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This is VAERS ID 1057541

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1057541
VAERS Form:2
Age:
Sex:Female
Location:Foreign
Vaccinated:2021-01-01
Onset:2021-01-01
Submitted:0000-00-00
Entered:2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-01
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: Chronic obstructive pulmonary disease
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': SEMODERNATX, INC.MOD20210

Write-up: AVLIDEN; A spontaneous report was received from a consumer (SWEDEN) concerning a 70 year old, female patient who was pronounced dead on ??-JAN-2021. The patient''s medical history included Chronic obstructive pulmonary disease. Concomitant product use was not provided/unknown by the reporter. The patient received the mRNA-1273 vaccine (Batch number not provided) on ??-JAN-2021. The dosage is unknown. The patient was pronounced dead on ??-JAN-2021. Treatment information was nor provided/unknown. Action taken with mRNA-1273 in response to the event was not provided/unknown. The patient died on ??-JAN-2021. The cause of death was not provided/unknown. Plans for an autopsy were unknown/not provided.; Reporter''s Comments: Very limited information regarding this events has been provided at this time. The cause of death was not provided. Plan for an autopsy was not provided. Company assessed the events to be unlikely related to company product.; Reported Cause(s) of Death: unknown cause of death

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1057541&WAYBACKHISTORY=ON

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