Adverse Event Reporting

VAERS ID 2050701
Gender Female
Age 83
StateCode MI
Pharmaceutical Company MODERNA
Lot Number 010A21A
Number of vaccinations 2
Vaccinated 2021-04-01
Onset 2022-01-18
Condition Hospitalized
Symptoms
  • SARS-CoV-2 test positive
  • COVID-19
  • Vaccine breakthrough infection

Current Illness

Preexisting Conditions

Other Medications

Previous Vaccinations

Allergies

Laboratory Data

COVID positive on 01/18/2022

Write-up

COVID breakthrough case