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This is VAERS ID 935511

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/15/2021

VAERS ID: 935511
VAERS Form:2
Age:56.0
Sex:Female
Location:South Dakota
Vaccinated:2021-01-08
Onset:2021-01-09
Submitted:0000-00-00
Entered:2021-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MODERNA / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-09
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 known of
Preexisting Conditions: history of vaginal adenocarcinoma- removed with surgery in 2019
Allergies: latex (skin reaction)
Diagnostic Lab Data: unknown
CDC 'Split Type':

Write-up: Patient received the 1st dose of Moderna and was found deceased in her home the next day.


Changed on 5/7/2021

VAERS ID: 935511 Before After
VAERS Form:2
Age:56.0
Sex:Female
Location:South Dakota
Vaccinated:2021-01-08
Onset:2021-01-09
Submitted:0000-00-00
Entered:2021-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MODERNA / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-09
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 known of
Preexisting Conditions: history of vaginal adenocarcinoma- removed with surgery in 2019
Allergies: latex (skin reaction) reaction)
Diagnostic Lab Data: unknown
CDC 'Split Type':

Write-up: Patient received the 1st dose of Moderna and was found deceased in her home the next day.


Changed on 5/14/2021

VAERS ID: 935511 Before After
VAERS Form:2
Age:56.0
Sex:Female
Location:South Dakota
Vaccinated:2021-01-08
Onset:2021-01-09
Submitted:0000-00-00
Entered:2021-01-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA MODERNA / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-09
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 known of
Preexisting Conditions: history of vaginal adenocarcinoma- removed with surgery in 2019
Allergies: latex (skin reaction) reaction)
Diagnostic Lab Data: unknown
CDC 'Split Type':

Write-up: Patient received the 1st dose of Moderna and was found deceased in her home the next day.

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