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Report #2839989

Received May 5, 2025

DiedLife-threateningHospitalizedER / ED visitOffice visitDisabled
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
78 yrs
State
NC
Recovered
Not recovered
Vaccinated
Feb 9, 2021
Onset
Jul 17, 2021
Days to onset
158
Hospital days
—

Vaccines (1)

TypeNameManufacturerDoseLotRoute / Site
COVID19COVID19 (COVID19 (MODERNA))MODERNA1016M20ARA

Symptoms (11)

Body temperature increasedCardiac failure congestiveCoronary arterial stent insertionDeathMyocardial infarctionPainPeripheral swellingRectal haemorrhageSkin weepingThrombectomyThrombosis

Symptom narrative

Thier are so many see intire Packet sent along with form will list. First. EMS. Call Emergency to Hospital. Legs swelling temp 105 Blood Press 217/110 unberable pain #2 Hospital Bleeding from Rectum. #3 Hospital Leg swelling. Had Heart attack in Emergency room #4 Hospital Put in a shunt on Heart Blood vessel. Diag swollen legs Remove massive blood clots from both legs. The clots stated by Doc Surgeon. Never have seen these kinds of Blood clots. Never seen by mankind. #5 Hospital congestive Heart failure fluid leak from skin #6 Hospital Congestive Heart Failure Fluid lek from skin

Current illness

Common cold, Aches/Pains 78 yr. old Still very active

Medical history

None Before Given the Moderna shots. 4 month after all. Sever illness accured July 17 2021, Devistating Events to Sept 4 2024 Death.

Other medications

Blood Pressure Colesterol, Atorvastatin, Baby Aspirin 81 mg Tylenol, Nexium, Multivitamin for over 60.

Allergies

Senokot Face Swelling Lips stopped use immediately One Dose Very allergic 20yrs ago maybe

Lab data

See all Inclosed Documents tons of then have all No room to List see above writings