Adverse Event Reporting
| VAERS ID | 924186 |
|---|---|
| Gender | Female |
| Age | 91 |
| StateCode | MI |
| Pharmaceutical Company | MODERNA |
| Lot Number | 025J20A |
| Number of vaccinations | 1 |
| Vaccinated | 2020-12-30 |
| Onset | 2021-01-03 |
| Condition | Died |
Symptoms
- Death
Current Illness
Covid positive previous with no s/s poor appetite Chronic wound right leg
Preexisting Conditions
alzheimers dementia, COPD , DM- type 2
Other Medications
aldactone, lasix, aspirin, tylenol, potassium, spiriva
Previous Vaccinations
Allergies
Codeine, Penicillin, Sulfa
Laboratory Data
Write-up
Resident expired 1/3/21