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This is VAERS ID 1088615

History of Changes from the VAERS Wayback Machine

First Appeared on 3/11/2021

VAERS ID: 1088615
VAERS Form:2
Age:59.0
Sex:Female
Location:Illinois
Vaccinated:2021-03-05
Onset:2021-03-06
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-06
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: Unknown
Current Illness: Unknown
Preexisting Conditions: Carotid Artery Bruit, Smoker, HTN, family hx of cardiovascular disease Sister MI at 56. 11/2015 Abnormal Stress Echo with elevated values on a lipid profile after c/o chest pain. Other medical history unknown.
Allergies: Morphine, Allegra, and Bee Stings
Diagnostic Lab Data: None available
CDC 'Split Type':

Write-up: Death within 30 days of vaccination, vaccinated on 3/5/2021 pronounced dead on 3/6/2021. Unknown if any side effects from vaccine. No ER visit found at local hospital.


Changed on 5/7/2021

VAERS ID: 1088615 Before After
VAERS Form:2
Age:59.0
Sex:Female
Location:Illinois
Vaccinated:2021-03-05
Onset:2021-03-06
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-06
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: Unknown
Current Illness: Unknown
Preexisting Conditions: Carotid Artery Bruit, Smoker, HTN, family hx of cardiovascular disease Sister MI at 56. 11/2015 Abnormal Stress Echo with elevated values on a lipid profile after c/o chest pain. Other medical history unknown.
Allergies: Morphine, Allegra, and Bee Stings Stings
Diagnostic Lab Data: None available
CDC 'Split Type':

Write-up: Death within 30 days of vaccination, vaccinated on 3/5/2021 pronounced dead on 3/6/2021. Unknown if any side effects from vaccine. No ER visit found at local hospital.


Changed on 5/14/2021

VAERS ID: 1088615 Before After
VAERS Form:2
Age:59.0
Sex:Female
Location:Illinois
Vaccinated:2021-03-05
Onset:2021-03-06
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011A21A / 2 AR / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-06
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: Unknown
Current Illness: Unknown
Preexisting Conditions: Carotid Artery Bruit, Smoker, HTN, family hx of cardiovascular disease Sister MI at 56. 11/2015 Abnormal Stress Echo with elevated values on a lipid profile after c/o chest pain. Other medical history unknown.
Allergies: Morphine, Allegra, and Bee Stings Stings
Diagnostic Lab Data: None available
CDC 'Split Type':

Write-up: Death within 30 days of vaccination, vaccinated on 3/5/2021 pronounced dead on 3/6/2021. Unknown if any side effects from vaccine. No ER visit found at local hospital.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1088615&WAYBACKHISTORY=ON

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