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This is VAERS ID 1229059

History of Changes from the VAERS Wayback Machine

First Appeared on 5/14/2021

VAERS ID: 1229059
VAERS Form:2
Age:54.0
Sex:Female
Location:Michigan
Vaccinated:2021-03-19
Onset:2021-03-24
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Private      Purchased by: ??
Symptoms: COVID-19

Life Threatening? No
Birth Defect? No
Died? No
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient diagnosed with COVID-19 on 3/24/2021 after receiving her first dose of Moderna COVID-19 vaccine on 3/19/2021


Changed on 7/16/2021

VAERS ID: 1229059 Before After
VAERS Form:2
Age:54.0
Sex:Female
Location:Michigan
Vaccinated:2021-03-19
Onset:2021-03-24
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / -

Administered by: Private      Purchased by: ??
Symptoms: COVID-19

Life Threatening? No
Birth Defect? No
Died? No Yes
   Date died:0000-00-00 2021-04-28
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient diagnosed with COVID-19 on 3/24/2021 after receiving her first dose of Moderna COVID-19 vaccine on 3/19/2021

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1229059&WAYBACKHISTORY=ON

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