Page breadcrumb nav

VAERS Report 2095636

Case Report Section

Vaer Report Details

Age: 93 years old

Gender: Female

State: Michigan

Patient Died?
No
Vaccine information

Name: COVID19 (COVID19 (MODERNA))

Type: Coronavirus 2019 vaccine

Manufacturer: MODERNA

Lot: 012l20a


Date report was received
2022-02-08
Date form completed
Date Vaccinated
2021-01-25
Date of Onset
375
Number of days (onset date – vaccination date)
375
Adverse Event Description

event occurred after 2nd dose. patient was diagnosed with covid-19. tylenol, in-patient

Lab Data
covid-19 test positive
List of symptoms
covid-19 sars-cov-2 test positive
Patient Died?
No
Date Died
NA
Birth defect
false
Vaccine Administered By:
Private
Vaccine Purchased By:
Unknown
Patient visit ER?
No
Patient Hospitalized?
Yes
Stay in hospital
No
Days in hospital
Unspecified
Permanent disability?
No
Allergies:
ativan, bactrim, iodine
Current Illness
na