Adverse Event Reporting

VAERS ID 2341836
Gender Female
Age 83
StateCode MI
Pharmaceutical Company MODERNA
Lot Number 039D21A
Number of vaccinations 3
Vaccinated 2021-12-07
Onset 2022-06-24
Condition Hospitalized
  • Inappropriate schedule of product administration
  • SARS-CoV-2 test positive
  • COVID-19

Current Illness

Preexisting Conditions

Other Medications

Previous Vaccinations


Laboratory Data

Positive Lab COVID test - 6/24/2022


Confirmed Positive Case COVID-19 (Moderna) 1 03/09/2021 Hospital Moderna 023M20A COVID-19 (Moderna) 2 04/08/2021 Hospital Moderna 018B21A COVID-19 (Moderna) 3 12/07/2021 Moderna 039D21A