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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 948181 |
VAERS Form: | 2 |
Age: | 89.0 |
Sex: | Male |
Location: | Michigan |
Vaccinated: | 0000-00-00 |
Onset: | 0000-00-00 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-15 |
Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | - / UNK | - / - |
Administered by: Unknown Purchased by: ??
Symptoms: Chest pain, Death, Heart rate irregular
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:0000-00-00
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: ANORA, Albuterol, Flovent, Bumex, Carvediol; omeprazole
Current Illness:
Preexisting Conditions: COPD, CHF, renal; ASCVD; MI hx
Allergies: 0
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Death Chest pain; irreg heart rhythm; evening of vaccine; death on toilet on 1/13/21
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