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This is VAERS ID 992347

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 992347
VAERS Form:2
Age:78.0
Sex:Male
Location:Oklahoma
Vaccinated:2021-02-01
Onset:2021-02-01
Submitted:0000-00-00
Entered:2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-01
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: hydrocodone, fentanyl, albuterol
Current Illness: none known
Preexisting Conditions: degenerative disc disease, chronic back pain, hypothyroidism, hypertension, GERD, COPD, tobacco dependence
Allergies: NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death


Changed on 5/7/2021

VAERS ID: 992347 Before After
VAERS Form:2
Age:78.0
Sex:Male
Location:Oklahoma
Vaccinated:2021-02-01
Onset:2021-02-01
Submitted:0000-00-00
Entered:2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-01
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: hydrocodone, fentanyl, albuterol
Current Illness: none known
Preexisting Conditions: degenerative disc disease, chronic back pain, hypothyroidism, hypertension, GERD, COPD, tobacco dependence
Allergies: NKDA NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death


Changed on 5/14/2021

VAERS ID: 992347 Before After
VAERS Form:2
Age:78.0
Sex:Male
Location:Oklahoma
Vaccinated:2021-02-01
Onset:2021-02-01
Submitted:0000-00-00
Entered:2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-01
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: hydrocodone, fentanyl, albuterol
Current Illness: none known
Preexisting Conditions: degenerative disc disease, chronic back pain, hypothyroidism, hypertension, GERD, COPD, tobacco dependence
Allergies: NKDA NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=992347&WAYBACKHISTORY=ON


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