not be used to calculate incidence or infer causation. Full disclaimer

Overview

Sex: Male
Age: 80 yrs
State: AL
Recovered: Not recovered
Vaccinated: Apr 17, 2021
Onset: Jun 18, 2021
Days to onset: 62
Hospital days: —

Vaccines (2)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA MNEXSPIKE))	MODERNA	1	007B21A	IM / LA
COVID19	COVID19 (COVID19 (MODERNA MNEXSPIKE))	MODERNA	2	046B21A	IM / LA

Symptoms (2)

Cardiac arrestDeath

Symptom narrative

2nd jab on 5/15/2021 at the same pharmacy. Death by cardiac arrest June 19 2021.

Current illness

None

Medical history

None

Other medications

Tums

Allergies

None

Lab data

None