Adverse Event Reporting

VAERS ID 2510868
Gender Female
Age 83
StateCode MI
Pharmaceutical Company MODERNA
Lot Number 001M21A
Number of vaccinations 4
Vaccinated 2022-04-12
Onset 2022-11-06
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 +

Write-up

Breakthrough case admission after four vaccines Moderna 1/21/21 Lot# 029L20A; Moderna 2/18/21 Lot# 024M20A; Moderna 11/8/21 Lot# 065F21A; Moderna 4/12/22 Lot# 001M21A