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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 944641 |
VAERS Form: | 2 |
Age: | 83.0 |
Sex: | Female |
Location: | Florida |
Vaccinated: | 2021-01-12 |
Onset: | 2021-01-13 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-14 |
Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 011L20A / 1 | LA / IM |
Administered by: Other Purchased by: ??
Symptoms: Death
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:2021-01-13
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: Atorvastatin 80mg daily, biotin 2500mg daily, Calcium-Mag-Zinc tab daily, Restasis eye drop q12hr, ezetimibe 10mg qhs, gabapentin 100mg bid, lysine 1000mg daily, metoprolol tart 50mg bid, fish oil 1000mg daily, prilosec 20mg daily, ranola
Current Illness: CAD, angina, coronary bypass in 1990''s, Cardiac Cath on 12/28/2020
Preexisting Conditions: CAD
Allergies: Sulfa
Diagnostic Lab Data: NA
CDC 'Split Type':
Write-up: Patient died on 1/21-2021
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