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This is VAERS ID 982354

History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 982354
VAERS Form:2
Age:91.0
Sex:Male
Location:Unknown
Vaccinated:2020-12-29
Onset:2021-01-23
Submitted:0000-00-00
Entered:2021-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-23
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient received COVID vaccine on 12/29/2020 and passed away on 1/23/2021

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=982354&WAYBACKHISTORY=ON


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