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This is VAERS ID 1757761

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1757761
VAERS Form:2
Age:
Sex:Female
Location:California
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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: 3 deaths after the second dose of the Moderna vaccine; This spontaneous case was reported by a consumer and describes the occurrence of DEATH (3 deaths after the second dose of the Moderna vaccine) in a female 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, received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. Death occurred on an unknown date The cause of death was not reported. It is unknown if an autopsy was performed. Concomitant medications were not reported. Treatment medications were not reported. This case concerns a unspecified patient with no reported medical history experienced serious events of death after unspecified days after the second dose of Spikevax. The event''s causality considered possible by reporter. Patient experienced AEs after second dose and no information about the first dose is available rechallenge is not applicable . The benefit-risk relationship of Spikevax is not affected by this report. This case was linked to MOD-2021-334634, MOD-2021-334642 (Patient Link).; Sender''s Comments: This case concerns a unspecified patient with no reported medical history experienced serious events of death after unspecified days after the second dose of Spikevax. The event''s causality considered possible by reporter. Patient experienced AEs after second dose and no information about the first dose is available rechallenge is not applicable .The benefit-risk relationship of Spikevax is not affected by this report.; Reported Cause(s) of Death: unknown cause of death

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