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|History of Changes from the VAERS Wayback Machine|
|Vaccination / Manufacturer||Lot / Dose||Site / Route|
|COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA||G26761A / 1||- / OT|
Administered by: Unknown Purchased by: ??
Life Threatening? No
Birth Defect? No
Permanent Disability? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No medical history)
Diagnostic Lab Data:
CDC 'Split Type': PLMODERNATX, INC.MOD20210
Write-up: Death; A regulatory authority report (Poland) was received from a physician concerning a 73-years old, patient who received Moderna''s COVID-19 Vaccine (mRNA-1273) and the patient died. The patient''s medical history was not provided by the reporter. On 17 Feb 2021, the patient received their first of two planned doses of mRNA-1273 (lot number G26761A) intramuscularly in the left arm for prophylaxis of COVID-19 infection. On an unknown date, the patient died. Death occurred several days after vaccination . The Reporter described as uncertain of the effect of the vaccination on death. There is a time relationship between vaccination and the occurrence of side effects. No treatment information was provided. Action taken with mRNA-1273 in response to the events was not reported. The cause of death was not reported. Autopsy performed was unknown.; Reporter''s Comments: Very limited information regarding the events has been provided at this time and is insufficient for causality assessment.; Sender''s Comments: Zgon wystapil kilka dni po szczepieniu u starszej osoby. Nieznana jest historia medyczna pacjenta. Lekarz opisal jako niepewny wplyw szczepionki na zgon. Istnieje zwiazek czasowy miedzy szczepieniem a wystapieniem dzialan niepozadanych. Osoba zglaszajaca NOP zakwalifikowala go jako ciezki. URPL ocenil NOP jako ciezki.; Reported Cause(s) of Death: death
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