National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1761030

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1761030
VAERS Form:2
Age:70.0
Sex:Female
Location:New Jersey
Vaccinated:2021-06-07
Onset:2021-10-02
Submitted:0000-00-00
Entered:2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 2 - / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Cough, Dyspnoea, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: amiodarone 200 mg Tablet Directions: 1 tablet oral daily (Active) amLODIPine (NorvASC) 5 mg Tablet Directions: 1 tablet oral daily (Active) clopidogrel 75 mg Tablet Directions: 1 tablet oral daily (Active) famotidine (Pepcid) 20 mg
Current Illness:
Preexisting Conditions: CAD, COPD COPD, O2 dependent; Depression, Diabetes, GERD, HTN, Obesity; Other History of Polyp of Colon, Insomnia, Anxiety Disorder. CABG done at Medical Center within the past month; Tracheostomy; Other Cardiac Catheterization, Colonoscopic Polypectomy, Hx CAD w/ Stent Placement, PEG Tube Maintenance. Smoking Status Former Smoker.
Allergies: Codeine, penicillin, azithromycin.
Diagnostic Lab Data: 10/2/21, SARS-CoV-2 PCR (POSITIVE).
CDC 'Split Type':

Write-up: 71-year-old female with h/o COPD, CAD, HTN ,a.fib receved her 2nd dose of covid vaccine in may. started with cough sob hence brought into ED. tested postive for covid

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1761030&WAYBACKHISTORY=ON


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