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This is VAERS ID 1238280

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1238280
VAERS Form:2
Age:70.0
Sex:Male
Location:Colorado
Vaccinated:2021-03-10
Onset:2021-04-05
Submitted:0000-00-00
Entered:2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M2OA / 1 UN / UN

Administered by: Unknown      Purchased by: ??
Symptoms: No adverse event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-05
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: The decedent was visiting family. There are no reported adverse effects known.


Changed on 5/7/2021

VAERS ID: 1238280 Before After
VAERS Form:2
Age:70.0
Sex:Male
Location:Colorado
Vaccinated:2021-03-10
Onset:2021-04-05
Submitted:0000-00-00
Entered:2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M2OA / 1 UN / UN

Administered by: Unknown      Purchased by: ??
Symptoms: No adverse event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-05
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: The decedent was visiting family. There are no reported adverse effects known.


Changed on 5/14/2021

VAERS ID: 1238280 Before After
VAERS Form:2
Age:70.0
Sex:Male
Location:Colorado
Vaccinated:2021-03-10
Onset:2021-04-05
Submitted:0000-00-00
Entered:2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M2OA / 1 UN / UN

Administered by: Unknown      Purchased by: ??
Symptoms: No adverse event

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-05
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: The decedent was visiting family. There are no reported adverse effects known.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1238280&WAYBACKHISTORY=ON


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