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This is VAERS ID 1370350

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1370350
VAERS Form:2
Age:79.0
Sex:Male
Location:California
Vaccinated:2021-01-19
Onset:2021-05-14
Submitted:0000-00-00
Entered:2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029I20A / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Dyspnoea, Lymphadenopathy, Cardiac disorder

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-15
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: Diabetes; Liver disorder (liver problems); Lung cancer (in remission since November)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20211

Write-up: Heart problems; Breathing problems; Lymph nodes swollen; This spontaneous case was reported by a consumer and describes the occurrence of CARDIAC DISORDER (Heart problems), DYSPNOEA (Breathing problems) and LYMPHADENOPATHY (Lymph nodes swollen) in a 79-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 024m20a and 029I20a) for COVID-19 vaccination. Concurrent medical conditions included Diabetes, Lung cancer (in remission since November) and Liver disorder (liver problems). On 19-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 19-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 14-May-2021, the patient experienced CARDIAC DISORDER (Heart problems) (seriousness criterion death), DYSPNOEA (Breathing problems) (seriousness criterion death) and LYMPHADENOPATHY (Lymph nodes swollen) (seriousness criterion death). The patient died on 15-May-2021. The cause of death was not reported. It is unknown if an autopsy was performed. No relevant concomitant medications were provided. Daughter of the patient reported that the patient passed away after his lymph nodes swollen, had breathing problems, and hart problems. She stated that the patient was in remission of lung cancer since November, and that he was diabetic and had liver problems. They wanted to be part of the trials for the vaccine. She wanted his cases to be research because his lymph nodes were swollen, and that for her means there''s a correlation between the vaccine taking and his demised. No treatment information was provided. Very limited information regarding these events has been provided at this time. Further information has been requested. The patient''s medical history of diabetes, liver disorder and lung cancer are confounding factors that may play possible contributory roles.; Sender''s Comments: Very limited information regarding these events has been provided at this time. Further information has been requested. The patient''s medical history of diabetes, liver disorder and lung cancer are confounding factors that may play possible contributory roles.; Reported Cause(s) of Death: passed away

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