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VAERS Report 2157445

Case Report Section

Vaer Report Details

Age: 79 years old

Gender: Female

State: Michigan

Patient Died?
No
Vaccine information

Name: COVID19 (COVID19 (MODERNA))

Type: Coronavirus 2019 vaccine

Manufacturer: MODERNA

Lot: 939904


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2021-10-27
Date of Onset
66
Number of days (onset date – vaccination date)
66
Adverse Event Description

patient presented to emergency department on 1/1/2022 following an intentional drug overdose. she was found to be covid-19 positive during screening for admission. patient was asymptomatic for covid-19 during admission and required no treatment or supportive care for infection. patient was discharged home on 1/8/2022

Lab Data
covid-19 pcr test positive on 1/1/2022
List of symptoms
sars-cov-2 test positive asymptomatic covid-19
Patient Died?
No
Date Died
NA
Birth defect
false
Vaccine Administered By:
Pharmacy or store
Vaccine Purchased By:
Unknown
Patient visit ER?
No
Patient Hospitalized?
Yes
Stay in hospital
No
Days in hospital
Unspecified
Permanent disability?
No
Allergies:
azithromycin
Current Illness
na