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This is VAERS ID 987877

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 987877
VAERS Form:2
Age:86.0
Sex:Male
Location:Michigan
Vaccinated:2021-01-14
Onset:2021-01-26
Submitted:0000-00-00
Entered:2021-01-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-26
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: PT WAS ON HOSPICE CARE AT TIME OF VACCINATION
Preexisting Conditions: UNKNOWN
Allergies: PCN
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: REC''D CALL FROM PT''S SON, PT HAS BEEN ON HOSPICE CARE AND PASSED 1/26/21. DOES NOT BELIEVE THIS IS RELATED TO VACCINE ADMINISTRATION, BUT WANTED TO REPORT TO US.

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=987877&WAYBACKHISTORY=ON


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