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||012M20A / 1||LA / IM|
Administered by: Private Purchased by: ??
Life Threatening? No
Birth Defect? No
Permanent Disability? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: gastroesophageal reflux disease degenerative joint disease hepatitis C scoliosis ulnar neuropathy reactive airway disease seasonal allergies chronic pain alcohol abuse hypertension
Diagnostic Lab Data: none
CDC 'Split Type':
Write-up: patient expired 3 days after first vaccination. Did not present to our facility for care after vaccination; did not have any adverse reactions during vaccination waiting period. Per the Medical examiner, patient passed away at his residence, and his death was not related to the COVID vaccine.
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