VAERS ID: 1053191

AGE: 67| SEX: F|STATE: IN (United States)

Description

Vaccine administered 02/08/2021 , by Thursday 02/11/2021 patient almost nonverbal, by Monday 02/15/2021 patient went to the hospital with bruising, sores on her stomach and clots reported as thrombocytopenia, deceased by Friday 02/19/2021.

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Symptoms

Thrombocytopenia, Thrombosis, Aphasia, Contusion, Death, Communication disorder

Vaccines

VAX DATE: 02-08-2021| ONSET DATE: 02-11-2021| DAYS TO ONSET: 3
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 1 COVID19 MODERNA 004M20A IM AR

RECVDATE:02-24-2021
RPT_DATE:
CAGE_YR:67
CAGE_MO:
DIED:Y
DATEDIED:02-19-2021
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:
V_ADMINBY:SEN
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:02-24-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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