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This is VAERS ID 1435443

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First Appeared on 7/2/2021

VAERS ID: 1435443
VAERS Form:2
Age:94.0
Sex:Male
Location:Foreign
Vaccinated:2021-06-08
Onset:2021-06-09
Submitted:0000-00-00
Entered:2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Subarachnoid haemorrhage

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-06-09
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': JPTAKEDA2021TJP040352

Write-up: Subarachnoid haemorrhage; This spontaneous case was reported by a consumer and describes the occurrence of SUBARACHNOID HAEMORRHAGE (Subarachnoid haemorrhage) in a 94-year-old male patient who received mRNA-1273 (COVID 19 Vaccine Moderna) for COVID-19 vaccination. No Medical History information was reported. On 08-Jun-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 09-Jun-2021, after starting mRNA-1273 (COVID 19 Vaccine Moderna), the patient experienced SUBARACHNOID HAEMORRHAGE (Subarachnoid haemorrhage) (seriousness criteria death, hospitalization and medically significant). The patient died on 09-Jun-2021. The reported cause of death was Subarachnoid haemorrhage. It is unknown if an autopsy was performed. Concomitant product use was not provided by the reporter. ? No treatment information was provided. The event developed after the administration of COVID-19 vaccine mRNA (mRNA 1273) but details about other factors were not obtained. Action taken with mRNA-1273 in response to the event was not applicable On 09-JUN-2021, in the morning, the patient was urgently admitted to the hospital due to loss of consciousness, and diagnosed with subarachnoid haemorrhage. The patient died at 22:00. Company comment: Based on the 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: Based on the 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: Subarachnoid haemorrhage

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