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From the 11/12/2021 release of VAERS data:

This is VAERS ID 1740603

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Case Details

VAERS ID: 1740603 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: California  
Vaccinated:2021-02-05
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 042L20A / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Oxygen saturation, Pneumonia
SMQs:, Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Drug allergy (The patient was allergic to Bactrim, because hand was turning red and developed a rash on the face, back and itching hands.)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Oxygen level; Result Unstructured Data: low
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Developed pneumonia after the vaccine; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of PNEUMONIA (Developed pneumonia after the vaccine) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 026B21A and 042L20A) for COVID-19 vaccination. Concurrent medical conditions included Drug allergy (The patient was allergic to Bactrim, because hand was turning red and developed a rash on the face, back and itching hands.). On 05-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 31-Mar-2021, received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced PNEUMONIA (Developed pneumonia after the vaccine) (seriousness criteria death, hospitalization and medically significant). The patient was hospitalized for 8 days due to PNEUMONIA. The patient was treated with ZOLEDRONIC ACID (RECLAST) for Adverse event, at an unspecified dose and frequency. The reported cause of death was Pneumonia. It is unknown if an autopsy was performed. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Oxygen saturation: low (Low) low. No concomitant medications were reported. Company Comment: This case concerns a patient with of unknown age and gender, as well as unknown medical history, who experienced the unexpected event of pneumonia that ended with fatal outcome. The temporal relationship remained unknown having in mind that the date of vaccination and date of the event were not provided. If was unknown if the autopsy was performed. The rechallenge was not applicable, as the event ended with fatal outcome. The benefit-risk relationship of Moderna COVID-19 Vaccine is not affected by this report. This case was linked to MOD-2021-325775, MOD-2021-325636 (Patient Link).; Sender''s Comments: This case concerns a patient with of unknown age and gender, as well as unknown medical history, who experienced the unexpected event of pneumonia that ended with fatal outcome. The temporal relationship remained unknown having in mind that the date of vaccination and date of the event were not provided. If was unknown if the autopsy was performed. The rechallenge was not applicable, as the event ended with fatal outcome. The benefit-risk relationship of Moderna COVID-19 Vaccine is not affected by this report.; Reported Cause(s) of Death: Pneumonia


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