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This is VAERS ID 1431597

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First Appeared on 7/2/2021

VAERS ID: 1431597
VAERS Form:2
Age:86.0
Sex:Female
Location:Foreign
Vaccinated:2021-05-28
Onset:2021-05-29
Submitted:0000-00-00
Entered:2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3002186 / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Atrial fibrillation, Cerebral artery thrombosis, Cerebral infarction

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-06-01
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: GALANTAMINE; LOSATRIX; PLAVIX; NITROSID; PIOGLITAZONE; PARACETAMOL; SIMVASTATIN; ATENBLOCK; TRAJENTA
Current Illness:
Preexisting Conditions: Comments: No medical history was provided.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FIMODERNATX, INC.MOD20212

Write-up: Atrial fibrillation; Cerebral infarction; Middle cerebral artery thrombosis; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 18-Jun-2021 and was forwarded to Moderna on 18-Jun-2021. This regulatory authority case was reported by a physician and describes the occurrence of ATRIAL FIBRILLATION (Atrial fibrillation), CEREBRAL INFARCTION (Cerebral infarction) and CEREBRAL ARTERY THROMBOSIS (Middle cerebral artery thrombosis) in an 86-year-old female patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. 3002186) for COVID-19 vaccination. No medical history was provided. Concomitant products included GALANTAMINE, LOSARTAN POTASSIUM (LOSATRIX), CLOPIDOGREL BISULFATE (PLAVIX), ISOSORBIDE DINITRATE (NITROSID), PIOGLITAZONE, PARACETAMOL, SIMVASTATIN, ATENOLOL (ATENBLOCK) and LINAGLIPTIN (TRAJENTA) for an unknown indication. On 28-May-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 29-May-2021, the patient experienced ATRIAL FIBRILLATION (Atrial fibrillation) (seriousness criteria death and medically significant), CEREBRAL INFARCTION (Cerebral infarction) (seriousness criteria death and medically significant) and CEREBRAL ARTERY THROMBOSIS (Middle cerebral artery thrombosis) (seriousness criteria death and medically significant). The patient died on 01-Jun-2021. The reported cause of death was Cerebral infarction. It is unknown if an autopsy was performed. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. The action taken with mRNA-1273 in response to the events was not applicable since the patient died. This fatal case concerns an 86-year-old female with serious unexpected events of atrial fibrillation, cerebral infarction, and cerebral artery thrombosis. Event latency 2 days after first dose mRNA-1273. Event outcome death. 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.; Sender''s Comments: This fatal case concerns an 86-year-old female with serious unexpected events of atrial fibrillation, cerebral infarction, and cerebral artery thrombosis. Event latency 2 days after first dose mRNA-1273. Event outcome death. 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: Cerebral infarction

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