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This is VAERS ID 1484677

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1484677
VAERS Form:2
Age:60.0
Sex:Female
Location:California
Vaccinated:2021-06-21
Onset:2021-07-06
Submitted:0000-00-00
Entered:2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / IM

Administered by: Private      Purchased by: ??
Symptoms: Abdominal pain upper, Death, Electrocardiogram abnormal, Inflammation, Carditis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-07-06
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: Hair, Skin, nail vitamin B6 Calcium
Current Illness:
Preexisting Conditions: LUpus
Allergies: NONE
Diagnostic Lab Data: EKG
CDC 'Split Type':

Write-up: Daughter stated that patient passed on 07/06, a few weeks after getting her 1st vaccine. Daughter stated that she noticed that her mother had stomach pains the day before and the day of passing. Daughter stated tat Mother had EKG test and heart inflammation was found. Patient passed due to heart inflammation.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1484677&WAYBACKHISTORY=ON

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