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This is VAERS ID 1218779

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1218779
VAERS Form:2
Age:78.0
Sex:Female
Location:Maryland
Vaccinated:2021-04-14
Onset:2021-04-16
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA O31B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-16
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: Basaglar, Trulicity, Metformin, Plavix, Crestor, Lasix, Enalapril, Synthroid, Arimidex, Xanax
Current Illness: No acute illness at the time of the vaccine. Was having problems with uncontrolled DM2.
Preexisting Conditions: DM2, HPL, HTN, Breast CA in remission, Lung CA in remission, CVA, hypothyroidism, asthma
Allergies: Codeine, Invokana, Glyburide, Aleve, Aromacin
Diagnostic Lab Data: None. Found dead outside of home by EMS.
CDC 'Split Type':

Write-up: Death


Changed on 5/7/2021

VAERS ID: 1218779 Before After
VAERS Form:2
Age:78.0
Sex:Female
Location:Maryland
Vaccinated:2021-04-14
Onset:2021-04-16
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA O31B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-16
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: Basaglar, Trulicity, Metformin, Plavix, Crestor, Lasix, Enalapril, Synthroid, Arimidex, Xanax
Current Illness: No acute illness at the time of the vaccine. Was having problems with uncontrolled DM2.
Preexisting Conditions: DM2, HPL, HTN, Breast CA in remission, Lung CA in remission, CVA, hypothyroidism, asthma
Allergies: Codeine, Invokana, Glyburide, Aleve, Aromacin Aromacin
Diagnostic Lab Data: None. Found dead outside of home by EMS.
CDC 'Split Type':

Write-up: Death


Changed on 5/21/2021

VAERS ID: 1218779 Before After
VAERS Form:2
Age:78.0
Sex:Female
Location:Maryland
Vaccinated:2021-04-14
Onset:2021-04-16
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA O31B21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-16
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: Basaglar, Trulicity, Metformin, Plavix, Crestor, Lasix, Enalapril, Synthroid, Arimidex, Xanax
Current Illness: No acute illness at the time of the vaccine. Was having problems with uncontrolled DM2.
Preexisting Conditions: DM2, HPL, HTN, Breast CA in remission, Lung CA in remission, CVA, hypothyroidism, asthma
Allergies: Codeine, Invokana, Glyburide, Aleve, Aromacin Aromacin
Diagnostic Lab Data: None. Found dead outside of home by EMS.
CDC 'Split Type':

Write-up: Death

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