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This is VAERS ID 1428029

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1428029
VAERS Form:2
Age:32.0
Sex:Female
Location:Georgia
Vaccinated:2021-06-23
Onset:2021-06-23
Submitted:0000-00-00
Entered:2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-06-23
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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Flagyl, Quinolones
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: N/A -- patient was perfectly fine during wait time

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1428029&WAYBACKHISTORY=ON

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