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This is VAERS ID 1123405

History of Changes from the VAERS Wayback Machine

First Appeared on 3/26/2021

VAERS ID: 1123405
VAERS Form:2
Age:80.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-03-02
Onset:2021-03-19
Submitted:0000-00-00
Entered:2021-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 010A21A / 2 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Unevaluable event

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? No
Previous Vaccinations:
Other Medications: Flovent, Magnesium, Senna
Current Illness: ESRD, aortic stenosis, DM
Preexisting Conditions: ESRD, aortic stenosis, DM
Allergies: codeine, hydrocodone
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: None stated.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1123405&WAYBACKHISTORY=ON


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