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This is VAERS ID 974138

History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 974138
VAERS Form:2
Age:78.0
Sex:Female
Location:Georgia
Vaccinated:1920-01-18
Onset:2021-01-23
Submitted:0000-00-00
Entered:2021-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-23
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: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: DEATH- NO OTHER INFORMATION KNOWN


Changed on 5/7/2021

VAERS ID: 974138 Before After
VAERS Form:2
Age:78.0
Sex:Female
Location:Georgia
Vaccinated:1920-01-18
Onset:2021-01-23
Submitted:0000-00-00
Entered:2021-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-23
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: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN UNKNOWN
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: DEATH- NO OTHER INFORMATION KNOWN


Changed on 5/14/2021

VAERS ID: 974138 Before After
VAERS Form:2
Age:78.0
Sex:Female
Location:Georgia
Vaccinated:1920-01-18
Onset:2021-01-23
Submitted:0000-00-00
Entered:2021-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-23
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: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN UNKNOWN
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: DEATH- NO OTHER INFORMATION KNOWN

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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=974138&WAYBACKHISTORY=ON

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