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This is VAERS ID 1371745

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1371745
VAERS Form:2
Age:83.0
Sex:Female
Location:Oregon
Vaccinated:2021-05-04
Onset:2021-05-16
Submitted:0000-00-00
Entered:2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death, Vaccination complication

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-01
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: unknown
Allergies: unknown
Diagnostic Lab Data: unknown
CDC 'Split Type':

Write-up: Was informed by the husband on Thursday May 27, 2021 that his wife had passed away 10 days after the first moderna vaccine and that her physician said it was contributing factor to her death. The husband was waiting for the death certificate.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1371745&WAYBACKHISTORY=ON

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