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VAERS Report 2157447

Case Report Section

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