VAERS ID: 1112773

AGE: 56| SEX: F|STATE: CA (United States)

Description

Moderna #1 vaccine given at 130pm March 11th 2021. Pt had history of asthma and frequent nebulizer use and had it in car with her for drive-thru vaccine clinic we did at location, which has a large parking lot. We gave 80 doses. Pt checked off anaphylaxis on the intake form so Dr spoke to her and she changed it to no history of anaphylaxis and only has history of asthma. So we gave her the vaccine. About 5 minutes later in car parking lot she started to use her personal nebulizer. I saw her in passenger side of car using a personal nebulizer so I talked to her and her daughter to find out what was going on. They said she has exacerbations all the time and this was not out of ordinary for her. I checked pulse ox and did a lung exam, etc, and she was stable. She seemed baseline according to history by her and her daughter. As she seemed at baseline and clinically was comfortable and conversant whole time, and she felt better after her nebulizer, I told them to have a low threshold for going to ER or calling 911 if her asthma was worse or different than her usual symptoms. They agreed. According to daughter, she did well until about 24 hours the next day. The daughter said she was fine and she went to store and when she returned EMTs were intubating patient and apparently the patient used her epipen and called 911 herself. Approximate time of expiration was 230pm on March12th 2021.

Open in Wayback Machine
(If this is a foreign report without a description you will be able to read the description in the Wayback Machine on Medalerts if the report became public for the first time before November 18, 2022.)

Symptoms

Death, Endotracheal intubation

Vaccines

VAX DATE: 03-11-2021| ONSET DATE: 03-12-2021| DAYS TO ONSET: 1
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 1 COVID19 MODERNA 036A21A IM LA

RECVDATE:03-18-2021
RPT_DATE:
CAGE_YR:56
CAGE_MO:
DIED:Y
DATEDIED:03-12-2021
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:
V_ADMINBY:PVT
OTHER_MEDS:nebulizer with medications (unknown specifics), had O2 at home, had epipen Rx already from past
CUR_ILL:Asthma with home O2 and regular exacerbations and nebulizer use.
HISTORY:severe chronic asthma with home O2
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:03-18-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:no known specific allergies to us, just history of severe asthma
V_FUNDBY:

Questions? Comments? Bugs?
[email protected]
Due to the high volume of inquiries, please be patient with response times.

AND PLEASE read the FAQ first.

OpenVAERS is a private organization that posts publicly available CDC/FDA data of injuries reported post-vaccination. Reports are not proof of causality.