National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1271382

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1271382
VAERS Form:2
Age:62.0
Sex:Female
Location:Tennessee
Vaccinated:2021-02-01
Onset:2021-02-25
Submitted:0000-00-00
Entered:2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-04
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: Unknown
Current Illness:
Preexisting Conditions: Diabetes, heart disease, renal disease, CVA, seizures, dementia, bipolar
Allergies: Unknown
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was admitted to facility 2/25 and passed away 3/4.


Changed on 5/7/2021

VAERS ID: 1271382 Before After
VAERS Form:2
Age:62.0
Sex:Female
Location:Tennessee
Vaccinated:2021-02-01
Onset:2021-02-25
Submitted:0000-00-00
Entered:2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-04
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: Unknown
Current Illness:
Preexisting Conditions: Diabetes, heart disease, renal disease, CVA, seizures, dementia, bipolar
Allergies: Unknown Unknown
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was admitted to facility 2/25 and passed away 3/4.


Changed on 5/14/2021

VAERS ID: 1271382 Before After
VAERS Form:2
Age:62.0
Sex:Female
Location:Tennessee
Vaccinated:2021-02-01
Onset:2021-02-25
Submitted:0000-00-00
Entered:2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-04
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: Unknown
Current Illness:
Preexisting Conditions: Diabetes, heart disease, renal disease, CVA, seizures, dementia, bipolar
Allergies: Unknown Unknown
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was admitted to facility 2/25 and passed away 3/4.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1271382&WAYBACKHISTORY=ON

Government Disclaimer on use of this data


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