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This is VAERS ID 971813

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 971813
VAERS Form:2
Age:85.0
Sex:Female
Location:Alabama
Vaccinated:2021-01-20
Onset:2021-01-20
Submitted:0000-00-00
Entered:2021-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death, Posture abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-21
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: not known
Current Illness: A fib, type 2 diabetes, HTN, seizure disorder, CHF
Preexisting Conditions: A fib, type 2 diabetes, HTN, seizure disorder, CHF, Z alpha hydroxylase deficiency
Allergies: Iodine
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient received vaccine on 1/20/2121, later that night husband found her slumped in chair, called EMS and patient was taken to Hospital where she died on 1/21/2021


Changed on 5/7/2021

VAERS ID: 971813 Before After
VAERS Form:2
Age:85.0
Sex:Female
Location:Alabama
Vaccinated:2021-01-20
Onset:2021-01-20
Submitted:0000-00-00
Entered:2021-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death, Posture abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-21
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: not known
Current Illness: A fib, type 2 diabetes, HTN, seizure disorder, CHF
Preexisting Conditions: A fib, type 2 diabetes, HTN, seizure disorder, CHF, Z alpha hydroxylase deficiency
Allergies: Iodine Iodine
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient received vaccine on 1/20/2121, later that night husband found her slumped in chair, called EMS and patient was taken to Hospital where she died on 1/21/2021


Changed on 5/21/2021

VAERS ID: 971813 Before After
VAERS Form:2
Age:85.0
Sex:Female
Location:Alabama
Vaccinated:2021-01-20
Onset:2021-01-20
Submitted:0000-00-00
Entered:2021-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death, Posture abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-21
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: not known
Current Illness: A fib, type 2 diabetes, HTN, seizure disorder, CHF
Preexisting Conditions: A fib, type 2 diabetes, HTN, seizure disorder, CHF, Z alpha hydroxylase deficiency
Allergies: Iodine Iodine
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient received vaccine on 1/20/2121, later that night husband found her slumped in chair, called EMS and patient was taken to Hospital where she died on 1/21/2021

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=971813&WAYBACKHISTORY=ON


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