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This is VAERS ID 1222366

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1222366
VAERS Form:2
Age:78.0
Sex:Female
Location:Puerto Rico
Vaccinated:2021-02-23
Onset:2021-04-07
Submitted:0000-00-00
Entered:2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 2 UN / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-07
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: Norvasc, Losartan, Gabapentin, Atorvastatin, Prednisone, Aspirin, Vitamin D
Current Illness: None reported
Preexisting Conditions: Rheumatoid arthritis, Hypertension, Insomnia, Anxiety
Allergies: None reported
Diagnostic Lab Data: None reported
CDC 'Split Type': PR10321

Write-up: Died a natural death


Changed on 5/7/2021

VAERS ID: 1222366 Before After
VAERS Form:2
Age:78.0
Sex:Female
Location:Puerto Rico
Vaccinated:2021-02-23
Onset:2021-04-07
Submitted:0000-00-00
Entered:2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 2 UN / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-07
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: Norvasc, Losartan, Gabapentin, Atorvastatin, Prednisone, Aspirin, Vitamin D
Current Illness: None reported
Preexisting Conditions: Rheumatoid arthritis, Hypertension, Insomnia, Anxiety
Allergies: None reported reported
Diagnostic Lab Data: None reported
CDC 'Split Type': PR10321

Write-up: Died a natural death


Changed on 5/14/2021

VAERS ID: 1222366 Before After
VAERS Form:2
Age:78.0
Sex:Female
Location:Puerto Rico
Vaccinated:2021-02-23
Onset:2021-04-07
Submitted:0000-00-00
Entered:2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 2 UN / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-07
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: Norvasc, Losartan, Gabapentin, Atorvastatin, Prednisone, Aspirin, Vitamin D
Current Illness: None reported
Preexisting Conditions: Rheumatoid arthritis, Hypertension, Insomnia, Anxiety
Allergies: None reported reported
Diagnostic Lab Data: None reported
CDC 'Split Type': PR10321

Write-up: Died a natural death

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1222366&WAYBACKHISTORY=ON

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