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This is VAERS ID 1754283

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1754283
VAERS Form:2
Age:81.0
Sex:Female
Location:Colorado
Vaccinated:2021-09-24
Onset:2021-09-25
Submitted:0000-00-00
Entered:2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939901 / 1 RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-09-25
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: Acetaminophen Tablet 650 MG Give 1 tablet by mouth every 6 hours as needed for General Discomfort Pharmacy Active 8/19/2021 17:38 8/19/2021 Furosemide Tablet 40 MG Give 1 tablet by mouth one time a day for Edema Pharmacy Active 8/20/2021
Current Illness: None
Preexisting Conditions: CKD, COPD, Diabetes, dementia
Allergies: Sulfa
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Death

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