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This is VAERS ID 1229810

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1229810
VAERS Form:2
Age:88.0
Sex:Female
Location:Arizona
Vaccinated:2021-02-16
Onset:2021-02-17
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 1 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-17
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: Azithromycin and Dexamethasone
Current Illness: COVID-19 (1/16/2021)
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: No adverse reactions


Changed on 5/7/2021

VAERS ID: 1229810 Before After
VAERS Form:2
Age:88.0
Sex:Female
Location:Arizona
Vaccinated:2021-02-16
Onset:2021-02-17
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 1 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-17
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: Azithromycin and Dexamethasone
Current Illness: COVID-19 (1/16/2021)
Preexisting Conditions: none
Allergies: none none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: No adverse reactions


Changed on 5/14/2021

VAERS ID: 1229810 Before After
VAERS Form:2
Age:88.0
Sex:Female
Location:Arizona
Vaccinated:2021-02-16
Onset:2021-02-17
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004M20A / 1 AR / SYR

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-17
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: Azithromycin and Dexamethasone
Current Illness: COVID-19 (1/16/2021)
Preexisting Conditions: none
Allergies: none none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: No adverse reactions

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1229810&WAYBACKHISTORY=ON

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