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This is VAERS ID 1450577

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1450577
VAERS Form:2
Age:92.0
Sex:Female
Location:Unknown
Vaccinated:2021-04-28
Onset:2021-06-06
Submitted:0000-00-00
Entered:2021-07-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Death, Acute kidney injury

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-06-10
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 N17.9 - Acute kidney failure, unspecified

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