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This is VAERS ID 1768087

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1768087
VAERS Form:2
Age:60.0
Sex:Female
Location:Michigan
Vaccinated:2021-05-18
Onset:2021-10-05
Submitted:0000-00-00
Entered:2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017BZ1A / 2 - / -

Administered by: Private      Purchased by: ??
Symptoms: 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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: history of developmental delay, schizoaffective disorder, morbid obesity, osteoarthritis, DVT
Allergies:
Diagnostic Lab Data: COVID positive on 10/5/2021
CDC 'Split Type':

Write-up: COVID vaccine breakthrough case

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