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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 956903 |
VAERS Form: | 2 |
Age: | 86.0 |
Sex: | Male |
Location: | Unknown |
Vaccinated: | 2020-12-22 |
Onset: | 2020-12-27 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-09 |
Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | 011J20A / 1 | LA / IM |
Administered by: Other Purchased by: ??
Symptoms: SARS-CoV-2 test positive, Asymptomatic COVID-19
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:2020-12-27
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: mi Narrative: patient with asymptomatic covid 19, covid positive 12/10/2020.
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