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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 918518 |
VAERS Form: | 2 |
Age: | 50.0 |
Sex: | Female |
Location: | Nebraska |
Vaccinated: | 2020-12-31 |
Onset: | 2020-12-31 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-04 |
Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 011L20A / 1 | UN / IM |
Administered by: Private Purchased by: ??
Symptoms: Cardio-respiratory arrest, Death, Resuscitation, Syncope, Autopsy
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:2020-12-31
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: To be determined
Current Illness: To be determined
Preexisting Conditions: To be determined
Allergies: To be determined
Diagnostic Lab Data: Autopsy being performed
CDC 'Split Type':
Write-up: syncopal episode - arrested - CPR - death
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