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This is VAERS ID 943362

History of Changes from the VAERS Wayback Machine

First Appeared on 1/15/2021

VAERS ID: 943362
VAERS Form:2
Age:73.0
Sex:Female
Location:Michigan
Vaccinated:2021-01-13
Onset:2021-01-13
Submitted:0000-00-00
Entered:2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death, Syncope, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-13
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 none reported
Current Illness: none known
Preexisting Conditions: none
Allergies: none reported
Diagnostic Lab Data: currently undergoing preliminary autopsy
CDC 'Split Type':

Write-up: Pt collapsed at home approx 5:30 pm and died


Changed on 5/7/2021

VAERS ID: 943362 Before After
VAERS Form:2
Age:73.0
Sex:Female
Location:Michigan
Vaccinated:2021-01-13
Onset:2021-01-13
Submitted:0000-00-00
Entered:2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death, Syncope, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-13
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 none reported
Current Illness: none known
Preexisting Conditions: none
Allergies: none reported reported
Diagnostic Lab Data: currently undergoing preliminary autopsy
CDC 'Split Type':

Write-up: Pt collapsed at home approx 5:30 pm and died


Changed on 5/14/2021

VAERS ID: 943362 Before After
VAERS Form:2
Age:73.0
Sex:Female
Location:Michigan
Vaccinated:2021-01-13
Onset:2021-01-13
Submitted:0000-00-00
Entered:2021-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death, Syncope, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-13
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 none reported
Current Illness: none known
Preexisting Conditions: none
Allergies: none reported reported
Diagnostic Lab Data: currently undergoing preliminary autopsy
CDC 'Split Type':

Write-up: Pt collapsed at home approx 5:30 pm and died

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=943362&WAYBACKHISTORY=ON


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