National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1322111

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1322111
VAERS Form:2
Age:81.0
Sex:Male
Location:California
Vaccinated:2021-05-04
Onset:2021-05-04
Submitted:0000-00-00
Entered:2021-05-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / IM

Administered by: Other      Purchased by: ??
Symptoms: Complication associated with device, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: lipitor, lasix, zyrtec,insulin,metoprolol, phoslo, hydraziline
Current Illness: Covid+ 2/10/21 requiring hosp, neg Covid pcr 3/17, 4/5. positive covid 5/12(Ct 40.40 Covid + 5/16 (Ct 38.5)
Preexisting Conditions: hemodialysis, diabetes, ESRD, MGUS
Allergies: n/a
Diagnostic Lab Data: positive covid pcr 5/12,5/17
CDC 'Split Type':

Write-up: hospitalized 5/12 because unable to dialyze in his unit

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1322111&WAYBACKHISTORY=ON


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