National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1764920

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1764920
VAERS Form:2
Age:95.0
Sex:Female
Location:Tennessee
Vaccinated:2021-05-14
Onset:2021-06-17
Submitted:0000-00-00
Entered:2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNAVAILABLE (PL / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-06-17
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: Blood pressure medication
Current Illness:
Preexisting Conditions: Vascular dementia
Allergies:
Diagnostic Lab Data: None.
CDC 'Split Type':

Write-up: Patient died about a month later. Unknown whether she had a second vaccination for COVID. She was resident at Rehab Facility.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1764920&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166