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This is VAERS ID 1759308

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1759308
VAERS Form:2
Age:92.0
Sex:Female
Location:Georgia
Vaccinated:2021-04-01
Onset:2021-05-04
Submitted:0000-00-00
Entered:2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 2 LA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Death, Dementia, Dementia Alzheimer's type, Glaucoma, Pulmonary hypertension, Sepsis, Hyperlipidaemia, Vaccine breakthrough infection, Adult failure to thrive, COVID-19, SARS-CoV-2 test positive, Asymptomatic COVID-19

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-22
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: Cardiovascular disease, Renal disease
Allergies:
Diagnostic Lab Data: 05/04/2021 PCR+ COVID-19 test
CDC 'Split Type':

Write-up: Asymptomatic breakthrough COVID-19 case. Death 5/22/2021. From Records cod = ALZHEIMER''S DEMENTIA, COVID 19, HYPERLIPIDEMIA, PULMONARY HYPERTENSION. Other patient details: pt has dementia, adult failure to thrive . glaucoma, and sepsis. place of death: HOSPITAL-EMERGENCY ROOM/OUTPATIENT; certified by: PRONOUNCING AND CERTIFYING PHYSICIAN; occupation: PLAYGROUND DIRECTOR-BOARD OF ELECTIONS

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