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This is VAERS ID 1217281

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1217281
VAERS Form:2
Age:86.0
Sex:Male
Location:Foreign
Vaccinated:2021-03-18
Onset:2021-03-23
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-23
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: PLAVIX; BELOC ZOK; COMILORID; FELODIPIN; CELECOXIB; DUODART; OMEZOL LYO
Current Illness: Diabetes mellitus; Hypertension
Preexisting Conditions: Medical History/Concurrent Conditions: Myocardial infarct; Renal failure; Stroke
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CHMODERNATX, INC.MOD20210

Write-up: death; This regulatory authority case was reported by a physician (subsequently medically confirmed) and describes the occurrence of DEATH (death) in an 86-year-old male patient who received mRNA-1273 (COVID-19 Vaccine Moderna) for COVID-19 vaccination. The patient''s past medical history included Myocardial infarct, Stroke and Renal failure. Concurrent medical conditions included Diabetes mellitus and Hypertension. Concomitant products included CLOPIDOGREL BISULFATE (PLAVIX), METOPROLOL SUCCINATE (BELOC ZOK), AMILORIDE HYDROCHLORIDE, HYDROCHLOROTHIAZIDE (COMILORID), FELODIPIN, CELECOXIB, DUTASTERIDE, TAMSULOSIN HYDROCHLORIDE (DUODART) and OMEPRAZOLE SODIUM (OMEZOL LYO) for an unknown indication. On 18-Mar-2021, the patient received first dose of mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular) 1 dosage form. Death occurred on 23-Mar-2021 The patient died on 23-Mar-2021. The cause of death was not reported. An autopsy was not performed. For mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular), the reporter considered DEATH (death) to be unlikely related. Treatment was not provided. On 22-Mar, he was visited by the attending physician for non-specific symptoms (fluctuating vertigo, mild chest tightness, arterial hypotension), partly known but aggravated symptoms. Clinical examination and ECG without pathological findings, D-Dimer negative, Troponin-T non-pathological in view of age and concomitant chronic renal failure.; Sender''s Comments: This is a case of death in a 86-year-old male subject with a medical history of Diabetes mellitus, Hypertension. Myocardial infarct, Stroke and Renal failure, who died 5 days after receiving the first dose of vaccine. Based on reporter''s causality that patient''s age and clinical condition with several known pathologies, the death is assessed as unlikely related to mRNA-1273.; Reported Cause(s) of Death: unknown cause of death

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