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This is VAERS ID 1371177

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1371177
VAERS Form:2
Age:81.0
Sex:Male
Location:Georgia
Vaccinated:2021-02-18
Onset:2021-05-03
Submitted:0000-00-00
Entered:2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030M20A / 2 - / -

Administered by: Other      Purchased by: ??
Symptoms: Death, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-17
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? Yes, days: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Cardiovascular Disease, Chronic Renal Disease, Hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient hospitalized and died after testing positive for COVID-19. Tested positive on 5/3/2021.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1371177&WAYBACKHISTORY=ON

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