National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1036770

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1036770
VAERS Form:2
Age:90.0
Sex:Female
Location:Ohio
Vaccinated:2021-01-19
Onset:2021-02-10
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 RA / SYR

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-10
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: generic multi vitamin
Current Illness: none
Preexisting Conditions: none, very healthy
Allergies: none
Diagnostic Lab Data: None, she was found in her bed dead in the morning. She had no prior health issues.
CDC 'Split Type':

Write-up: Feb 10th died in her sleep. No apparent reason.


Changed on 5/7/2021

VAERS ID: 1036770 Before After
VAERS Form:2
Age:90.0
Sex:Female
Location:Ohio
Vaccinated:2021-01-19
Onset:2021-02-10
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 RA / SYR

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-10
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: generic multi vitamin
Current Illness: none
Preexisting Conditions: none, very healthy
Allergies: none none
Diagnostic Lab Data: None, she was found in her bed dead in the morning. She had no prior health issues.
CDC 'Split Type':

Write-up: Feb 10th died in her sleep. No apparent reason.


Changed on 5/14/2021

VAERS ID: 1036770 Before After
VAERS Form:2
Age:90.0
Sex:Female
Location:Ohio
Vaccinated:2021-01-19
Onset:2021-02-10
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 RA / SYR

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-10
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: generic multi vitamin
Current Illness: none
Preexisting Conditions: none, very healthy
Allergies: none none
Diagnostic Lab Data: None, she was found in her bed dead in the morning. She had no prior health issues.
CDC 'Split Type':

Write-up: Feb 10th died in her sleep. No apparent reason.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1036770&WAYBACKHISTORY=ON

Government Disclaimer on use of this data


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