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This is VAERS ID 1149493

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1149493
VAERS Form:2
Age:72.0
Sex:Male
Location:Tennessee
Vaccinated:2021-02-04
Onset:2021-03-04
Submitted:0000-00-00
Entered:2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: WHEN CALLED TO SCHEDULE 2ND DOSE, FAMILY STATES HE IS DECEASED.


Changed on 5/7/2021

VAERS ID: 1149493 Before After
VAERS Form:2
Age:72.0
Sex:Male
Location:Tennessee
Vaccinated:2021-02-04
Onset:2021-03-04
Submitted:0000-00-00
Entered:2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: WHEN CALLED TO SCHEDULE 2ND DOSE, FAMILY STATES HE IS DECEASED.


Changed on 5/14/2021

VAERS ID: 1149493 Before After
VAERS Form:2
Age:72.0
Sex:Male
Location:Tennessee
Vaccinated:2021-02-04
Onset:2021-03-04
Submitted:0000-00-00
Entered:2021-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: WHEN CALLED TO SCHEDULE 2ND DOSE, FAMILY STATES HE IS DECEASED.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1149493&WAYBACKHISTORY=ON

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