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This is VAERS ID 986631

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 986631
VAERS Form:2
Age:87.0
Sex:Female
Location:Michigan
Vaccinated:2021-01-14
Onset:2021-01-15
Submitted:0000-00-00
Entered:2021-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Myocardial infarction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Hypertension, hyperthyroidism
Allergies: No known allergies.
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Suspected myocardial infarction on 01/15/2021. Patient passed away on 01/15/2021.


Changed on 5/7/2021

VAERS ID: 986631 Before After
VAERS Form:2
Age:87.0
Sex:Female
Location:Michigan
Vaccinated:2021-01-14
Onset:2021-01-15
Submitted:0000-00-00
Entered:2021-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Myocardial infarction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Hypertension, hyperthyroidism
Allergies: No known allergies. allergies.
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Suspected myocardial infarction on 01/15/2021. Patient passed away on 01/15/2021.


Changed on 5/21/2021

VAERS ID: 986631 Before After
VAERS Form:2
Age:87.0
Sex:Female
Location:Michigan
Vaccinated:2021-01-14
Onset:2021-01-15
Submitted:0000-00-00
Entered:2021-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / SYR

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Myocardial infarction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: Hypertension, hyperthyroidism
Allergies: No known allergies. allergies.
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Suspected myocardial infarction on 01/15/2021. Patient passed away on 01/15/2021.

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