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This is VAERS ID 1478326

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1478326
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 2 - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Fall, SARS-CoV-2 test positive, Asymptomatic COVID-19

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: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Eliquis, cardizem, flonase, lasix, avapro, xopenex, melatonin, lopressor, senna, zanaflex
Current Illness: N/A
Preexisting Conditions: hyperlipidemia, depression, ADHD, CKD stage 3, GERD, osteoarthritis, coronary artery disease, hypertension, afib, obesity, COPD, cardiorenal syndrome, RLS, cervical spinal stenosis
Allergies: ciprofloxacin, bee pollen, PCN, sulfa''s
Diagnostic Lab Data: COVID Positive PCR on 07/01/2021. Prior COVID positive test in April per family.
CDC 'Split Type':

Write-up: Fully vaccinated patient tested positive for COVID upon admission to hospital for unrelated event. Patient admitted through ED on 07/01/21 for orthopedic needs after a fall. No s/s COVID throughout stay. Patient also with positive COVID test in 04/2021.

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