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This is VAERS ID 1067873

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1067873
VAERS Form:2
Age:90.0
Sex:Female
Location:Foreign
Vaccinated:2021-01-28
Onset:2021-02-03
Submitted:0000-00-00
Entered:2021-03-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 300042698 / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Gastrointestinal haemorrhage, Injection site erythema, Injection site inflammation, Myocardial infarction, Injection site swelling

Life Threatening? Yes
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: ACETYLSALICYLZUUR CARDIO; ASCORBINEZUUR CF; OMEPRAZOL [OMEPRAZOLE]; FUROSEMIDE [FUROSEMIDE SODIUM]; METFORMINE [METFORMIN]; SIMVASTATINE; INSULINE INSULATARD HM NPH; VALSARTAN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No reported medical history.)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NLMODERNATX, INC.MOD20210

Write-up: Myocardial infarction; Gastrointestinal haemorrhage; Injection site erythema; Injection site swelling; Injection site inflammation; A Regulatory Authority report was received from a physician concerning a 90-year-old, female patient who experienced Injection site erythema, Injection site swelling, Injection site inflammation, Myocardial infarction, and Gastrointestinal hemorrhage. The patient''s medical history was not provided. Products known to have been used by the patient included [ACETYLSALICYLZUUR TABLET 80MG, ASCORBINEZUUR TABLET 500MG, OMEPRAZOL CAPSULE MSR 40MG, FUROSEMIDE TABLET 40MG, METFORMINE TABLET 500MG, SIMVASTATINE TABLET FO 40MG, INSULINE ISOFAAN INJSUSP 100IE/ML, VALSARTAN TABLET OMHULD] On 28 JAN 2021, prior to the onset of the symptoms, the patient received their first of two planned doses of mRNA-1273 (Batch number: [300042698]) intramuscularly for prophylaxis of COVID-19 infection. The patient developed Injection site erythema on 03 FEB 2021 and Course of the Event was 03 FEB 2021 to 08 FEB 2021. The patient developed Injection site swelling on 03 FEB 2021 and Course of the Event was 03 FEB 2021 to 08 FEB 2021. The patient developed Injection site inflammation on 03 FEB 2021 and Course of the Event was 03 FEB 2021 to 08 FEB 2021. The patient experienced Myocardial infarction and Gastrointestinal hemorrhage on 10 FEB 2021. Treatment information was not provided/unknown. Action taken with mRNA-1273 in response to the event(s) was unknown. The event(s), Injection site erythema, Injection site swelling, Injection site inflammation, were considered recovered/resolved on 08 FEB 2021. The patient died on UNK-Feb-2021. The cause of death was reported as Myocardial infarction, and Gastrointestinal hemorrhage. Plans for an autopsy were unknown.; Reporter''s Comments: This case concerns a 90 Y/O F with serious unexpected Myocardial infarction and Gastrointestinal hemorrhage and NS expected injection site erythema, injection site swelling, injection site inflammation. Serious events occurred 14 days after first dose of mRNA-1273. Treatment not reported. Event outcome fatal. Autopsy plan unknown. Based on current available information and temporal association between use of the product and the start date of the event, a causal relationship cannot be excluded.; Reported Cause(s) of Death: myocard infarct;

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