| VAERS ID: |
1033448 (history) |
| Form: |
Version 2.0 |
| Age: |
82.0 |
| Sex: |
Female |
| Location: |
Minnesota |
| Vaccinated: | 2021-01-26 |
| Onset: | 2021-01-27 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-02-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA |
- / UNK |
- / - |
Administered by: Senior Living Purchased by: ?
Symptoms: Death,
Dyspnoea,
Pneumonia,
Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-02-01
Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Blood Thinners Pyschotropics
Current Illness: Had Covid-19 one month prior
Preexisting Conditions: Irregular Heart Asthma pneumonia prone
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Fever by the next day, difficulty breathing, pneumonia, and then DEATH within a few days. (Died 02/01/2021) |
