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This is VAERS ID 1193971

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1193971
VAERS Form:2
Age:74.0
Sex:Male
Location:Foreign
Vaccinated:2021-02-20
Onset:2021-03-03
Submitted:0000-00-00
Entered:2021-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 300042721 / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Asthenia, Dizziness, Feeling hot, Myalgia, Respiratory failure, COVID-19

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Spinal disorder (Degeneration of the spine)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': PLMODERNATX, INC.MOD20210

Write-up: Respiratory failure; Dizziness; Feeling hot; Weakness generalized; Muscle pain; COVID-19; This regulatory authority case was reported by a non-health professional and describes the occurrence of RESPIRATORY FAILURE (Respiratory failure) and COVID-19 (COVID-19) in a 74-year-old male patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. 300042721) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Spinal disorder (Degeneration of the spine). On 20-Feb-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 03-Mar-2021, the patient experienced DIZZINESS (Dizziness), FEELING HOT (Feeling hot), ASTHENIA (Weakness generalized) and MYALGIA (Muscle pain). On 05-Mar-2021, the patient experienced RESPIRATORY FAILURE (Respiratory failure) (seriousness criterion death) and COVID-19 (COVID-19) (seriousness criterion death). The patient died on 05-Mar-2021. The reported cause of death was Respiratory failure and covid-19, virus identified. It is unknown if an autopsy was performed. At the time of death, DIZZINESS (Dizziness), FEELING HOT (Feeling hot), ASTHENIA (Weakness generalized) and MYALGIA (Muscle pain) outcome was unknown. Concomitant product use was not provided. Treatment information was not provided. The reporter''s contact information was not provided. Reporter did not allow further contact; Reported Cause(s) of Death: Respiratory failure; COVID-19, virus identified

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