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This is VAERS ID 1103586

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1103586
VAERS Form:2
Age:
Sex:Female
Location:Foreign
Vaccinated:2021-01-22
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EM04777 / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Epilepsy, Seizure, General physical health deterioration

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 medical history reported)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': BEMODERNATX, INC.MOD20210

Write-up: Epileptic seizure; Convulsions; General physical health deterioration; A regulatory authority report was received from a pharmacist concerning, a 79 years old female patient who received Moderna (mRNA-1273) vaccine and experienced Epileptic seizure, Convulsions and General physical health deterioration. The patient had no history of epilepsy. Concomitant product use was not provided by the reporter. On 22 Jan 2021, approximately two hours prior to the onset of the symptoms, the patient received their first of two planned doses of mRNA-1273 (Batch number: EM04777) for prophylaxis of COVID-19 infection. Two hours post vaccine the patient experienced Epileptic seizure and was admitted to Emergency room. The patient''s condition stabilized with initiation of depakene and brought to the state of consciousness, but with visible general degradation of patient''s health. The patient was back to nursing home. The patient tested positive for COVID-19 on 26 Jan 2021 and was transferred in Hospital Covid unit. The patient had very degraded output on 3 Feb 2021. Call received from the Nursing home on 4 Feb 2021 for DEG. The patient was readmitted to the hospital. The patient developed the condition of epileptic pain. The patient was given second and then third line of treatment with no success Passage Palliative care. The patient died on 10 Feb 2021. No laboratory information was provided by the reporter. Treatment information for the event Epileptic seizure, provided included: Depakene. Action taken with mRNA-1273 in response to the event(s) was Not applicable. The event(s), Epileptic seizure, Convulsions and General physical health deterioration were considered as Fatal. The cause of death was reported as Epileptic seizure, Convulsions and General physical health deterioration. Plans for an autopsy were unknown.; Reporter''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender''s Comments: Case narrative was translated from the source document by the case processor. Errors in translation could be expected. Please refer the source document.; Reported Cause(s) of Death: Epileptic seizure; General physical health deterioration

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