VAERS ID: 918843

AGE: 52| SEX: F|STATE: NC (United States)

Description

Does not know if this was vaccine related or not, but patient had onset of GI bleeding and went to the ER. Got diagnosis of diverticulitis.

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Symptoms

Gastrointestinal haemorrhage, Blood test, Computerised tomogram, Diverticulitis

Vaccines

VAX DATE: 12-23-2020| ONSET DATE: 12-24-2020| DAYS TO ONSET: 1
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 1 COVID19 MODERNA 011J20A IM RA

RECVDATE:01-04-2021
RPT_DATE:
CAGE_YR:52
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:CT scan and blood work performed on 12/24/20.
V_ADMINBY:SEN
OTHER_MEDS:Estradiol, progesterone
CUR_ILL:
HISTORY:IBS, asthma
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:01-04-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:Y
ALLERGIES:Sulfa antibiotics Emycin
V_FUNDBY:

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