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This is VAERS ID 1800410

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/22/2021

VAERS ID: 1800410
VAERS Form:2
Age:17.0
Sex:Male
Location:Foreign
Vaccinated:2021-09-01
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / 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': CAMODERNATX, INC.MOD20213

Write-up: Found dead in the bedroom; This spontaneous case was reported by a non-health professional and describes the occurrence of DEATH (Found dead in the bedroom) in a 17-year-old male patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. In September 2021, the patient received second dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) 1 dosage form. Death occurred on 2021 The cause of death was not reported. It is unknown if an autopsy was performed. No relevant concomitant medications were reported. Treatment information was unknown. Patient was found dead in the bedroom, few days after 2nd dose of Moderna vaccine. Company comment: This case involves a 17-year-old male subject with unknown medical history who experienced the serious unlisted adverse event of death a few das after receiving his second dose of mRNA-1273. The patient was found dead in his bedroom. No further information is currently available on the reason of his death or events that may have resulted in death. The reporter declined further information on his name or address. The benefit-risk relationship of mRNA-1273 is not affected by this report.; Sender''s Comments: This case involves a 17-year-old male subject with unknown medical history who experienced the serious unlisted adverse event of death a few das after receiving his second dose of mRNA-1273. The patient was found dead in his bedroom. No further information is currently available on the reason of his death or events that may have resulted in death. The reporter declined further information on his name or address. The benefit-risk relationship of mRNA-1273 is not affected by this report.; Reported Cause(s) of Death: Unknown cause of death

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