National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1755938

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1755938
VAERS Form:2
Age:
Sex:Male
Location:Pennsylvania
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Malaise, Pain in extremity, COVID-19

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-09-23
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20213

Write-up: hurt his leg; didn''t feel well; had COVID-19; This spontaneous case was reported by a consumer and describes the occurrence of COVID-19 (had COVID-19), PAIN IN EXTREMITY (hurt his leg) and MALAISE (didn''t feel well) 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 dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced COVID-19 (had COVID-19) (seriousness criterion death), PAIN IN EXTREMITY (hurt his leg) (seriousness criteria death and hospitalization) and MALAISE (didn''t feel well) (seriousness criterion death). The patient died on 23-Sep-2021. The cause of death was not reported. It is unknown if an autopsy was performed. No relevant concomitant and treatment medications were reported. Company Comment - This case concerns an unknown age male with no medical history provided. Limited information regarding this case is provided. The patient experienced Covid-19, Pain in Extremity, and Malaise. He died on on 23-Sep-2021. No date for which the vaccination is provided, nor is the date of any of the events provided.The benefit-risk relationship of Moderna COVID-19 Vaccine in not affected by this report.; Sender''s Comments: This case concerns an unknown age male with no medical history provided. Limited information regarding this case is provided. The patient experienced Covid-19, Pain in Extremity, and Malaise. He died on on 23-Sep-2021. No date for which the vaccination is provided, nor is the date of any of the events provided.The benefit-risk relationship of Moderna COVID-19 Vaccine in not affected by this report.; Reported Cause(s) of Death: unknown cause of death

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1755938&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166