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This is VAERS ID 1747900

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/1/2021

VAERS ID: 1747900
VAERS Form:2
Age:
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Cardiac failure congestive, Dyspnoea, Fibrin D dimer, Myocarditis, Brain natriuretic peptide, Hepatic enzyme

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-08-28
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: Test Name: BNP; Result Unstructured Data: BNP is elevated; Test Name: D-dimer; Result Unstructured Data: D-dimer elevated; Test Name: Liver enzymes; Result Unstructured Data: liver enzymes elevated
CDC 'Split Type': USMODERNATX, INC.MOD20213

Write-up: Congestive heart failure; short of breath; Myocarditis; This spontaneous case was reported by a consumer and describes the occurrence of CARDIAC FAILURE CONGESTIVE (Congestive heart failure), DYSPNOEA (short of breath) and MYOCARDITIS (Myocarditis) in a male patient of an unknown age 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 second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced CARDIAC FAILURE CONGESTIVE (Congestive heart failure) (seriousness criteria death and medically significant), DYSPNOEA (short of breath) (seriousness criterion death) and MYOCARDITIS (Myocarditis) (seriousness criteria death and medically significant). The patient died on 28-Aug-2021. The cause of death was not reported. It is unknown if an autopsy was performed. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Brain natriuretic peptide: elevated (High) BNP is elevated. On an unknown date, Fibrin D dimer: elevated (High) D-dimer elevated. On an unknown date, Hepatic enzyme: elevated (High) liver enzymes elevated. No concomitant medications were provided by the reporter. No treatment information was provided by the reporter. Company Comment: This case concerns a consumer of unknown gender and age with no relevant medical history who experienced serious fatal unexpected events of cardiac congestive failure dyspnea, and myocarditis after receiving a second dose of the Moderna Covid 19 vaccine. Autopsy was not performed. Rechallenge is not applicable. The benefit-risk relationship is not affected by this report. Reporter did not allow further contact; Sender''s Comments: This case concerns a consumer of unknown gender and age with no relevant medical history who experienced serious fatal unexpected events of cardiac congestive failure dyspnea, and myocarditis after receiving a second dose of the Moderna Covid 19 vaccine. Autopsy was not performed. Rechallenge is not applicable. The benefit-risk relationship is not affected by this report.; Reported Cause(s) of Death: Unknown cause of death

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