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This is VAERS ID 1747792

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First Appeared on 10/1/2021

VAERS ID: 1747792
VAERS Form:2
Age:48.0
Sex:Female
Location:Kentucky
Vaccinated:0000-00-00
Onset:2021-09-01
Submitted:0000-00-00
Entered:2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: COVID-19

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-09-01
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20213

Write-up: died from COVID; This spontaneous case was reported by a consumer and describes the occurrence of COVID-19 (died from COVID) in a 48-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. In September 2021, the patient experienced COVID-19 (died from COVID) (seriousness criterion death). The patient died in September 2021. The reported cause of death was died from covid. It is unknown if an autopsy was performed. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications were provided by the reporter. No treatment information was provided by the reporter. Company comment: This case concerns a 48-year-old, female patient with no relevant medical history reported, who experienced the unexpected event of COVID-19. The event occurred approximately on an unknown number of days after an unknown number of doses of mRNA-1273 and had a fatal outcome, with death occurring on an unknown date of September. No autopsy report was provided. The rechallenge was unknown. The benefit-risk relationship of mRNA-1273 is not affected by this report.; Sender''s Comments: This case concerns a 48-year-old, female patient with no relevant medical history reported, who experienced the unexpected event of COVID-19. The event occurred approximately on an unknown number of days after an unknown number of doses of mRNA-1273 and had a fatal outcome, with death occurring on an unknown date of September. No autopsy report was provided. The rechallenge was unknown. The benefit-risk relationship of mRNA-1273 is not affected by this report.; Reported Cause(s) of Death: died from COVID

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