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This is VAERS ID 981061

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 981061
VAERS Form:2
Age:87.0
Sex:Female
Location:Tennessee
Vaccinated:2021-01-22
Onset:2021-01-25
Submitted:0000-00-00
Entered:2021-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-25
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: Unsure
Current Illness: None
Preexisting Conditions: Unsure
Allergies: Unsure
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died 3 days post Moderna vaccine.


Changed on 5/7/2021

VAERS ID: 981061 Before After
VAERS Form:2
Age:87.0
Sex:Female
Location:Tennessee
Vaccinated:2021-01-22
Onset:2021-01-25
Submitted:0000-00-00
Entered:2021-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-25
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: Unsure
Current Illness: None
Preexisting Conditions: Unsure
Allergies: Unsure Unsure
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died 3 days post Moderna vaccine.


Changed on 5/14/2021

VAERS ID: 981061 Before After
VAERS Form:2
Age:87.0
Sex:Female
Location:Tennessee
Vaccinated:2021-01-22
Onset:2021-01-25
Submitted:0000-00-00
Entered:2021-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-25
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: Unsure
Current Illness: None
Preexisting Conditions: Unsure
Allergies: Unsure Unsure
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient died 3 days post Moderna vaccine.

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