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This is VAERS ID 1057281

History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 1057281
VAERS Form:2
Age:77.0
Sex:Female
Location:Maryland
Vaccinated:2021-02-05
Onset:2021-02-19
Submitted:0000-00-00
Entered:2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death

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:
Current Illness: per husband, stage 4 pancreatic cancer
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient''s husband reported her death that happened after first COVID-19 vaccine


Changed on 5/7/2021

VAERS ID: 1057281 Before After
VAERS Form:2
Age:77.0
Sex:Female
Location:Maryland
Vaccinated:2021-02-05
Onset:2021-02-19
Submitted:0000-00-00
Entered:2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death

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:
Current Illness: per husband, stage 4 pancreatic cancer
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient''s husband reported her death that happened after first COVID-19 vaccine


Changed on 5/14/2021

VAERS ID: 1057281 Before After
VAERS Form:2
Age:77.0
Sex:Female
Location:Maryland
Vaccinated:2021-02-05
Onset:2021-02-19
Submitted:0000-00-00
Entered:2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010M20A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death

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:
Current Illness: per husband, stage 4 pancreatic cancer
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient''s husband reported her death that happened after first COVID-19 vaccine

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1057281&WAYBACKHISTORY=ON

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