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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1439026

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Case Details

VAERS ID: 1439026 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-04-12
Onset:2021-04-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3001655 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Bedridden, Cardiac failure, Muscular weakness, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (narrow), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LIXIANA; COSYREL; NEXIUM; FLEIDERINA
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Carcinoma gastrointestinal; Hypertension arterial; Partial nephrectomy; Previous renal neoplasm
Allergies:
Diagnostic Lab Data:
CDC Split Type: ITMODERNATX, INC.MOD20212

Write-up: This regulatory authority case was reported by a consumer and describes the occurrence of MUSCULAR WEAKNESS, BEDRIDDEN, CARDIAC FAILURE and PARAESTHESIA in a 67-year-old male patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. 3001655) for COVID-19 vaccination. The patient''s past medical history included Carcinoma gastrointestinal, Previous renal neoplasm, Hypertension arterial and Partial nephrectomy. Concomitant products included EDOXABAN TOSILATE (LIXIANA), BISOPROLOL FUMARATE, PERINDOPRIL ARGININE (COSYREL), NEXIUM and FLECAINIDE ACETATE (FLEIDERINA) for an unknown indication. On 12-Apr-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 13-Apr-2021, the patient experienced MUSCULAR WEAKNESS (seriousness criterion death), BEDRIDDEN (seriousness criterion death), CARDIAC FAILURE(seriousness criteria death and medically significant) and PARAESTHESIA (seriousness criterion death). The patient died on 13-Apr-2021. The reported cause of death was Paraesthesia hand, Decompensation cardiac, Bedridden and Hands weakness of. It is unknown if an autopsy was performed. No treatment medication was not reported. This is a case of death in a 67-year-old male subject with a history of Gastrointestinal Carcinoma, Renal neoplasia, Arterial Hypertension and Partial nephrectomy who died 2 days after receiving first dose of vaccine. Very limited information has been provided at this time.; Sender''s Comments: This is a case of death in a 67-year-old male subject with a history of Gastrointestinal Carcinoma, Renal neoplasia, Arterial Hypertension and Partial nephrectomy who died 2 days after receiving first dose of vaccine. Very limited information has been provided at this time.; Reported Cause(s) of Death: Paraesthesia hand; Decompensation cardiac; Bedridden; Hands weakness of


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