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This is VAERS ID 1418473

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First Appeared on 6/25/2021

VAERS ID: 1418473
VAERS Form:2
Age:82.0
Sex:Male
Location:Foreign
Vaccinated:2021-05-10
Onset:2021-05-11
Submitted:0000-00-00
Entered:2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3001945 / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Lymphocyte count increased, Ischaemic stroke

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Cancer of lung
Preexisting Conditions: Medical History/Concurrent Conditions: Basal cell carcinoma; Hypertension arterial; Hypertensive heart disease NOS
Allergies:
Diagnostic Lab Data: Test Name: Lymphocyte count increased; Result Unstructured Data: Increased for more than 2 years
CDC 'Split Type': FRMODERNATX, INC.MOD20212

Write-up: accident vasculaire c?r?bral isch?mique; This regulatory authority case was reported by a physician and describes the occurrence of ISCHAEMIC STROKE (accident vasculaire c?r?bral isch?mique) in an 82-year-old male patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. 3001945) for COVID-19 vaccination. The patient''s past medical history included Hypertension arterial, Basal cell carcinoma and Hypertensive heart disease NOS. Concurrent medical conditions included Cancer of lung since 2021. On 10-May-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 11-May-2021, after starting mRNA-1273 (COVID 19 Vaccine Moderna), the patient experienced ISCHAEMIC STROKE (accident vasculaire c?r?bral isch?mique) (seriousness criteria death, hospitalization and medically significant). The patient died on 15-May-2021. The reported cause of death was Ischemic stroke. It is unknown if an autopsy was performed. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Lymphocyte count increased: increased (High) Increased for more than 2 years. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medications were not provided. Treatment information was not reported. Company Comment This case concerns an 82-year-old female with a serious unexpected event of ischaemic stroke with fatal outcome. Event latency 2 days after first dose mRNA-1273. Based on current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. Most recent FOLLOW-UP information incorporated above includes: On 10-Jun-2021: Translation received on 17-jun-2021, updated with the lab data information.; Sender''s Comments: This case concerns an 82-year-old female with a serious unexpected event of ischaemic stroke with fatal outcome. Event latency 2 days after first dose mRNA-1273. Based on current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.; Reported Cause(s) of Death: Ischemic stroke

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