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This is VAERS ID 982218

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 982218
VAERS Form:2
Age:63.0
Sex:Male
Location:Missouri
Vaccinated:2021-01-08
Onset:2021-01-13
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
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: 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.


Changed on 5/7/2021

VAERS ID: 982218 Before After
VAERS Form:2
Age:63.0
Sex:Male
Location:Missouri
Vaccinated:2021-01-08
Onset:2021-01-13
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
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: 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 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.


Changed on 5/14/2021

VAERS ID: 982218 Before After
VAERS Form:2
Age:63.0
Sex:Male
Location:Missouri
Vaccinated:2021-01-08
Onset:2021-01-13
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
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: 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 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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