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This is VAERS ID 1362465

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1362465
VAERS Form:2
Age:74.0
Sex:Female
Location:Pennsylvania
Vaccinated:2021-05-26
Onset:2021-05-27
Submitted:0000-00-00
Entered:2021-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 033C21A / 2 - / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Chest pain, Death, Fatigue

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-29
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: metformin
Current Illness: nil
Preexisting Conditions: diabetes
Allergies: nil
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: chest pain, fatigue, death

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1362465&WAYBACKHISTORY=ON

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