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This is VAERS ID 1326488

History of Changes from the VAERS Wayback Machine

First Appeared on 5/21/2021

VAERS ID: 1326488
VAERS Form:2
Age:87.0
Sex:Female
Location:Michigan
Vaccinated:2021-04-23
Onset:2021-05-02
Submitted:0000-00-00
Entered:2021-05-18
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
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
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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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1326488&WAYBACKHISTORY=ON


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