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This is VAERS ID 928933

History of Changes from the VAERS Wayback Machine

First Appeared on 1/15/2021

VAERS ID: 928933
VAERS Form:2
Age:56.0
Sex:Female
Location:Iowa
Vaccinated:2020-12-23
Onset:2021-01-08
Submitted:0000-00-00
Entered:2021-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J202A / 1 RA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Death, Resuscitation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-08
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had been diagnosed with COVID-19 on Dec. 11th, 2020. Symptoms were thought to have started on 12/5/2020. Received Moderna vaccine on 12/23. Unexpected death on 1/8/2021. Resuscitation attempts unsuccessful


Changed on 5/7/2021

VAERS ID: 928933 Before After
VAERS Form:2
Age:56.0
Sex:Female
Location:Iowa
Vaccinated:2020-12-23
Onset:2021-01-08
Submitted:0000-00-00
Entered:2021-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J202A / 1 RA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Death, Resuscitation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-08
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had been diagnosed with COVID-19 on Dec. 11th, 2020. Symptoms were thought to have started on 12/5/2020. Received Moderna vaccine on 12/23. Unexpected death on 1/8/2021. Resuscitation attempts unsuccessful


Changed on 5/14/2021

VAERS ID: 928933 Before After
VAERS Form:2
Age:56.0
Sex:Female
Location:Iowa
Vaccinated:2020-12-23
Onset:2021-01-08
Submitted:0000-00-00
Entered:2021-01-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J202A / 1 RA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Death, Resuscitation

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-08
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had been diagnosed with COVID-19 on Dec. 11th, 2020. Symptoms were thought to have started on 12/5/2020. Received Moderna vaccine on 12/23. Unexpected death on 1/8/2021. Resuscitation attempts unsuccessful

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=928933&WAYBACKHISTORY=ON


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