National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 997642

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 997642
VAERS Form:2
Age:62.0
Sex:Female
Location:Montana
Vaccinated:2021-01-19
Onset:2021-02-02
Submitted:0000-00-00
Entered:2021-02-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-02
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: possible blood clots, not disclosed at time of vaccination
Preexisting Conditions: chronic back pain
Allergies: vibramyacin
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: We were notified 02/02/2021 of patient''s death. Unknown cause at this time.

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=997642&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166