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This is VAERS ID 1218479

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1218479
VAERS Form:2
Age:92.0
Sex:Female
Location:Foreign
Vaccinated:2021-02-09
Onset:2021-03-10
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 300042722; 3000 / 2 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Alanine aminotransferase, Blood albumin, Blood alkaline phosphatase, Blood bilirubin, Blood creatinine, Blood gases, Blood glucose, Blood lactate dehydrogenase, Blood lactic acid, Blood potassium, Blood sodium, Blood urea, C-reactive protein, Cerebrovascular accident, Echocardiogram, Electrocardiogram, Fibrin D dimer, Gamma-glutamyltransferase, Haemoglobin, International normalised ratio, Loss of consciousness, Neutrophil count, Platelet count, White blood cell count, Troponin T, Angiogram

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-10
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: ELTROXIN; KALEORID; LERCATIO; HEART MAGNIL; SPIRIVA; LOSARTAN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Apoplexy; Atherosclerosis
Allergies:
Diagnostic Lab Data: Test Date: 20210310; Test Name: Alanine aminotransferase; Test Result: Inconclusive ; Result Unstructured Data: 248 Unit not specified; Test Date: 20210310; Test Name: CT angiography; Test Result: Inconclusive ; Result Unstructured Data: occlusion of the left ICA; Test Date: 20210310; Test Name: CT angiography; Test Result: Inconclusive ; Result Unstructured Data: thrombus in the left a. Cerebri media; Test Date: 20210310; Test Name: CT angiography; Test Result: Inconclusive ; Result Unstructured Data: stenosis of the left a. Carotis interna; Test Date: 20210310; Test Name: Albumin; Result Unstructured Data: Normal; Test Date: 20210310; Test Name: Alkaline phosphatase; Test Result: Inconclusive ; Result Unstructured Data: 145 Unit not specified; Test Date: 20210310; Test Name: Bilirubin; Result Unstructured Data: Normal; Test Date: 20210310; Test Name: Creatinine; Test Result: Inconclusive ; Result Unstructured Data: 187 Unit not specified; Test Date: 20210310; Test Name: Arterial blood gases; Test Result: Inconclusive ; Result Unstructured Data: Metabolic acidosis Unit not specified; Test Date: 20210310; Test Name: Glucose; Result Unstructured Data: Normal; Test Date: 20210310; Test Name: LDH; Test Result: Inconclusive ; Result Unstructured Data: 1080 Unit not specified; Test Date: 20210310; Test Name: Lactate; Test Result: Inconclusive ; Result Unstructured Data: 11 to 14 Unit not specified; Test Date: 20210310; Test Name: Potassium; Result Unstructured Data: Normal; Test Date: 20210310; Test Name: Sodium; Result Unstructured Data: Normal; Test Date: 20210310; Test Name: Urea; Test Result: Inconclusive ; Result Unstructured Data: 10.5 Unit not specified; Test Date: 20210310; Test Name: C-reactive protein; Result Unstructured Data: Normal; Test Date: 20210310; Test Name: Echocardiography; Test Result: Inconclusive ; Result Unstructured Data: thrombus in coronary artery; Test Date: 20210310; Test Name: EKG; Test Result: Inconclusive ; Result Unstructured Data: Inferior STEMI; Test Date: 20210310; Test Name: Fibrin D dimer; Test Result: Inconclusive ; Result Unstructured Data: $g35, too high to measure Unit not specified; Test Date: 20210310; Test Name: GGT; Result Unstructured Data: Normal; Test Date: 20210310; Test Name: Hemoglobin; Test Result: Inconclusive ; Result Unstructured Data: 6.8 Unit not specified; Test Date: 20210310; Test Name: INR; Test Result: Inconclusive ; Result Unstructured Data: 1.11 Unit not specified; Test Date: 20210310; Test Name: Neutrophil count; Test Result: Inconclusive ; Result Unstructured Data: 19.3 Unit not specified; Test Date: 20210310; Test Name: Thrombocyte count; Test Result: Inconclusive ; Result Unstructured Data: 303 Unit not specified; Test Date: 20210310; Test Name: Troponin T; Test Result: Inconclusive ; Result Unstructured Data: 3130 Unit not specified; Test Date: 20210310; Test Name: Leukocyte count; Test Result: Inconclusive ; Result Unstructured Data: 22 Unit not specified
CDC 'Split Type': DKMODERNATX, INC.MOD20210

