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|History of Changes from the VAERS Wayback Machine|
|Vaccination / Manufacturer||Lot / Dose||Site / Route|
|COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA||030A21A / 1||RA / IM|
Administered by: Public Purchased by: ??
Life Threatening? No
Birth Defect? No
Permanent Disability? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Other Medications: unknown - did list Eliquis as being taken.
Current Illness: none noted
Preexisting Conditions: unknown
Allergies: indicated none
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Our agency was alerted that the patient passed away on 3/16/2021
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