National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/26/2021 release of VAERS data:

This is VAERS ID 1454844

Government Disclaimer on use of this data



Case Details

VAERS ID: 1454844 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-02-25
Onset:2021-04-15
   Days after vaccination:49
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 RA / SYR
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 022M20A / 2 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Death, Dyspnoea, Respiratory arrest, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Respiratory failure (narrow), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-27
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Revlimid
Current Illness:
Preexisting Conditions: Multiple Myeloma (not having achieved remission); deficiency of B group vitamins; COPD
Allergies: SULFAMETHOXAZOLE W-TRIMETHOPRIM
Diagnostic Lab Data: Patient tested positive for COVID-19 on 04/20/2021 despite being fully vaccinated against it.
CDC Split Type:

Write-up: Patient admitted to hospital on 04/20/2021 for significant shortness of breath; patent tested positive for COVID-19 despite being fully vaccinated against it. Patient died on 04/24/2021. Death Certificate Information: Part I: Cause of Death: A. Repiratory Arrest B. COVID-19 Part II Other Significant Conditions COPD; Multiple Myeloma


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1454844


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