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

This is VAERS ID 1180051



Case Details

VAERS ID: 1180051 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-01-07
Onset:2021-03-31
   Days after vaccination:83
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012L20A / 1 LA / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038K20A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ageusia, Anosmia, COVID-19, Chills, Exposure to SARS-CoV-2, Fatigue, Headache, Myalgia, Nausea, Oropharyngeal pain, Productive cough, Pyrexia, Respiratory tract congestion, Rhinorrhoea, SARS-CoV-2 test positive, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-31
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: COVID-19 infection one month after vaccination
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: Tested positive for COVID-19 by PCR on 3/06/2021 & 3/16/2021. 1st Moderna vaccine administered on 1/7/2021, 2nd Moderna vaccine administered on 2/4/2021.
CDC Split Type:

Write-up: Was hospitalized (unsure dates on hospitalization); has no known pre-existing conditions; symptom onset was 3/3/2021 with fever, chills, rigors, myalgia, rhinorrhea/congestion, sore throat, cough (wet productive), nausea/vomiting, headache, loss of smell and taste, and fatigue. Was a household contact to a known COID-19 case.


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1180051

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