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From the 11/26/2021 release of VAERS data:

Found 78 cases where Age is 18-or-more-and-under-30 and Vaccine targets COVID-19 (COVID19) and Manufacturer is MODERNA and Patient Died

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Case Details

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VAERS ID: 1480185 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-05-27
Onset:2021-06-19
   Days after vaccination:23
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Angiocardiogram, Blood bicarbonate, Blood creatine phosphokinase, Blood creatinine, Blood fibrinogen, Blood gases, Blood lactic acid, Blood test, Chest X-ray, Computerised tomogram head, Death, Glomerular filtration rate, Haemoglobin, International normalised ratio, Neck pain, PCO2, PO2, Platelet count, Prothrombin time, Troponin I, White blood cell count, pH body fluid
SMQs:, Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-22
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210619; Test Name: aPTT; Result Unstructured Data: 60 sec; Test Date: 20210619; Test Name: CAG; Test Result: Inconclusive ; Result Unstructured Data: date was estimated most likely date, between start of events 19/6 and death 22/6; Test Date: 20210619; Test Name: bicarbonaat; Test Result: Inconclusive ; Result Unstructured Data: 19 mmol/L; Test Date: 20210619; Test Name: CK; Result Unstructured Data: 902 = high (<200= normal); Test Date: 20210619; Test Name: kreatinine; Result Unstructured Data: 97= normal for male; Test Date: 20210619; Test Name: fibrinogeen; Result Unstructured Data: 2.6 g/L = normal; Test Date: 20210619; Test Name: bloedgassen; Test Result: Inconclusive ; Result Unstructured Data: pH 7.28, pCO2 5.5 kPa, bicarbonaat 19 mmol/L. paO2 19.0 kPa.; Test Date: 20210619; Test Name: lactaat; Result Unstructured Data: 3.1 mmol/l; Test Date: 20210619; Test Name: Electrolyten; Result Unstructured Data: electrolytes normal; Test Date: 20210619; Test Name: Thorax X; Test Result: Inconclusive ; Result Unstructured Data: unknown; Test Date: 20210619; Test Name: CT Cerebrum; Test Result: Inconclusive ; Result Unstructured Data: unknown; Test Date: 20210619; Test Name: eGFR; Result Unstructured Data: $g90= normal; Test Date: 20210619; Test Name: hemoglobine; Result Unstructured Data: 11.3 mmlo/l = increased; Test Date: 20210619; Test Name: INR; Test Result: Inconclusive ; Result Unstructured Data: 1.2= normal; Test Date: 20210619; Test Name: pco2; Test Result: Inconclusive ; Result Unstructured Data: 5.5 kPa; Test Date: 20210619; Test Name: PH; Test Result: Inconclusive ; Result Unstructured Data: 7.28; Test Date: 20210619; Test Name: trombocyten; Result Unstructured Data: 454 = increased; Test Date: 20210619; Test Name: pao2; Test Result: Inconclusive ; Result Unstructured Data: 19 kPa; Test Date: 20210619; Test Name: PT; Result Unstructured Data: 16 sec = high; Test Date: 20210619; Test Name: Troponine I; Result Unstructured Data: 4319; Test Date: 20210619; Test Name: leukocyten; Result Unstructured Data: 19.6 = increased
CDC Split Type: NLMODERNATX, INC.MOD20212

