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This is VAERS ID 1617531

History of Changes from the VAERS Wayback Machine

First Appeared on 8/27/2021

VAERS ID: 1617531
VAERS Form:2
Age:69.0
Sex:Female
Location:Washington
Vaccinated:2021-02-22
Onset:2021-04-01
Submitted:0000-00-00
Entered:2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 024M2OA / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Abdominal pain upper, Computerised tomogram, Death, Septic shock, Organ failure, Blood test

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-03
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: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Jardiance, Glucotrol, Levothyroxine, Omeprazole, Korcon, Amlodipine, Vitamin D supplements, Vitamin B supplements
Current Illness:
Preexisting Conditions: Diabetic, 10+ year cancer survivor, high blood pressure
Allergies: Not known
Diagnostic Lab Data: Blood tests, CT scans from 4/1/21 to 4/3/21. Please ask Hospital for a full list of tests and lab results.
CDC 'Split Type':

Write-up: Severe septic shock, followed by death. Stomach pain, followed by hospitalization, gradual organ failure, septic shock and death.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1617531&WAYBACKHISTORY=ON

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