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This is VAERS ID 981849

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 981849
VAERS Form:2
Age:92.0
Sex:Male
Location:Indiana
Vaccinated:2021-01-13
Onset:2021-01-16
Submitted:0000-00-00
Entered:2021-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / UNK LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death

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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: died 01/16/2021


Changed on 5/7/2021

VAERS ID: 981849 Before After
VAERS Form:2
Age:92.0
Sex:Male
Location:Indiana
Vaccinated:2021-01-13
Onset:2021-01-16
Submitted:0000-00-00
Entered:2021-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / UNK LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death

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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown unknown
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: died 01/16/2021


Changed on 5/14/2021

VAERS ID: 981849 Before After
VAERS Form:2
Age:92.0
Sex:Male
Location:Indiana
Vaccinated:2021-01-13
Onset:2021-01-16
Submitted:0000-00-00
Entered:2021-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013L20A / UNK LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death

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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown unknown
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: died 01/16/2021

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=981849&WAYBACKHISTORY=ON


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