This is VAERS ID 956903

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/22/2021

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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