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This is VAERS ID 1052972

History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 1052972
VAERS Form:2
Age:87.0
Sex:Female
Location:Missouri
Vaccinated:2021-02-23
Onset:2021-02-23
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SC

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

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: NO
Current Illness: NO
Preexisting Conditions: ACUTE KIDNEY DISEASE, DIABETES, HYPERTENSIVE HEART
Allergies: NO
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: RESIDENT EXPIRED


Changed on 5/7/2021

VAERS ID: 1052972 Before After
VAERS Form:2
Age:87.0
Sex:Female
Location:Missouri
Vaccinated:2021-02-23
Onset:2021-02-23
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SC

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

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: NO
Current Illness: NO
Preexisting Conditions: ACUTE KIDNEY DISEASE, DIABETES, HYPERTENSIVE HEART
Allergies: NO NO
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: RESIDENT EXPIRED


Changed on 5/14/2021

VAERS ID: 1052972 Before After
VAERS Form:2
Age:87.0
Sex:Female
Location:Missouri
Vaccinated:2021-02-23
Onset:2021-02-23
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 RA / SC

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

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: NO
Current Illness: NO
Preexisting Conditions: ACUTE KIDNEY DISEASE, DIABETES, HYPERTENSIVE HEART
Allergies: NO NO
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: RESIDENT EXPIRED

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1052972&WAYBACKHISTORY=ON

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