Adverse Event Reporting
| VAERS ID | 1061059 |
|---|---|
| Gender | Female |
| Age | 77 |
| StateCode | CA |
| Pharmaceutical Company | MODERNA |
| Lot Number | |
| Number of vaccinations | 1 |
| Vaccinated | 2021-01-29 |
| Onset | 2021-01-30 |
| Condition | Hospitalized Died |
Symptoms
- Pain
- Muscle spasms
- Computerised tomogram abdomen
- Death
Current Illness
Was undergoing diagnostic testing for gastrointestinal complaints of several weeks duration. Had CT morning of 1/29/2021.
Preexisting Conditions
History of type 2 diabetes Hip replacement had been postponed due to pandemic
Other Medications
Not known to reporter
Previous Vaccinations
Allergies
not known to reporter
Laboratory Data
Write-up
Do not know if patient informed her physician that she received vaccine on 1/29/2021.
She had appt at 3:15 pm on 1/29 and afterwards stated she received the Moderna vaccine.
Reporter is uncertain if this was at a health office or clinic.
She drove herself to the ER at about 3am on 1/30/2021 with increased cramping and pain.