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This is VAERS ID 1378395

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1378395
VAERS Form:2
Age:77.0
Sex:Female
Location:Minnesota
Vaccinated:2021-03-30
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 UN / IM

Administered by: Private      Purchased by: ??
Symptoms: COVID-19, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ASA, CA, Diovan, Fish oil, Gentamicin-prednisolone, Insulin, Metformin, Multivitamin, Omeprazole, rosuvastatin, valsartan Vit C.
Current Illness: unk
Preexisting Conditions: diabetes, HTN, kidney disease
Allergies: none
Diagnostic Lab Data: COVID19 Detection BDMAX
CDC 'Split Type':

Write-up: breakthrough COVID 19

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1378395&WAYBACKHISTORY=ON


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