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|History of Changes from the VAERS Wayback Machine|
|Vaccination / Manufacturer||Lot / Dose||Site / Route|
|COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA||- / 1||- / IM|
Administered by: Other Purchased by: ??
Symptoms: Death, Dizziness, Nausea, Pyrexia
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: Received COVID-19 monoclonal antibodies 02/2021
Current Illness: tested positive for COVID-19 on 01/28/2021 via PCR testing
Preexisting Conditions: Obesity
Diagnostic Lab Data: 01/28/2021 COVID-19 PCR test positive
CDC 'Split Type':
Write-up: 03/31/2021 received 1st dose of Moderna COVID-19 vaccine 04/01/2021 104 F fever, dizziness, nausea 04/03/2021 symptoms subsided 04/04/2021 case expired as a result of undetermined natural causes per medical examiner final report
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