Vaer Report Details
Age: 79 years old
Gender: Female
State: Michigan
- Patient Died?
- No
- Vaccine information
-
Name: COVID19 (COVID19 (MODERNA))
Type: Coronavirus 2019 vaccine
Manufacturer: MODERNA
Lot: 939904
- Date report was received
- 2022-03-04
- Date form completed
- Date Vaccinated
- 2021-10-27
- Date of Onset
- 66
- Number of days (onset date – vaccination date)
- 66
- Adverse Event Description
-
patient presented to emergency department on 1/1/2022 following an intentional drug overdose. she was found to be covid-19 positive during screening for admission. patient was asymptomatic for covid-19 during admission and required no treatment or supportive care for infection. patient was discharged home on 1/8/2022
- Lab Data
-
covid-19 pcr test positive on 1/1/2022
- List of symptoms
-
sars-cov-2 test positive asymptomatic covid-19
- Patient Died?
- No
- Date Died
- NA
- Birth defect
- false
- Vaccine Administered By:
- Pharmacy or store
- Vaccine Purchased By:
- Unknown
- Patient visit ER?
- No
- Patient Hospitalized?
- Yes
- Stay in hospital
- No
- Days in hospital
- Unspecified
- Permanent disability?
- No
- Allergies:
-
azithromycin
- Current Illness
-
na