National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1247318

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1247318
VAERS Form:2
Age:69.0
Sex:Female
Location:Nebraska
Vaccinated:2021-04-22
Onset:2021-04-23
Submitted:0000-00-00
Entered:2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-23
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: Abilify; Acidophilus; Albuterol sulfate; Amantadine; Anoro Elipta; Betamethasone; Cyanocobalamin (monthly) Diclofenac; Lomotil (prn); Fluticasone propionate; Furosemide; Ipratropium-Albuterol; losartan Potassium; Mucinex (prn); Namenda; Nor
Current Illness:
Preexisting Conditions: CHF, COPD, Fibromyalgia, Major depressive d/o, anemia, edema, cellulitis,
Allergies: PCN, Morphine; Sulfa Atb, Tetracycline, Keflex, Mandol
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Death


Changed on 5/7/2021

VAERS ID: 1247318 Before After
VAERS Form:2
Age:69.0
Sex:Female
Location:Nebraska
Vaccinated:2021-04-22
Onset:2021-04-23
Submitted:0000-00-00
Entered:2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-23
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: Abilify; Acidophilus; Albuterol sulfate; Amantadine; Anoro Elipta; Betamethasone; Cyanocobalamin (monthly) Diclofenac; Lomotil (prn); Fluticasone propionate; Furosemide; Ipratropium-Albuterol; losartan Potassium; Mucinex (prn); Namenda; Nor
Current Illness:
Preexisting Conditions: CHF, COPD, Fibromyalgia, Major depressive d/o, anemia, edema, cellulitis,
Allergies: PCN, Morphine; Sulfa Atb, Tetracycline, Keflex, Mandol Mandol
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Death


Changed on 5/14/2021

VAERS ID: 1247318 Before After
VAERS Form:2
Age:69.0
Sex:Female
Location:Nebraska
Vaccinated:2021-04-22
Onset:2021-04-23
Submitted:0000-00-00
Entered:2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006C21A / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-23
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: Abilify; Acidophilus; Albuterol sulfate; Amantadine; Anoro Elipta; Betamethasone; Cyanocobalamin (monthly) Diclofenac; Lomotil (prn); Fluticasone propionate; Furosemide; Ipratropium-Albuterol; losartan Potassium; Mucinex (prn); Namenda; Nor
Current Illness:
Preexisting Conditions: CHF, COPD, Fibromyalgia, Major depressive d/o, anemia, edema, cellulitis,
Allergies: PCN, Morphine; Sulfa Atb, Tetracycline, Keflex, Mandol Mandol
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Death

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1247318&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166