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This is VAERS ID 1666414

History of Changes from the VAERS Wayback Machine

First Appeared on 9/3/2021

VAERS ID: 1666414
VAERS Form:2
Age:88.0
Sex:Unknown
Location:Tennessee
Vaccinated:0000-00-00
Onset:2021-08-23
Submitted:0000-00-00
Entered:2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001L20A / 2 - / IM

Administered by: Public      Purchased by: ??
Symptoms: Death, Malaise

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-08-23
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient fully vaccinated with two vaccines. Developed symptoms of Covid 19 and admitted to hospital on 8/23/2021. Case expired while still hospitalized on 08/24/2021.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1666414&WAYBACKHISTORY=ON

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