Adverse Event Reporting
| VAERS ID | 914473 |
|---|---|
| Gender | Female |
| Age | 83 |
| StateCode | MO |
| Pharmaceutical Company | MODERNA |
| Lot Number | 025J20A |
| Number of vaccinations | 1 |
| Vaccinated | 2020-12-28 |
| Onset | 2020-12-29 |
| Condition | Permanent Disability |
Symptoms
- Fatigue
- Pyrexia
- Tremor
- Asthenia
- Hypertension
- Rash
- Decreased appetite
- Chest X-ray
- Laboratory test
- Mental status changes
- Facial paralysis
- Rash macular
- Livedo reticularis
- Speech disorder
- Computerised tomogram head
- Cognitive disorder
- Depressed level of consciousness
Current Illness
COVID-19 positive
Preexisting Conditions
hypertension, hypokalemia, malignant neoplasm, tremor,
Other Medications
Eliquis, carbidopa-levidopa, Cardizem, Comtan, gabapentin, metoprolol, omeprazole, potassium citrate
Previous Vaccinations
Allergies
Cipro, Levaquin, topiramate
Laboratory Data
Lab, Chest x-ray, Head CT, IVF
Write-up
Weakness, fatigue, decreased appetite, upper extremity shaking, sternal red blotchy rash, decreased mental status, non-verbal, decreased level of conscious, mottling, left side facial droop, hypertensive, fever, unable to follow commands