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This is VAERS ID 1064294

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/5/2021

VAERS ID: 1064294
VAERS Form:2
Age:92.0
Sex:Female
Location:California
Vaccinated:2021-02-26
Onset:2021-02-28
Submitted:0000-00-00
Entered:2021-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 2 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-28
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan 50 mg bid, Calcium Carbonate 500 nmg qd, Aspirin 81 mg qd, multivitamins, Macuhealth
Current Illness: none
Preexisting Conditions: Hypertension, Hyperlipidemia, Diverticulosis, Osteopenia, Kyphosis
Allergies: nkda
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Death on 2-28-21. Not felt by this provider to be likely related to vaccination.


Changed on 5/7/2021

VAERS ID: 1064294 Before After
VAERS Form:2
Age:92.0
Sex:Female
Location:California
Vaccinated:2021-02-26
Onset:2021-02-28
Submitted:0000-00-00
Entered:2021-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 2 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-28
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan 50 mg bid, Calcium Carbonate 500 nmg qd, Aspirin 81 mg qd, multivitamins, Macuhealth
Current Illness: none
Preexisting Conditions: Hypertension, Hyperlipidemia, Diverticulosis, Osteopenia, Kyphosis
Allergies: nkda nkda
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Death on 2-28-21. Not felt by this provider to be likely related to vaccination.


Changed on 5/21/2021

VAERS ID: 1064294 Before After
VAERS Form:2
Age:92.0
Sex:Female
Location:California
Vaccinated:2021-02-26
Onset:2021-02-28
Submitted:0000-00-00
Entered:2021-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M20A / 2 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-28
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Losartan 50 mg bid, Calcium Carbonate 500 nmg qd, Aspirin 81 mg qd, multivitamins, Macuhealth
Current Illness: none
Preexisting Conditions: Hypertension, Hyperlipidemia, Diverticulosis, Osteopenia, Kyphosis
Allergies: nkda nkda
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Death on 2-28-21. Not felt by this provider to be likely related to vaccination.

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