Adverse Event Reporting
| VAERS ID | 920815 |
|---|---|
| Gender | Female |
| Age | 58 |
| StateCode | KY |
| Pharmaceutical Company | MODERNA |
| Lot Number | |
| Number of vaccinations | 1 |
| Vaccinated | 2020-12-30 |
| Onset | 2021-01-04 |
| Condition | Died |
Symptoms
- Death
Current Illness
unknown
Preexisting Conditions
Per employee health records HTN, DM, Breast CA 2016 with radiation, obesity, gastric sleeve 10 years ago, arthritis, plantar fasciitis, ankle tendonitis, DeQuarvains, carpal tunnel, anxiety
Other Medications
unknown
Previous Vaccinations
Allergies
Lisinpril, Codeine, Latex , environmental (hay fever)
Laboratory Data
Write-up
Found deceased in her home, unknown cause, 6 days after vaccine.