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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1756876

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Case Details

VAERS ID: 1756876 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-03-10
Onset:2021-09-17
   Days after vaccination:191
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Senior Living       Purchased by: ?
Symptoms: COVID-19, Death, Fall, Fracture, SARS-CoV-2 test positive
SMQs:, Accidents and injuries (narrow), Osteoporosis/osteopenia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-23
   Days after onset: 6
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Norco, duloxetine, midodrine, melatonin, calcium carbonate, amitriptyline, senna, lidocaine, nitrofurantoin, nystain,
Current Illness: depression, iron deficiency, repeated falls, constipation, dementia
Preexisting Conditions: dementia, anemia, depression
Allergies: morphine
Diagnostic Lab Data: Abbot rapid nasal covid swab on 09/17/2021 X 2, both with + results
CDC Split Type:

Write-up: Received covid vaccine at another (unknown) location prior to admission to facility. experienced multiple falls with significant fractures (prior to facility admission), which put her in the hospital, then needing rehab. transferred to this facility, facility sent to the hospital r/t medical concerns on 09/05/2021, returned to the facility on 09/10/2021, tested positive for covid 19 on 09/17/2021. was treated per facility APRN and MD, however, despite efforts, expired on 09/23/2021. Death is under investigation with health department for cause.


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