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This is VAERS ID 1035845

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1035845
VAERS Form:2
Age:74.0
Sex:Female
Location:Wisconsin
Vaccinated:2021-02-03
Onset:2021-02-11
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-11
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: Not sick at time of vaccination, unknown prior.
Preexisting Conditions: Unknown
Allergies: none
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: We were informed by EMS that the patient was found deceased on 2/11/2021 at her home. EMS states she was dead for some time, no medical care given.


Changed on 5/7/2021

VAERS ID: 1035845 Before After
VAERS Form:2
Age:74.0
Sex:Female
Location:Wisconsin
Vaccinated:2021-02-03
Onset:2021-02-11
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-11
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: Not sick at time of vaccination, unknown prior.
Preexisting Conditions: Unknown
Allergies: none none
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: We were informed by EMS that the patient was found deceased on 2/11/2021 at her home. EMS states she was dead for some time, no medical care given.


Changed on 5/14/2021

VAERS ID: 1035845 Before After
VAERS Form:2
Age:74.0
Sex:Female
Location:Wisconsin
Vaccinated:2021-02-03
Onset:2021-02-11
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 RA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-11
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: Not sick at time of vaccination, unknown prior.
Preexisting Conditions: Unknown
Allergies: none none
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: We were informed by EMS that the patient was found deceased on 2/11/2021 at her home. EMS states she was dead for some time, no medical care given.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1035845&WAYBACKHISTORY=ON

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