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This is VAERS ID 1431167

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1431167
VAERS Form:2
Age:81.0
Sex:Female
Location:Unknown
Vaccinated:2021-02-17
Onset:2021-05-17
Submitted:0000-00-00
Entered:2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Death, Pneumonia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-06-19
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Death J18.9 - Pneumonia of both lower lobes due to infectious organism

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1431167&WAYBACKHISTORY=ON

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