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This is VAERS ID 1049406

History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 1049406
VAERS Form:2
Age:86.0
Sex:Female
Location:Florida
Vaccinated:2021-01-26
Onset:2021-02-21
Submitted:0000-00-00
Entered:2021-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, COVID-19, SARS-CoV-2 test positive, Exposure to SARS-CoV-2

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-21
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: unknown
Preexisting Conditions: unknown
Allergies: none listed
Diagnostic Lab Data: unknown
CDC 'Split Type':

Write-up: Patient rcvd 1st covid 19 vaccine on 1/26/2021. Patient had house guests on 1/30/21. Those house guests tested positive for covid on 2/1/2021. Patient started getting symptoms on 02/2/2021. Patient tested postivie on 2/4/2021. Patient was hospitalized 2/7/2021. Patient passed away on 2/21/21.


Changed on 5/7/2021

VAERS ID: 1049406 Before After
VAERS Form:2
Age:86.0
Sex:Female
Location:Florida
Vaccinated:2021-01-26
Onset:2021-02-21
Submitted:0000-00-00
Entered:2021-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, COVID-19, SARS-CoV-2 test positive, Exposure to SARS-CoV-2

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-21
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: unknown
Preexisting Conditions: unknown
Allergies: none listed listed
Diagnostic Lab Data: unknown
CDC 'Split Type':

Write-up: Patient rcvd 1st covid 19 vaccine on 1/26/2021. Patient had house guests on 1/30/21. Those house guests tested positive for covid on 2/1/2021. Patient started getting symptoms on 02/2/2021. Patient tested postivie on 2/4/2021. Patient was hospitalized 2/7/2021. Patient passed away on 2/21/21.


Changed on 5/14/2021

VAERS ID: 1049406 Before After
VAERS Form:2
Age:86.0
Sex:Female
Location:Florida
Vaccinated:2021-01-26
Onset:2021-02-21
Submitted:0000-00-00
Entered:2021-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, COVID-19, SARS-CoV-2 test positive, Exposure to SARS-CoV-2

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-21
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: unknown
Preexisting Conditions: unknown
Allergies: none listed listed
Diagnostic Lab Data: unknown
CDC 'Split Type':

Write-up: Patient rcvd 1st covid 19 vaccine on 1/26/2021. Patient had house guests on 1/30/21. Those house guests tested positive for covid on 2/1/2021. Patient started getting symptoms on 02/2/2021. Patient tested postivie on 2/4/2021. Patient was hospitalized 2/7/2021. Patient passed away on 2/21/21.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1049406&WAYBACKHISTORY=ON

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