National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/19/2021 release of VAERS data:

This is VAERS ID 1241639

Government Disclaimer on use of this data



Case Details

VAERS ID: 1241639 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-02-24
Onset:2021-02-27
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 032H20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 016M20A / 2 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood glucose normal, Hypertension, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-28
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopryl 10 MG, Procardia 30 MG, Ativan 2 MG, Klonopin 2 MG.
Current Illness: Unknown.
Preexisting Conditions: Cardiomegalia, COPD, CHR.
Allergies: Unknown.
Diagnostic Lab Data: None.
CDC Split Type:

Write-up: Two days after the 2nd dose, the patient presents the following symptoms: 75% oxigenation, 35% Puls, 153 sugar, HBP 64/44 and vomiting.


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1241639


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166