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This is VAERS ID 1153614

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1153614
VAERS Form:2
Age:100.0
Sex:Female
Location:Foreign
Vaccinated:2021-02-15
Onset:2021-02-17
Submitted:0000-00-00
Entered:2021-04-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Bronchiolitis, Depressed level of consciousness, Decreased appetite

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-27
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CHMODERNATX, INC.MOD20210

Write-up: Rarely was conscious; Could not eat and drink; Bronchiolitis; A regulatory authority report was received concerning a 100-year-old, female patient who experienced bronchiolitis, could not eat and drink/decreased appetite and rarely was conscious/ depressed level of consciousness. The patient''s medical history included COVID-19 in Oct 2021. Concomitant product use was not provided by the reporter. On 15 Feb 2021, prior to the onset of the symptoms, the patient received their second of two planned doses of mRNA-1273 (Batch number not provided) via an unknown route for prophylaxis of COVID-19 infection. On 17 Feb 2021, the patient experienced reduced level of consciousness with difficulty in eating and drinking by mouth. On an unknown date,the patient was hospitalized. On 27 Feb 2021, the patient died with a diagnosis of bronchiolitis, with no accompanying fever. Treatment for the event included oxygen, buscopan as needed and morphine for pain and discomfort as well as temesta for sedation. Action taken with mRNA-1273 in response to the events was not applicable. The outcome of the events, could not eat and drink/decreased appetite and rarely was conscious/ depressed level of consciousness was unknown. The Patient died on 27 Feb 2021. Cause of death was reported as bronchiolitis. Plans for autopsy was not reported.; Reporter''s Comments: This case concerns a 100-year-old, female patient who experienced fatal event of bronchiolitis, decreased appetite and depressed level of consciousness. Very limited information regarding this event has been provided at this time. The patient''s advanced age and previous COVID-19 infection remains a risk factor. Cause of death was reported as bronchiolitis. Plans for autopsy was not reported.; Reported Cause(s) of Death: Bronchiolitis

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