VAERS ID: 1000849

AGE: 62| SEX: M|STATE: (United States)

Description

Narrative: Respiratory failure / respiratory depression went to ED / ICU 2/1/2021. Frail patient. 1st vaccine 12/23/2020 Moderna Lot 039K20A exp 6/20/2021, 2nd vaccine 1/20/2020 Moderna Lot 013L20A exp 7/8/2021

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Symptoms

Asthenia, Intensive care, Respiratory failure, Respiratory depression, PO2 decreased

Vaccines

VAX DATE: 01-20-2021| ONSET DATE: 02-01-2021| DAYS TO ONSET: 12
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 1 COVID19 MODERNA 039k20a IM LA

RECVDATE:02-04-2021
RPT_DATE:
CAGE_YR:
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:Y
ER_VISIT:
HOSPITAL:Y
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:P02 % dropped to 66% on O2 through nasal cannula 1/31/2021
V_ADMINBY:OTH
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:02-01-2021
BIRTH_DEFECT:U
OFC_VISIT:Y
ER_ED_VISIT:Y
ALLERGIES:
V_FUNDBY:

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