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This is VAERS ID 1319628

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1319628
VAERS Form:2
Age:77.0
Sex:Female
Location:Foreign
Vaccinated:2021-04-15
Onset:2021-04-16
Submitted:0000-00-00
Entered:2021-05-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3001937 / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-16
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:
Preexisting Conditions: Medical History/Concurrent Conditions: Churg Strauss syndrome; COPD; Trigeminal neuralgia (Autopsy asked for, but no performed at the time of the report.)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NOMODERNATX, INC.MOD20211

Write-up: SUDDEN DEATH; This regulatory authority case was reported by a physician (subsequently medically confirmed) and describes the occurrence of SUDDEN DEATH (SUDDEN DEATH) in a 77-year-old female patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. 3001937) for COVID-19 vaccination. Concurrent medical conditions included COPD, Trigeminal neuralgia (Autopsy asked for, but no performed at the time of the report.) and Churg Strauss syndrome. On 15-Apr-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. The patient died on 16-Apr-2021. The cause of death was not reported. An autopsy was not performed. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter considered SUDDEN DEATH (SUDDEN DEATH) to be possibly related. No Concomitant medications were reported by the reporter. Treatment medications were not reported. Action taken with mRNA-1273 in response to the drug was not applicable. The reporter (29 years old physician) was asked in the feedback to provide an update on the autopsy result when they are available. Based on the current available information and temporal association between the use of the product and the death, a causal relationship cannot be excluded. Cause of death not provided. Awaiting translation; Reporter''s Comments: .; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the death, a causal relationship cannot be excluded. Cause of death not provided. Awaiting translation; Reported Cause(s) of Death: unknown cause of death

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