Adverse Event Reporting

VAERS ID 919546
Gender Female
Age 51
StateCode AL
Pharmaceutical Company MODERNA
Lot Number 011J20A
Number of vaccinations 1
Vaccinated 2020-12-29
Onset 2021-01-01
Condition Hospitalized Life Threatening Permanent Disability
  • Antinuclear antibody positive
  • Blood cholesterol increased
  • Aphasia
  • Mechanical ventilation
  • Antiphospholipid antibodies
  • Blood homocysteine
  • Coagulation time
  • Craniotomy
  • Low density lipoprotein increased
  • Thrombotic stroke

Current Illness

PMH- Lupus; HTN; marked hyperlipidemia

Preexisting Conditions

Lupus Hypertension Hyperlipidemia

Other Medications

Plaquenil Fioricet Midrin

Previous Vaccinations


None listed

Laboratory Data

Total cholesterol- 465 LDL- 351 ANA (+) Labs pending- Lupus AC; antiphospholipid AB, homocysteine levels; hypercoagulability profile


thrombotic stroke -necessitating hospitalization; and craniotomy; required mechanical ventilator for 2 days.
Patient now extubated, breathing on her own.
Patient remains hospitalized with marked deficits (aphasic)