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This is VAERS ID 1052172

History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 1052172
VAERS Form:2
Age:55.0
Sex:Male
Location:Michigan
Vaccinated:2021-02-18
Onset:2021-02-19
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death, Sudden death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-19
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: statins- stated no allergic reaction but can''t take
Diagnostic Lab Data: Autopsy completed 2/20/2021 at medical school by MD
CDC 'Split Type': na

Write-up: Agency contacted 2/19 In evening by employer representative- client Died Suddenly after work"


Changed on 5/7/2021

VAERS ID: 1052172 Before After
VAERS Form:2
Age:55.0
Sex:Male
Location:Michigan
Vaccinated:2021-02-18
Onset:2021-02-19
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death, Sudden death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-19
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: statins- stated no allergic reaction but can''t take take
Diagnostic Lab Data: Autopsy completed 2/20/2021 at medical school by MD
CDC 'Split Type': na

Write-up: Agency contacted 2/19 In evening by employer representative- client Died Suddenly after work"


Changed on 5/14/2021

VAERS ID: 1052172 Before After
VAERS Form:2
Age:55.0
Sex:Male
Location:Michigan
Vaccinated:2021-02-18
Onset:2021-02-19
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 023M20A / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death, Sudden death, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-19
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: statins- stated no allergic reaction but can''t take take
Diagnostic Lab Data: Autopsy completed 2/20/2021 at medical school by MD
CDC 'Split Type': na

Write-up: Agency contacted 2/19 In evening by employer representative- client Died Suddenly after work"

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1052172&WAYBACKHISTORY=ON

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