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This is VAERS ID 979773

History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 979773
VAERS Form:2
Age:75.0
Sex:Female
Location:Texas
Vaccinated:2020-12-30
Onset:2021-01-16
Submitted:0000-00-00
Entered:2021-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Pulmonary embolism

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-16
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: none as far as i know
Current Illness: none per care giver
Preexisting Conditions: none that was reported
Allergies: none reported
Diagnostic Lab Data: none that i know of
CDC 'Split Type':

Write-up: Not sure if it has to do with the COVID vaccine but her caregiver reported to me today (1/27/20201) that she passed away on 01/16/2021 from a pulmonary embolism that was 18 days after vaccine


Changed on 5/7/2021

VAERS ID: 979773 Before After
VAERS Form:2
Age:75.0
Sex:Female
Location:Texas
Vaccinated:2020-12-30
Onset:2021-01-16
Submitted:0000-00-00
Entered:2021-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Pulmonary embolism

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-16
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: none as far as i know
Current Illness: none per care giver
Preexisting Conditions: none that was reported
Allergies: none reported reported
Diagnostic Lab Data: none that i know of
CDC 'Split Type':

Write-up: Not sure if it has to do with the COVID vaccine but her caregiver reported to me today (1/27/20201) that she passed away on 01/16/2021 from a pulmonary embolism that was 18 days after vaccine


Changed on 5/14/2021

VAERS ID: 979773 Before After
VAERS Form:2
Age:75.0
Sex:Female
Location:Texas
Vaccinated:2020-12-30
Onset:2021-01-16
Submitted:0000-00-00
Entered:2021-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025L20A / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Pulmonary embolism

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-16
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: none as far as i know
Current Illness: none per care giver
Preexisting Conditions: none that was reported
Allergies: none reported reported
Diagnostic Lab Data: none that i know of
CDC 'Split Type':

Write-up: Not sure if it has to do with the COVID vaccine but her caregiver reported to me today (1/27/20201) that she passed away on 01/16/2021 from a pulmonary embolism that was 18 days after vaccine

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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=979773&WAYBACKHISTORY=ON


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