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This is VAERS ID 1180051

History of Changes from the VAERS Wayback Machine

First Appeared on 4/8/2021

VAERS ID: 1180051
VAERS Form:2
Age:70.0
Sex:Female
Location:Kentucky
Vaccinated:2021-01-07
Onset:2021-03-31
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Ageusia, Anosmia, Chills, Fatigue, Headache, Myalgia, Nausea, Productive cough, Pyrexia, Rhinorrhoea, Vomiting, Respiratory tract congestion, Oropharyngeal pain, COVID-19, SARS-CoV-2 test positive, Exposure to SARS-CoV-2

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-31
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: COVID-19 infection one month after vaccination
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: Tested positive for COVID-19 by PCR on 3/06/2021 & 3/16/2021. 1st Moderna vaccine administered on 1/7/2021, 2nd Moderna vaccine administered on 2/4/2021.
CDC 'Split Type':

Write-up: Was hospitalized (unsure dates on hospitalization); has no known pre-existing conditions; symptom onset was 3/3/2021 with fever, chills, rigors, myalgia, rhinorrhea/congestion, sore throat, cough (wet productive), nausea/vomiting, headache, loss of smell and taste, and fatigue. Was a household contact to a known COID-19 case.


Changed on 5/7/2021

VAERS ID: 1180051 Before After
VAERS Form:2
Age:70.0
Sex:Female
Location:Kentucky
Vaccinated:2021-01-07
Onset:2021-03-31
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Ageusia, Anosmia, Chills, Fatigue, Headache, Myalgia, Nausea, Productive cough, Pyrexia, Rhinorrhoea, Vomiting, Respiratory tract congestion, Oropharyngeal pain, COVID-19, SARS-CoV-2 test positive, Exposure to SARS-CoV-2

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-31
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: COVID-19 infection one month after vaccination
Preexisting Conditions: unknown
Allergies: unknown unknown
Diagnostic Lab Data: Tested positive for COVID-19 by PCR on 3/06/2021 & 3/16/2021. 1st Moderna vaccine administered on 1/7/2021, 2nd Moderna vaccine administered on 2/4/2021.
CDC 'Split Type':

Write-up: Was hospitalized (unsure dates on hospitalization); has no known pre-existing conditions; symptom onset was 3/3/2021 with fever, chills, rigors, myalgia, rhinorrhea/congestion, sore throat, cough (wet productive), nausea/vomiting, headache, loss of smell and taste, and fatigue. Was a household contact to a known COID-19 case.


Changed on 5/14/2021

VAERS ID: 1180051 Before After
VAERS Form:2
Age:70.0
Sex:Female
Location:Kentucky
Vaccinated:2021-01-07
Onset:2021-03-31
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Ageusia, Anosmia, Chills, Fatigue, Headache, Myalgia, Nausea, Productive cough, Pyrexia, Rhinorrhoea, Vomiting, Respiratory tract congestion, Oropharyngeal pain, COVID-19, SARS-CoV-2 test positive, Exposure to SARS-CoV-2

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-31
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: COVID-19 infection one month after vaccination
Preexisting Conditions: unknown
Allergies: unknown unknown
Diagnostic Lab Data: Tested positive for COVID-19 by PCR on 3/06/2021 & 3/16/2021. 1st Moderna vaccine administered on 1/7/2021, 2nd Moderna vaccine administered on 2/4/2021.
CDC 'Split Type':

Write-up: Was hospitalized (unsure dates on hospitalization); has no known pre-existing conditions; symptom onset was 3/3/2021 with fever, chills, rigors, myalgia, rhinorrhea/congestion, sore throat, cough (wet productive), nausea/vomiting, headache, loss of smell and taste, and fatigue. Was a household contact to a known COID-19 case.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1180051&WAYBACKHISTORY=ON

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