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This is VAERS ID 966888

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 966888
VAERS Form:2
Age:56.0
Sex:Female
Location:Nevada
Vaccinated:2021-01-22
Onset:2021-01-22
Submitted:0000-00-00
Entered:2021-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-22
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: At 04:30 on 1/22/2021, facility was notified of employee death at home.


Changed on 5/7/2021

VAERS ID: 966888 Before After
VAERS Form:2
Age:56.0
Sex:Female
Location:Nevada
Vaccinated:2021-01-22
Onset:2021-01-22
Submitted:0000-00-00
Entered:2021-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-22
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: At 04:30 on 1/22/2021, facility was notified of employee death at home.


Changed on 5/14/2021

VAERS ID: 966888 Before After
VAERS Form:2
Age:56.0
Sex:Female
Location:Nevada
Vaccinated:2021-01-22
Onset:2021-01-22
Submitted:0000-00-00
Entered:2021-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-22
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: At 04:30 on 1/22/2021, facility was notified of employee death at home.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=966888&WAYBACKHISTORY=ON


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