Write-up: ; This regulatory authority case was reported by a physician and describes the occurrence of DEATH in a 29-year-old male patient who received mRNA-1273 (COVID 19 Vaccine Moderna) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 27-May-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 19-Jun-2021, the patient experienced NECK PAIN (nekpijn). On 22-Jun-2021, NECK PAIN outcome was unknown. The patient died on 22-Jun-2021. The cause of death was not reported. An autopsy was performed, but no results were provided. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 19-Jun-2021, Activated partial thromboplastin time (30-40): 60 (High) 60 sec. On 19-Jun-2021, Angiocardiogram: inconclusive (Inconclusive) date was estimated most likely date, between start of events 19/6 and death 22/6. On 19-Jun-2021, Blood bicarbonate: 19 mmol/l (Inconclusive) 19 mmol/L. On 19-Jun-2021, Blood creatine phosphokinase: 902 (High) 902 = high (<200= normal). On 19-Jun-2021, Blood creatinine: normal (normal) 97= normal for male. On 19-Jun-2021, Blood fibrinogen: 2.6 (normal) 2.6 g/L = normal. On 19-Jun-2021, Blood gases: ph 7.28, pco2 5.5 kpa, bicarbonaat 19 mmol/l. (Inconclusive) pH 7.28, pCO2 5.5 kPa, bicarbonaat 19 mmol/L. paO2 19.0 kPa.. On 19-Jun-2021, Blood lactic acid: 3.1 (High) 3.1 mmol/l. On 19-Jun-2021, Blood test: normal (normal) electrolytes normal. On 19-Jun-2021, Chest X-ray: unknown (Inconclusive) unknown. On 19-Jun-2021, Computerised tomogram head: unknown (Inconclusive) unknown. On 19-Jun-2021, Glomerular filtration rate: normal (normal) $g90= normal. On 19-Jun-2021, Haemoglobin: 11.3 (High) 11.3 mmlo/l = increased. On 19-Jun-2021, International normalised ratio: 1.2 (Inconclusive) 1.2= normal. On 19-Jun-2021, PCO2: 5.5 kpa (Inconclusive) 5.5 kPa. On 19-Jun-2021, PO2: 19 kpa (Inconclusive) 19 kPa. On 19-Jun-2021, Platelet count: 454 (High) 454 = increased. On 19-Jun-2021, Prothrombin time (11-14): 16 sec (High) 16 sec = high. On 19-Jun-2021, Troponin I: 4319 (High) 4319. On 19-Jun-2021, White blood cell count: 19.6 (High) 19.6 = increased. On 19-Jun-2021, pH body fluid: 7.28 (Inconclusive) 7.28. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication was reported. Treatment drug information was not given. Company Comment : This is a case of sudden death in 29-year-old male with no hx provided and associated of AE of neck pain, who died 1 month after receiving the first dose of vaccine. Very limited information has been provided at this time; Sender''s Comments: This is a case of sudden death in 29-year-old male with no hx provided and associated of AE of neck pain, who died 1 month after receiving the first dose of vaccine. Very limited information has been provided at this time; Reported Cause(s) of Death


VAERS ID: 1480374 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-05-26
Onset:2021-06-04
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-04
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: TRITTICO
Current Illness: Insomnia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: PLMODERNATX, INC.MOD20212

Write-up: Suspicion of pulmonary embolism; Headache; This regulatory authority case was reported by a consumer and describes the occurrence of PULMONARY EMBOLISM (Suspicion of pulmonary embolism) and HEADACHE (Headache) in a 28-year-old male patient who received mRNA-1273 (COVID 19 Vaccine Moderna) for COVID-19 vaccination. Concurrent medical conditions included Insomnia. Concomitant products included TRAZODONE HYDROCHLORIDE (TRITTICO) for Insomnia. On 26-May-2021, the patient received dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 04-Jun-2021 at 1:00 AM, after starting mRNA-1273 (COVID 19 Vaccine Moderna), the patient experienced HEADACHE (Headache) (seriousness criterion death). On 04-Jun-2021 at 11:33 AM, the patient experienced PULMONARY EMBOLISM (Suspicion of pulmonary embolism) (seriousness criteria death and medically significant). The patient died on 04-Jun-2021. The reported cause of death was suspicion of pulmonary embolism. An autopsy was not performed. No Treatment information was provided. This is a case of sudden death in a 28-year-old male subject, who died 9 days after receiving first dose of vaccine, cause of death was not specified, an autopsy was not performed, Very limited information has been provided at this time.; Sender''s Comments: This is a case of sudden death in a 28-year-old male subject,who died 9 days after receiving first dose of vaccine, cause of death was not specified an autopsy was not performed, Very limited information has been provided at this time.; Reported Cause(s) of Death: Suspicion of pulmonary embolism


VAERS ID: 1488561 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-01-01
Onset:2021-05-01
   Days after vaccination:120
Submitted: 0000-00-00
Entered: 2021-07-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Foetal death
SMQs:, Termination of pregnancy and risk of abortion (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-01
   Days after onset: 31
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: No medical history was provided.
Allergies:
Diagnostic Lab Data:
CDC Split Type: GBMODERNATX, INC.MOD20212

Write-up: Fetal death; This regulatory authority case was reported by a consumer and describes the occurrence of FOETAL DEATH (Fetal death) in a 26-year-old male patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) for COVID-19 vaccination. No medical history was provided. On 01-Jan-2021, the patient received second dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (Intramuscular) 1 dosage form. On 01-May-2021, after starting mRNA-1273 (Moderna CoviD-19 Vaccine), the patient experienced FOETAL DEATH (Fetal death) (seriousness criteria death and medically significant). The patient died on 01-Jun-2021. The cause of death was not reported. It is unknown if an autopsy was performed. Concomitant medications were not reported. Treatment details were not provided. This is a case of Fetal death in a 26-year-old reported as male patient (unable to confirm patient gender), 120 days after receiving second dose of vaccine (Lot number unknown). Very limited information regarding the clinical details pertaining to the fetal death in terms of gestational age at the time of vaccination and death, and the unconfirmed patient''s gender was provided at this time. No further information is expected.; Sender''s Comments: This is a case of Fetal death in a 26-year-old reported as male patient (unable to confirm patient gender), 120 days after receiving second dose of vaccine (Lot number unknown). Very limited information regarding the clinical details pertaining to the fetal death in terms of gestational age at the time of vaccination and death, and the unconfirmed patient''s gender was provided at this time. No further information is expected.; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1500341 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-07
Onset:2021-07-10
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-07-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Epilepsy, Malaise
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Generalised convulsive seizures following immunisation (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CARBAMAZEPINE
Current Illness: Epilepsy (Family History is negative for epilepsy.)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: NLMODERNATX, INC.MOD20212

