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This is VAERS ID 992977

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 992977
VAERS Form:2
Age:84.0
Sex:Female
Location:Ohio
Vaccinated:2021-01-20
Onset:2021-01-20
Submitted:0000-00-00
Entered:2021-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Cerebrovascular accident, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-25
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: pantoprazole, tramadol, duloxetine, vesicare
Current Illness: unsure
Preexisting Conditions: unsure
Allergies: cephalosporins, sulfa, penicillins, opiods,
Diagnostic Lab Data: unsure
CDC 'Split Type':

Write-up: spoke with patient husband on Saturday 1/23 and he said that she had been in the hospital. that she had had a stroke, the MD''s at the hospital told him that it was not contributed to the vaccine and that they were unsure even if the stroke had occurred prior to the vaccine or after. spoke with him again on 1-29 and he stated that she had passed away on 1/25/21

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