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This is VAERS ID 1123167

History of Changes from the VAERS Wayback Machine

First Appeared on 3/26/2021

VAERS ID: 1123167
VAERS Form:2
Age:90.0
Sex:Female
Location:Pennsylvania
Vaccinated:2021-03-11
Onset:2021-03-15
Submitted:0000-00-00
Entered:2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Cerebrovascular accident, Computerised tomogram, Magnetic resonance imaging

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-19
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? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Furosemide, Levothyroxine, Mirtazipine, omeprozole, pravastatin, thiamine,centrum,caltrate,Vitron-c
Current Illness: none
Preexisting Conditions: Chronic Back Pain with recent hospitalization, osteoporosis, anxiety disorder, Chronic heart failure, chronic atrial fib, hypothyroidism, ckd gerd
Allergies: none
Diagnostic Lab Data: ct,mri
CDC 'Split Type':

Write-up: Stroke


Changed on 5/7/2021

VAERS ID: 1123167 Before After
VAERS Form:2
Age:90.0
Sex:Female
Location:Pennsylvania
Vaccinated:2021-03-11
Onset:2021-03-15
Submitted:0000-00-00
Entered:2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013A21A / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Cerebrovascular accident, Computerised tomogram, Magnetic resonance imaging

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-19
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? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Furosemide, Levothyroxine, Mirtazipine, omeprozole, pravastatin, thiamine,centrum,caltrate,Vitron-c
Current Illness: none
Preexisting Conditions: Chronic Back Pain with recent hospitalization, osteoporosis, anxiety disorder, Chronic heart failure, chronic atrial fib, hypothyroidism, ckd gerd
Allergies: none none
Diagnostic Lab Data: ct,mri
CDC 'Split Type':

Write-up: Stroke

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1123167&WAYBACKHISTORY=ON


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