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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 1187918 |
VAERS Form: | 2 |
Age: | 15.0 |
Sex: | Female |
Location: | New Hampshire |
Vaccinated: | 0000-00-00 |
Onset: | 2021-04-05 |
Submitted: | 0000-00-00 |
Entered: | 2021-04-09 |
Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA | - / UNK | - / - |
Administered by: Private Purchased by: ??
Symptoms: Cardiac arrest, Intensive care
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:2021-04-06
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: levothyroxine
Current Illness:
Preexisting Conditions: Trisomey 21, Atrioventricular canal s/p repair, hypothyroidism, asthma, obstructive sleep apnea, cervical spine instability, hypotonia, scoliosis, feeding difficulties, renal dysplasia, autism, chronic constipation, bronchopulmonary dysplasia, mixed conductive and sensorineural hearing loss, binocular vision disorder, gastroesophgeal reflux,
Allergies: Cefdinir, Sulfa, Ex-Lax, NSAIDS
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: I do not know the exact date of the first or second Moderna Vaccine. I am the PICU attending who cared for the patient after her cardiac arrest which we believe was about 3-4 days after her second Moderna Vaccine
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