VAERS ID: 1708019

AGE: 72| SEX: M|STATE: MI (United States)

Description

Breakthrough case

Open in Wayback Machine
(If this is a foreign report without a description you will be able to read the description in the Wayback Machine on Medalerts if the report became public for the first time before November 18, 2022.)

Symptoms

Infection

Vaccines

VAX DATE: 02-25-2021| ONSET DATE: 09-01-2021| DAYS TO ONSET: 188
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 2 COVID19 MODERNA 010A21A IM UN

RECVDATE:09-17-2021
RPT_DATE:
CAGE_YR:72
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:unknown
V_ADMINBY:
OTHER_MEDS:unknown
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:09-17-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:NKDA
V_FUNDBY:

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OpenVAERS is a private organization that posts publicly available CDC/FDA data of injuries reported post-vaccination. Reports are not proof of causality.