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This is VAERS ID 1439379

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1439379
VAERS Form:2
Age:51.0
Sex:Female
Location:Foreign
Vaccinated:2021-05-15
Onset:2021-05-15
Submitted:0000-00-00
Entered:2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-17
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:
Preexisting Conditions: Medical History/Concurrent Conditions: Ex-smoker
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': NLMODERNATX, INC.MOD20212

Write-up: Fatal brain haemorrhage; This regulatory authority case was reported by a consumer and describes the occurrence of CEREBRAL HAEMORRHAGE (Fatal brain haemorrhage) in a 51-year-old female patient who received mRNA-1273 (COVID 19 Vaccine Moderna) for COVID-19 vaccination. The patient''s past medical history included Ex-smoker. On 15-May-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 15-May-2021, the patient experienced CEREBRAL HAEMORRHAGE (Fatal brain haemorrhage) (seriousness criteria death and medically significant). The patient died on 17-May-2021. The reported cause of death was brain haemorrhage . An autopsy was not performed. The action taken with mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) was unknown. Concomitant medications were not reported. Treatment information was not provided. Follow-up received on 15-Jun-2021 included no new information This is a case of sudden death in a 51-year-old female subject with past history of smoking, who died 1 day after receiving first dose of vaccine. Very limited information has been provided at this time. Most recent FOLLOW-UP information incorporated above includes: On 08-Jun-2021: Translation received on 15-Jun-2021 does not contain any new information. On 22-Jun-2021: Follow up was found to be significant: Medical history and Autopsy result was updated.; Sender''s Comments: This is a case of sudden death in a 51-year-old female subject with past history of smoking, who died 1 day after receiving first dose of vaccine. Very limited information has been provided at this time.; Reported Cause(s) of Death: brain haemorrhage

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