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Report #2839024

Received Apr 30, 2025

Hospitalized
A note on interpretation. VAERS reports are unverified and may be incomplete or coincidental. A report does not establish that a vaccine caused an event, and counts should not be used to calculate incidence or infer causation. Full disclaimer

Overview

Sex
Female
Age
56 yrs
State
MN
Recovered
Recovered
Vaccinated
Jun 9, 2021
Onset
Apr 18, 2025
Days to onset
1409
Hospital days
2

Vaccines (1)

TypeNameManufacturerDoseLotRoute / Site
COVID19COVID19 (COVID19 (MODERNA))MODERNA2039C21AIM / LA

Symptoms (2)

COVID-19SARS-CoV-2 test positive

Symptom narrative

Hospitalization related to COVID 19 following completion of primary vaccine series

Current illness

o Anxiety (F41.9) o Asthma (J45.909) o Candidal intertrigo (B37.2) o Cervicalgia (M54.2) o Chronic recurrent major depressive disorder (F33.9) o Chronic rhinitis (J31.0) o Chronic stasis dermatitis (I87.2) o Cough in adult (R05) o Degenerative joint disease of cervical spine (M47.812) o Dependent edema (R60.9) o Diabetes mellitus with nephropathy (E11.21) o Diabetic neuropathy (E11.40) o Diarrhea, unspecified type (R19.7) o Dry mouth (R68.2) o Eczema (L30.9) o Esophageal reflux (K21.9) o Herpes labialis (B00.1) o Hyperlipidemia (E78.5) o Hypertension (I10) o Hypokalemia (E87.6) o Ingrowing nail (L60.0) o Injury of right knee, initial encounter (S89.91XA) o Insomnia (G47.00) o Irritable bowel syndrome (K58.9) o Joint pain, hip (M25.559) o Lower back pain (M54.5) o Migraine headache (G43.909) o Morbid obesity (E66.01) o Neuropathic pain of both feet (G57.93) o Opioid dependence (F11.20) o Opioid use agreement exists (Z79.891) o Pain of toe of right foot (M79.674) o Personality disorder (F60.9) o Post-traumatic stress disorder (F43.10) o Primary osteoarthritis of both knees (M17.0) o Primary osteoarthritis of right knee (M17.11) o Psoriasis (L40.9) o Recurrent UTI (N39.0) o Shoulder pain, left (M25.512) o Shoulder pain, right (M25.511) o Sinus congestion (R09.81) o Sinusitis, acute frontal (J01.10) o Type 2 diabetes mellitus (E11.9) o Urinary incontinence (R32) o Venous insufficiency (I87.2) o Vulvitis (N76.2)

Medical history

o Anxiety (F41.9) o Asthma (J45.909) o Candidal intertrigo (B37.2) o Cervicalgia (M54.2) o Chronic recurrent major depressive disorder (F33.9) o Chronic rhinitis (J31.0) o Chronic stasis dermatitis (I87.2) o Cough in adult (R05) o Degenerative joint disease of cervical spine (M47.812) o Dependent edema (R60.9) o Diabetes mellitus with nephropathy (E11.21) o Diabetic neuropathy (E11.40) o Diarrhea, unspecified type (R19.7) o Dry mouth (R68.2) o Eczema (L30.9) o Esophageal reflux (K21.9) o Herpes labialis (B00.1) o Hyperlipidemia (E78.5) o Hypertension (I10) o Hypokalemia (E87.6) o Ingrowing nail (L60.0) o Injury of right knee, initial encounter (S89.91XA) o Insomnia (G47.00) o Irritable bowel syndrome (K58.9) o Joint pain, hip (M25.559) o Lower back pain (M54.5) o Migraine headache (G43.909) o Morbid obesity (E66.01) o Neuropathic pain of both feet (G57.93) o Opioid dependence (F11.20) o Opioid use agreement exists (Z79.891) o Pain of toe of right foot (M79.674) o Personality disorder (F60.9) o Post-traumatic stress disorder (F43.10) o Primary osteoarthritis of both knees (M17.0) o Primary osteoarthritis of right knee (M17.11) o Psoriasis (L40.9) o Recurrent UTI (N39.0) o Shoulder pain, left (M25.512) o Shoulder pain, right (M25.511) o Sinus congestion (R09.81) o Sinusitis, acute frontal (J01.10) o Type 2 diabetes mellitus (E11.9) o Urinary incontinence (R32) o Venous insufficiency (I87.2) o Vulvitis (N76.2)

Other medications

Albuterol Sulfate (2.5 MG/3ML) 0.083% Inhalation Nebulization SolutionUSE 1 UNIT DOSE EVERY 4-6 HOURS AS NEEDED FOR WHEEZING .Allergy 2-0.1 % CREAAPPLY TO AFFECTED AREA SPARINGLY THREE TIMES DAILYAnti-Itch Maximum Strength 2 % CREAAPPLY SPA

Allergies

o Augmentin TABS o Ceclor CAPS o Erythromycin Derivatives o Macrobid o metFORMIN HCl TABS o Penicillins o metal o Other

Lab data

Covid positive test date 04/18/2025