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This is VAERS ID 918518

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 918518
VAERS Form:2
Age:50.0
Sex:Female
Location:Nebraska
Vaccinated:2020-12-31
Onset:2020-12-31
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Cardio-respiratory arrest, Death, Resuscitation, Syncope, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-12-31
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: To be determined
Current Illness: To be determined
Preexisting Conditions: To be determined
Allergies: To be determined
Diagnostic Lab Data: Autopsy being performed
CDC 'Split Type':

Write-up: syncopal episode - arrested - CPR - death


Changed on 5/7/2021

VAERS ID: 918518 Before After
VAERS Form:2
Age:50.0
Sex:Female
Location:Nebraska
Vaccinated:2020-12-31
Onset:2020-12-31
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Cardio-respiratory arrest, Death, Resuscitation, Syncope, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-12-31
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: To be determined
Current Illness: To be determined
Preexisting Conditions: To be determined
Allergies: To be determined determined
Diagnostic Lab Data: Autopsy being performed
CDC 'Split Type':

Write-up: syncopal episode - arrested - CPR - death


Changed on 5/14/2021

VAERS ID: 918518 Before After
VAERS Form:2
Age:50.0
Sex:Female
Location:Nebraska
Vaccinated:2020-12-31
Onset:2020-12-31
Submitted:0000-00-00
Entered:2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: Cardio-respiratory arrest, Death, Resuscitation, Syncope, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2020-12-31
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: To be determined
Current Illness: To be determined
Preexisting Conditions: To be determined
Allergies: To be determined determined
Diagnostic Lab Data: Autopsy being performed
CDC 'Split Type':

Write-up: syncopal episode - arrested - CPR - death

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