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From the 5/7/2021 release of VAERS data (an older release, current is 11/19/2021):

This is VAERS ID 1272476

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Case Details

VAERS ID: 1272476 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-04-23
Onset:2021-04-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Death, Dizziness, Malaise
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-26
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: I do not know
Current Illness: Do not know
Preexisting Conditions: Diabetes
Allergies: Do not know
Diagnostic Lab Data:
CDC Split Type:

Write-up: She was quite sick, dizzy, went to ER three times between Saturday and Sunday, they sent her home each time, she died Monday morning.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210507&IDNUMBER=1272476


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