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This is VAERS ID 953129

History of Changes from the VAERS Wayback Machine

First Appeared on 1/22/2021

VAERS ID: 953129
VAERS Form:2
Age:74.0
Sex:Female
Location:Kentucky
Vaccinated:2021-01-09
Onset:2021-01-18
Submitted:0000-00-00
Entered:2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K208 / 1 AR / IM

Administered by: Private      Purchased by: ??
Symptoms: Arthralgia, Back pain, Cardiac arrest, Death, Unresponsive to stimuli

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-18
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: unknown
Current Illness: none known
Preexisting Conditions: hypertension; colon cancer (recovered); smoker
Allergies: none
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Patient presented to our Emergency Department via EMS in full code status; asystole. Patient expired. Per nursing, husband stated patient awoke this AM and reported pain in back between shoulders and in bilateral shoulders. Patient then went unresponsive and husband called EMS.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=953129&WAYBACKHISTORY=ON


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