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This is VAERS ID 1505509

History of Changes from the VAERS Wayback Machine

First Appeared on 7/30/2021

VAERS ID: 1505509
VAERS Form:2
Age:40.0
Sex:Female
Location:Oklahoma
Vaccinated:2021-05-18
Onset:2021-07-09
Submitted:0000-00-00
Entered:2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027A21A / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-07-17
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: Prescription Vitamin D
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient is deceased.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1505509&WAYBACKHISTORY=ON

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