Write-up: Apoplexy; Brought to the hospital unconscious; This regulatory authority case was reported by a physician (subsequently medically confirmed) and describes the occurrence of CEREBROVASCULAR ACCIDENT (Apoplexy) and LOSS OF CONSCIOUSNESS (Brought to the hospital unconscious) in a 92-year-old female patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch nos. 300042722; 3000489 and 300042722; 3000489) for COVID-19 vaccination. The patient''s past medical history included Atherosclerosis since an unknown date. Previously administered products included for an unreported indication: VESICARE in 2016. Concurrent medical conditions included Apoplexy. Concomitant products included ACETYLSALICYLSYRE (HEART MANGIL) from 23-Jun-2014 to an unknown date for Anticoagulant therapy, TIOTROPIUM BROMIDE (SPIRIVA) from 23-Jun-2014 to an unknown date for Chronic obstructive pulmonary disease, LERCANIDIPINE HYDROCHLORIDE (LERCATIO) from 24-Mar-2014 to an unknown date and LOSARTAN POTASSIUM (LOSARSTAD) from 19-Feb-2014 to an unknown date for Hypertension, LEVOTHYROXINE SODIUM (ELTROXIN) from 24-Apr-2014 to an unknown date for Hypometabolism, POTASSIUM CHLORIDE (KALEORID) for Potassium supplementation. On 09-Feb-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 09-Mar-2021, received second dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) dosage was changed to 1 dosage form. On 10-Mar-2021, the patient experienced CEREBROVASCULAR ACCIDENT (Apoplexy) (seriousness criterion death) and LOSS OF CONSCIOUSNESS (Brought to the hospital unconscious) (seriousness criterion death). The patient died on 10-Mar-2021. The reported cause of death was Apoplexy and Unconscious. An autopsy was not performed. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 10-Mar-2021, Alanine aminotransferase: 248 248 Unit not specified. On 10-Mar-2021, Angiogram: occlusion of the left ICA, thrombus in the left a. Middle Cerebral and stenosis of the left artery Carotid On 10-Mar-2021, Blood albumin: (normal) Normal. On 10-Mar-2021, Blood alkaline phosphatase: 145 145 Unit not specified. On 10-Mar-2021, Blood bilirubin: (normal) Normal. On 10-Mar-2021, Blood creatinine: 187 187 Unit not specified. On 10-Mar-2021, Blood gases: Metabolic acidosis Unit not specified. On 10-Mar-2021, Blood glucose: mg/dl (normal) Normal. On 10-Mar-2021, Blood lactate dehydrogenase: 1080 1080 Unit not specified. On 10-Mar-2021, Blood lactic acid: 11-14 11 to 14 Unit not specified. On 10-Mar-2021, Blood potassium: (normal) Normal. On 10-Mar-2021, Blood sodium: (normal) Normal. On 10-Mar-2021, Blood urea: 10.5 10.5 Unit not specified. On 10-Mar-2021, C-reactive protein: (normal) Normal. On 10-Mar-2021, Echocardiogram: thrombus in coronary artery. See Sender comments. On 10-Mar-2021, Electrocardiogram: inferior stemi Inferior STEMI. On 10-Mar-2021, Fibrin D dimer: $g35 $g35, too high to measure Unit not specified. On 10-Mar-2021, Gamma-glutamyltransferase: (normal) Normal. On 10-Mar-2021, Haemoglobin: 6.8 6.8 Unit not specified. On 10-Mar-2021, International normalised ratio: 1.11 1.11 Unit not specified. On 10-Mar-2021, Neutrophil count: 19.3 19.3 Unit not specified. On 10-Mar-2021, Platelet count: 303 303 Unit not specified. On 10-Mar-2021, Troponin T: 3130 3130 Unit not specified. On 10-Mar-2021, White blood cell count: 22 22 Unit not specified. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. Echocardiography, 10 Mar2021: Thrombus in coronary artery. Confirmed by elevated troponin T and high D dimer. Severe aortic stenosis, initial localised inferior hypokinesia, later takotsubo like heart failure, likely due to the apoplexies. Action taken with mRNA-1273 in response to the event was not applicable. Treatment information was not provided. Reporter did not allow further contact.; Sender''s Comments: Very limited information regarding the reported fatal events has been provided at this time. However, patient''s advanced age and underlying cardiovascular comorbidities may have been contributory. No further information has been requested.; Reported Cause(s) of Death: Apoplexy; Unconscious

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