Adverse Event Reporting

VAERS ID	1049012
Gender	Female
Age	72
StateCode	AZ
Pharmaceutical Company	MODERNA
Lot Number	006M20A
Number of vaccinations	1
Vaccinated	2021-02-12
Onset	2021-02-19
Condition	Died

Symptoms

• Death

Current Illness

Preexisting Conditions

Other Medications

lisinopril, lovastatin, diclofenac sodium, nifedipine ER, Anastrozole, Alendronate

Previous Vaccinations

Allergies

NKDA

Laboratory Data

Write-up

Patient was given vaccine on friday, one week later she passed away.
The family called the pharmacy to inform us on Saturday, Feb 20, 2021.
After the phone call was over, we saw in her pharmacy profile that she had received the vaccine one week prior