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This is VAERS ID 1036345

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1036345
VAERS Form:2
Age:79.0
Sex:Female
Location:Florida
Vaccinated:2021-01-29
Onset:2021-01-30
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Ageusia, Death, Lethargy, Malaise, Nausea, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: levothyroxine
Current Illness: none
Preexisting Conditions: thyroid issues
Allergies: crab allergy, none others
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient developed lethargy and malaise several hours after vaccine with a low grade fever. The following morning she reported to her husband inability to taste food or drink. She developed nausea and vomiting which persisted from 1/30/21 through her death. She was found deceased in bed by her husband this morning.


Changed on 5/7/2021

VAERS ID: 1036345 Before After
VAERS Form:2
Age:79.0
Sex:Female
Location:Florida
Vaccinated:2021-01-29
Onset:2021-01-30
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Ageusia, Death, Lethargy, Malaise, Nausea, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: levothyroxine
Current Illness: none
Preexisting Conditions: thyroid issues
Allergies: crab allergy, none others others
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient developed lethargy and malaise several hours after vaccine with a low grade fever. The following morning she reported to her husband inability to taste food or drink. She developed nausea and vomiting which persisted from 1/30/21 through her death. She was found deceased in bed by her husband this morning.


Changed on 5/14/2021

VAERS ID: 1036345 Before After
VAERS Form:2
Age:79.0
Sex:Female
Location:Florida
Vaccinated:2021-01-29
Onset:2021-01-30
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012M20A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Ageusia, Death, Lethargy, Malaise, Nausea, Pyrexia, Vomiting

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: levothyroxine
Current Illness: none
Preexisting Conditions: thyroid issues
Allergies: crab allergy, none others others
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient developed lethargy and malaise several hours after vaccine with a low grade fever. The following morning she reported to her husband inability to taste food or drink. She developed nausea and vomiting which persisted from 1/30/21 through her death. She was found deceased in bed by her husband this morning.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1036345&WAYBACKHISTORY=ON

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