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This is VAERS ID 1062304

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1062304
VAERS Form:2
Age:90.0
Sex:Female
Location:Foreign
Vaccinated:2021-02-02
Onset:2021-02-05
Submitted:0000-00-00
Entered:2021-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 300042698 / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Pyrexia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No adverse event history.)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NLMODERNATX, INC.MOD20210

Write-up: Pyrexia; A regulatory authority report was received from a health care professional concerning a 90 years old female patient who received Moderna''s COVID-19 vaccine (mRNA-1273) and experienced pyrexia. The patient''s medical history was not provided. No relevant concomitant medications were reported. On 02 Feb 2021 prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (Batch/Lot number: 300042698) for prophylaxis of COVID-19 infection. On 05 Feb 2021, pyrexia has started, which was confirmed by conducting pyrexia lab test with test result as: 38 tot 40.5 degrees Celsius. No treatment information was provided. Action taken with mRNA-1273 in response to the events was not applicable. The outcome of the event, pyrexia, was fatal.; Reporter''s Comments: Very limited information regarding the fatal event of pyrexia in this elderly patient has been provided at this time. Based on the limited information available, it is difficult to assess a cause and effect relationship.; Reported Cause(s) of Death: unknown cause of death

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