Vaer Report Details
Age: 70 years old
Gender: Male
State: Michigan
- Patient Died?
- No
- Vaccine information
-
Name: COVID19 (COVID19 (MODERNA))
Type: Coronavirus 2019 vaccine
Manufacturer: MODERNA
Lot: 012l20a
- Date report was received
- 2022-03-04
- Date form completed
- Date Vaccinated
- 2021-01-15
- Date of Onset
- 369
- Number of days (onset date – vaccination date)
- 369
- Adverse Event Description
-
patient presented to emergency department on 1/19/2022 for a fall. he had tested positive for covid-19 using a home test prior to presentation. patient was asymptomatic for covid-19 infection during admission. he was discharged to inpatient rehab facility on 1/25/2022. patient was readmitted from rehab facility with respiratory failure on 1/26/2022. he was treated with baricitinib and required supplemental oxygen. he was discharged to long-term acute care hospital on 2/15/2022
- Lab Data
-
covid-19 pcr test positive on 1/19/2022
- List of symptoms
-
fall sars-cov-2 test positive respiratory failure asymptomatic covid-19
- 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:
-
na
- Current Illness
-
na