National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 4/23/2021 release of VAERS data (an older release, current is 11/26/2021):

This is VAERS ID 1218779

Government Disclaimer on use of this data



Case Details

VAERS ID: 1218779 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-04-14
Onset:2021-04-16
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA O31B21A / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Basaglar, Trulicity, Metformin, Plavix, Crestor, Lasix, Enalapril, Synthroid, Arimidex, Xanax
Current Illness: No acute illness at the time of the vaccine. Was having problems with uncontrolled DM2.
Preexisting Conditions: DM2, HPL, HTN, Breast CA in remission, Lung CA in remission, CVA, hypothyroidism, asthma
Allergies: Codeine, Invokana, Glyburide, Aleve, Aromacin
Diagnostic Lab Data: None. Found dead outside of home by EMS.
CDC Split Type:

Write-up: Death


New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210423&IDNUMBER=1218779


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166