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Administered by: Unknown Purchased by: ?
Life Threatening? No
Write-up: Death NOS; This case was received via another Manufacturer (Reference number: QTS-210413-110) on 08-Apr-2021 and was forwarded to Moderna on 08-Apr-2021. This regulatory authority case was reported by a physician (subsequently medically confirmed) and describes the occurrence of DEATH (Death NOS) in a 63-year-old male 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 20-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. It is unknown if an autopsy was performed. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. Reporter did not allow further contact; Sender''s Comments: This is a case of death in a 63-year-old male subject with unknown medical history of, who died 3 days after receiving the first dose of vaccine. Very limited information has been provided at this time. No follow up is possible.
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