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From the 11/19/2021 release of VAERS data:

This is VAERS ID 982218

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Case Details

VAERS ID: 982218 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Male  
Location: Missouri  
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012120A / 1 - / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: On hospice: morphine, ativan, trazodone, tylenol
Current Illness: failure to thrive, pressure ulcer, pneumonitis d/t aspiration, dementia, COPD, alzheimer''s disease,
Preexisting Conditions: HTN, see above
Allergies: aspirin: severe unknown reaction
Diagnostic Lab Data:
CDC Split Type:

Write-up: resident was on hospice, chronically ill w dementia, COPD, HTN, failure to thrive, passed away 1/13/21. Not certain injection related as he was declining already.

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