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|History of Changes from the VAERS Wayback Machine|
|Vaccination / Manufacturer||Lot / Dose||Site / Route|
|COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA||025L20A / 1||LA / IM|
Administered by: Private Purchased by: ??
Life Threatening? No
Birth Defect? No
Permanent Disability? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Other Medications: Hydrochlorthiazide (by record, not confirmed)
Preexisting Conditions: Hypertension, sleep apnea, obesity. based on medical record
Allergies: no known allergies recorded in medical record
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: The patient was found deceased at home about 24 hours after immunization. Date of Death:: 12/29/2020; estimated time of death 6:00pm
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