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This is VAERS ID 1355126

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History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1355126
VAERS Form:2
Age:77.0
Sex:Female
Location:Puerto Rico
Vaccinated:2021-04-03
Onset:2021-05-12
Submitted:0000-00-00
Entered:2021-05-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Senior Living      Purchased by: ??
Symptoms: Chest pain, Dyspnoea, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-12
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: Unknown.
Preexisting Conditions: Cancer.
Allergies: Unknown.
Diagnostic Lab Data: Covid-19 Antigen lab test, negative result.
CDC 'Split Type':

Write-up: Difficulty breathing and pain in the chest.

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