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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1098680



Case Details

VAERS ID: 1098680 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Female  
Location: California  
Vaccinated:2021-02-18
Onset:2021-03-06
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 1 UN / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / SYR

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-11
   Days after onset: 5
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol, amlodipine, lipitor, breo ellipta, flexeril, wellbutrin, premarin, prozac, levothyroxine, losartan, singulair, prilosec,
Current Illness: 2nd toe arthroplasty surgery 3/4/2021, laminotomy, medial facetectomy and B foraminotomies L3-S1 on 2/22/21
Preexisting Conditions: Lumbar stenosis, hypertension, hypothryroidism, h/o breast CA, prediabetes, osteoarthritis, s/p hip replacement, anemia, gerd, asthma, cervical spondylosis with myelopathy
Allergies: Tape
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt completed 2 covid vaccine morderna doses Feb 18, 2021. Pt with increasing weakness and short of breath for 3 days PTA on 3/6/2021.


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1098680

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