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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 928513 |
VAERS Form: | 2 |
Age: | 72.0 |
Sex: | Female |
Location: | Michigan |
Vaccinated: | 2021-01-05 |
Onset: | 2021-01-06 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-08 |
Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 026L20A / 1 | RA / IM |
Administered by: Senior Living Purchased by: ??
Symptoms: Death
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:2021-01-06
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: Amiodarone Hcl, Carvedilol, Ferrous sulfate, Eliquis (cont)
Current Illness: Atrial fibrillation, Anemia, 1st degree AV block, CDK stage 4,
Preexisting Conditions: CDK stage 4, Atrial fibrillation, 1st degree AV block, Patient was under hospice care
Allergies: Aldactone, contrast dye
Diagnostic Lab Data: N/A
CDC 'Split Type':
Write-up: Resident passed away in her sleep
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