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This is VAERS ID 1074271

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/11/2021

VAERS ID: 1074271
VAERS Form:2
Age:74.0
Sex:Female
Location:California
Vaccinated:2021-02-28
Onset:2021-03-02
Submitted:0000-00-00
Entered:2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Thrombocytopenia, Mental status changes

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: furosemide, lactulose, zofran, compazine, spironolactone, tenofovir, advil, on chemotherapy
Current Illness: metastatic Cholangiocarcinoma, cirrhosis
Preexisting Conditions: as above
Allergies: sulfa, cotrimazole
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: altered mental status, acute on chronic thrombocytopenia, death


Changed on 5/7/2021

VAERS ID: 1074271 Before After
VAERS Form:2
Age:74.0
Sex:Female
Location:California
Vaccinated:2021-02-28
Onset:2021-03-02
Submitted:0000-00-00
Entered:2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Thrombocytopenia, Mental status changes

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: furosemide, lactulose, zofran, compazine, spironolactone, tenofovir, advil, on chemotherapy
Current Illness: metastatic Cholangiocarcinoma, cirrhosis
Preexisting Conditions: as above
Allergies: sulfa, cotrimazole cotrimazole
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: altered mental status, acute on chronic thrombocytopenia, death


Changed on 5/14/2021

VAERS ID: 1074271 Before After
VAERS Form:2
Age:74.0
Sex:Female
Location:California
Vaccinated:2021-02-28
Onset:2021-03-02
Submitted:0000-00-00
Entered:2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Thrombocytopenia, Mental status changes

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-03
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: furosemide, lactulose, zofran, compazine, spironolactone, tenofovir, advil, on chemotherapy
Current Illness: metastatic Cholangiocarcinoma, cirrhosis
Preexisting Conditions: as above
Allergies: sulfa, cotrimazole cotrimazole
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: altered mental status, acute on chronic thrombocytopenia, death

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1074271&WAYBACKHISTORY=ON


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