Your Health. Your Family. Your Choice.
|History of Changes from the VAERS Wayback Machine|
|Vaccination / Manufacturer||Lot / Dose||Site / Route|
|COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA||006C21A / UNK||- / IM|
Administered by: Other Purchased by: ??
Symptoms: Chest pain, Death
Life Threatening? Yes
Birth Defect? No
Permanent Disability? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Other Medications: none
Current Illness: None reported
Preexisting Conditions: Hypertension Diabetes Anemia
Allergies: None reported
Diagnostic Lab Data: Unknown. Medical Records at healthcare facility.
CDC 'Split Type':
Write-up: May 3, 2021, received a call from healthcare provider where the vaccine was given by healthcare provider. COVID 19 Prescreening Form Completed and Vaccine given 4/23/2021. Patient waited 15 minutes post vaccination no reaction. Her family also received a vaccine. Daughter and Son-In Law. Received a call that patient had died on 5/2/2021. Presented to healthcare facility for chest pain according to healthcare provider.
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