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This is VAERS ID 1084800

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/19/2021

VAERS ID: 1084800
VAERS Form:2
Age:54.0
Sex:Female
Location:Texas
Vaccinated:2021-03-08
Onset:2021-03-08
Submitted:0000-00-00
Entered:2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Cardiac arrest, Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-08
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: unknown
Current Illness: none reported
Preexisting Conditions: liver transplant. Doctor advised pt to get the covid vaccine.
Allergies: NKDAnone reported
Diagnostic Lab Data: Sent to ME office for autopsy
CDC 'Split Type':

Write-up: Death. EMS called to residence 9 hours later for cardiac arrest. Pt pronounced at Emergency Room. Pt sent to ME office for autopsy.


Changed on 5/7/2021

VAERS ID: 1084800 Before After
VAERS Form:2
Age:54.0
Sex:Female
Location:Texas
Vaccinated:2021-03-08
Onset:2021-03-08
Submitted:0000-00-00
Entered:2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Cardiac arrest, Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-08
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: unknown
Current Illness: none reported
Preexisting Conditions: liver transplant. Doctor advised pt to get the covid vaccine.
Allergies: NKDAnone reported reported
Diagnostic Lab Data: Sent to ME office for autopsy
CDC 'Split Type':

Write-up: Death. EMS called to residence 9 hours later for cardiac arrest. Pt pronounced at Emergency Room. Pt sent to ME office for autopsy.


Changed on 5/21/2021

VAERS ID: 1084800 Before After
VAERS Form:2
Age:54.0
Sex:Female
Location:Texas
Vaccinated:2021-03-08
Onset:2021-03-08
Submitted:0000-00-00
Entered:2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012A21A / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Cardiac arrest, Death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-08
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: unknown
Current Illness: none reported
Preexisting Conditions: liver transplant. Doctor advised pt to get the covid vaccine.
Allergies: NKDAnone reported reported
Diagnostic Lab Data: Sent to ME office for autopsy
CDC 'Split Type':

Write-up: Death. EMS called to residence 9 hours later for cardiac arrest. Pt pronounced at Emergency Room. Pt sent to ME office for autopsy.

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