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This is VAERS ID 1336774

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History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1336774
VAERS Form:2
Age:59.0
Sex:Female
Location:North Carolina
Vaccinated:2021-03-26
Onset:2021-05-13
Submitted:0000-00-00
Entered:2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 008B21-2A / 2 AR / IM

Administered by: Other      Purchased by: ??
Symptoms: Death, Dyspnoea, Headache, Pyrexia, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tacrolimus, Cellcept, prednisone and cyclosporine
Current Illness: Hx of double lung transplant in 2005 (chronic rejection) and ERSD on hemodialysis
Preexisting Conditions:
Allergies: Codeine, Morphine, Percocet
Diagnostic Lab Data: SARS CoV-2 PCR 5/13/21 Positive
CDC 'Split Type':

Write-up: Patient developed fever, dyspnea and headache on 5/12/2021; tested positive for COVID-19 on 5/12/2021; patient died on 5/20/21

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