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This is VAERS ID 1738603

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/1/2021

VAERS ID: 1738603
VAERS Form:2
Age:73.0
Sex:Female
Location:Hawaii
Vaccinated:2021-09-17
Onset:2021-09-18
Submitted:0000-00-00
Entered:2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 2 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-09-18
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: Ill and weak for at least a month that pushed off 2nd dose
Preexisting Conditions: Immunocompromised
Allergies: Patient and son verified that patient had no allergies, nor any history of allergic reactions or anaphylaxis
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Vaccine administration was uneventful. Patient and son confirmed that patient was cleared for vaccine and that she was well during and after the observation period. No signs of distress and no abnormality of breathing.

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