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This is VAERS ID 1193833

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1193833
VAERS Form:2
Age:
Sex:Female
Location:Foreign
Vaccinated:2021-03-03
Onset:2021-03-05
Submitted:0000-00-00
Entered:2021-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-05
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 reported medical history.)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CHMODERNATX, INC.MOD20210

Write-up: death; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 03-Apr-2021 and was forwarded to Moderna on 03-Apr-2021. This regulatory authority case was reported by a physician and describes the occurrence of DEATH (death) in an 88-year-old female patient who received mRNA-1273 (COVID-19 Vaccine Moderna) for COVID-19 vaccination. The patient''s past medical history included No adverse event (No reported medical history.). On 03-Mar-2021, the patient received dose of mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular) 1 dosage form. Death occurred on 05-Mar-2021 The patient died on 05-Mar-2021. The cause of death was not reported. It is unknown if an autopsy was performed. For mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular), the reporter considered DEATH (death) to be unlikely related. Reporter did not allow further contact; Sender''s Comments: This case refers to an 88 year-old elderly female patient who died 48 hours after receiving the mRNA-1273 vaccine. Very limited information has been provided at this time.; Reported Cause(s) of Death: Unknown cause of death

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1193833&WAYBACKHISTORY=ON

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