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This is VAERS ID 1059048

History of Changes from the VAERS Wayback Machine

First Appeared on 3/5/2021

VAERS ID: 1059048
VAERS Form:2
Age:72.0
Sex:Female
Location:Texas
Vaccinated:2021-02-22
Onset:2021-02-22
Submitted:0000-00-00
Entered:2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Chills, Death, Fatigue, Myalgia, Nausea, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-24
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: Aspirin 81 mg once daily, lorazepam 1 mg two tablets once daily, metoprolol er succinctness 100 mg once daily
Current Illness: None
Preexisting Conditions: Long QT Syndrome Atrial fibrillation
Allergies: None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Fever, chills, fatigue, muscle aches, nausea, death 48 hours after injection


Changed on 5/7/2021

VAERS ID: 1059048 Before After
VAERS Form:2
Age:72.0
Sex:Female
Location:Texas
Vaccinated:2021-02-22
Onset:2021-02-22
Submitted:0000-00-00
Entered:2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Chills, Death, Fatigue, Myalgia, Nausea, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-24
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: Aspirin 81 mg once daily, lorazepam 1 mg two tablets once daily, metoprolol er succinctness 100 mg once daily
Current Illness: None
Preexisting Conditions: Long QT Syndrome Atrial fibrillation
Allergies: None None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Fever, chills, fatigue, muscle aches, nausea, death 48 hours after injection


Changed on 5/14/2021

VAERS ID: 1059048 Before After
VAERS Form:2
Age:72.0
Sex:Female
Location:Texas
Vaccinated:2021-02-22
Onset:2021-02-22
Submitted:0000-00-00
Entered:2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Chills, Death, Fatigue, Myalgia, Nausea, Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-24
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: Aspirin 81 mg once daily, lorazepam 1 mg two tablets once daily, metoprolol er succinctness 100 mg once daily
Current Illness: None
Preexisting Conditions: Long QT Syndrome Atrial fibrillation
Allergies: None None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Fever, chills, fatigue, muscle aches, nausea, death 48 hours after injection

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1059048&WAYBACKHISTORY=ON

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