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VAERS ID: 1753041

AGE: 84| SEX: F|State: MI

Description

vaccine breakthrough event

Symptoms

COVID-19, SARS-CoV-2 test positive, Vaccine breakthrough infection

Vaccines

VAX DATE: 23 February 2021 | ONSET DATE: 28 September 2021 | DAYS TO ONSET: 217
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • MODERNA
  • COVID19 (COVID19 (MODERNA))

        RECVDATE:
        01 October 2021
        CAGE_YR:
        84
        CAGE_MO:
        RPT_DATE:
        DIED:
        DATEDIED:
        L_THREAT:
        ER_VISIT:
        HOSPITAL:
        Y
        HOSPDAYS:
        X_STAY:
        DISABLE:
        RECOVD:
        U
        LAB_DATA:
        COVID + test result 9/29/*21
        V_ADMINBY:
        PUB
        OTHER_MEDS:
        CUR_ILL:
        HISTORY:
        PRIOR_VAX:
        SPLTTYPE:
        FORM_VERS:
        2
        TODAYS_DATE:
        01 October 2021
        BIRTH_DEFECT:
        OFC_VISIT:
        ER_ED_VISIT:
        ALLERGIES:
        V_FUNDBY:
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