National Vaccine Information Center Your Health. Your Family. Your Choice. |
MedAlerts.org |
History of Changes from the VAERS Wayback Machine |
VAERS ID: | 920815 |
VAERS Form: | 2 |
Age: | 58.0 |
Sex: | Female |
Location: | Kentucky |
Vaccinated: | 2020-12-30 |
Onset: | 2021-01-04 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-05 |
Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | - / 1 | - / IM |
Administered by: Private Purchased by: ??
Symptoms: Death
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:2021-01-04
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: unknown
Preexisting Conditions: Per employee health records HTN, DM, Breast CA 2016 with radiation, obesity, gastric sleeve 10 years ago, arthritis, plantar fasciitis, ankle tendonitis, DeQuarvains, carpal tunnel, anxiety
Allergies: Lisinpril, Codeine, Latex , environmental (hay fever)
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Found deceased in her home, unknown cause, 6 days after vaccine.
Copyright ©
2024 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166