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This is VAERS ID 1087763

History of Changes from the VAERS Wayback Machine

First Appeared on 3/11/2021

VAERS ID: 1087763
VAERS Form:2
Age:62.0
Sex:Female
Location:Iowa
Vaccinated:2021-03-05
Onset:2021-03-08
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Death, Dyspnoea, Organ failure, Laboratory test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-10
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes
Allergies:
Diagnostic Lab Data: Numerous.
CDC 'Split Type':

Write-up: Difficulty breathing leading to organ failure and death


Changed on 5/7/2021

VAERS ID: 1087763 Before After
VAERS Form:2
Age:62.0
Sex:Female
Location:Iowa
Vaccinated:2021-03-05
Onset:2021-03-08
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Death, Dyspnoea, Organ failure, Laboratory test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-10
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes
Allergies:
Diagnostic Lab Data: Numerous.
CDC 'Split Type':

Write-up: Difficulty breathing leading to organ failure and death


Changed on 5/14/2021

VAERS ID: 1087763 Before After
VAERS Form:2
Age:62.0
Sex:Female
Location:Iowa
Vaccinated:2021-03-05
Onset:2021-03-08
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Death, Dyspnoea, Organ failure, Laboratory test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-10
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes
Allergies:
Diagnostic Lab Data: Numerous.
CDC 'Split Type':

Write-up: Difficulty breathing leading to organ failure and death

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1087763&WAYBACKHISTORY=ON

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