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This is VAERS ID 1245538

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1245538
VAERS Form:2
Age:80.0
Sex:Female
Location:Foreign
Vaccinated:2021-03-17
Onset:2021-04-01
Submitted:0000-00-00
Entered:2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Mesenteric artery thrombosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-01
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: Hypertension; Hypothyroidism; Osteoarthritis; Osteoporosis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FRMODERNATX, INC.MOD20210

Write-up: Mesenteric artery thrombosis; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 20-Apr-2021 and was forwarded to Moderna on 20-Apr-2021. This regulatory authority case was reported by a physician (subsequently medically confirmed) and describes the occurrence of MESENTERIC ARTERY THROMBOSIS (Mesenteric artery thrombosis) in an 80-year-old female patient who received mRNA-1273 (COVID 19 Vaccine Moderna) for COVID-19 vaccination. Concurrent medical conditions included Hypertension, Hypothyroidism, Osteoarthritis and Osteoporosis. On 17-Mar-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 01-Apr-2021, after starting mRNA-1273 (COVID 19 Vaccine Moderna), the patient experienced MESENTERIC ARTERY THROMBOSIS (Mesenteric artery thrombosis) (seriousness criterion death). The patient died on 01-Apr-2021. The reported cause of death was mesenteric ischemia. It is unknown if an autopsy was performed. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication reported. No treatment information was provided. sender''s case number 2021035738 Company comment: This case refers to an 80 year-old elderly female patient, with a history of hypertension and hypothyroidism, who died due to mesenteric artery thrombosis 15 days after receiving the first dose of mRNA-1273 vaccine. Very limited information has been provided at this time. Reporter did not allow further contact; Sender''s Comments: This case refers to an 80 year-old elderly female patient, with a history of hypertension and hypothyroidism, who died due to mesenteric artery thrombosis 15 days after receiving the first dose of mRNA-1273 vaccine. Very limited information has been provided at this time.; Reported Cause(s) of Death: mesenteric ischemia

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