Write-up: This regulatory authority case was reported by a physician and describes the occurrence of EPILEPSY and MALAISE in a 29-year-old male patient who received mRNA-1273 (COVID 19 Vaccine Moderna) for COVID-19 vaccination. Concurrent medical conditions included Epilepsy (Family History is negative for epilepsy.). Concomitant products included CARBAMAZEPINE for an unknown indication. On 07-Jul-2021, the patient received dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 10-Jul-2021, the patient experienced EPILEPSY (seriousness criteria death and medically significant) and MALAISE (seriousness criterion death). The patient died on 10-Jul-2021. The reported cause of death was unknown. An autopsy was performed, but no results were provided. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. No treatment information was provided by the reporter. Very limited information regarding these events has been provided at this time. No further follow up information is expected.; Sender''s Comments: Very limited information regarding these events has been provided at this time. No further follow up information is expected.; Reported Cause(s) of Death: Unknown


VAERS ID: 1504349 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-06-24
Submitted: 0000-00-00
Entered: 2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-24
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: No medical history was provided.
Allergies:
Diagnostic Lab Data:
CDC Split Type: ITMODERNATX, INC.MOD20212

Write-up: Morte; This regulatory authority case was reported by a consumer and describes the occurrence of DEATH (Morte) in a 23-year-old male patient who received mRNA-1273 (COVID 19 Vaccine Moderna) for COVID-19 vaccination. No medical history was provided. On an unknown date, the patient received second dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) dosage was changed to 1 dosage form. Death occurred on 24-Jun-2021 The patient died on 24-Jun-2021. The cause of death was not reported. It is unknown if an autopsy was performed. No relevant concomitant medications were reported. No treatment information was provided. Very limited information regarding this event has been provided at this time. Further information has been requested. Further information is not expected; Sender''s Comments: Very limited information regarding this event has been provided at this time. Further information has been requested. Further information is not expected; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1504956 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-12
Onset:2021-07-14
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3002916 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Death
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-14
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: BEMODERNATX, INC.MOD20212

Write-up: This regulatory authority case was reported by a physician and describes the occurrence of DEATH and CHEST PAIN in an 18-year-old male patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. 3002916) for COVID-19 vaccination. No Medical History information was reported. On 12-Jul-2021, the patient received second dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (unknown route) 1 dosage form. On 14-Jul-2021, the patient experienced DEATH and CHEST PAIN (seriousness criterion death). The patient died on 14-Jul-2021. The cause of death was not reported. It is unknown if an autopsy was performed. For mRNA-1273 (COVID 19 Vaccine Moderna) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were provided. No treatment information was provided. Company Comment: This is a case of death in a 18-year-old male subject, who died after receiving second dose of vaccine. Very limited information has been provided at this time.; Sender''s Comments: This is a case of death in a 18-year-old male subject, who died after receiving second dose of vaccine. Very limited information has been provided at this time.; Reported Cause(s) of Death: UNKNOWN


VAERS ID: 1576955 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-07
Onset:2021-07-10
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-08-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3003604 / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-07-10
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: NLMODERNATX, INC.MOD20212

Write-up: This case was received via Regulatory Authority (Reference number: 00646946) on 06-Aug-2021 and was forwarded to Moderna on 06-Aug-2021. This regulatory authority case was reported by a consumer and describes the occurrence of DEATH in a 29-year-old male patient who received mRNA-1273 (Spikevax) (batch no. 3003604) for COVID-19 vaccination. No Medical History information was reported. On 07-Jul-2021, the patient received first dose of mRNA-1273 (Spikevax) (unknown route) 1 dosage form. Death occurred on 10-Jul-2021 The patient died on 10-Jul-2021. The cause of death was not reported. It is unknown if an autopsy was performed. Concomitant products were not provided. Treatment medication were not reported. Company comment: This case refers to a 29-year-old male patient who died 4 days after receiving the dose 1 of mRNA-1273. Cause of death was not reported. Very limited information regarding the event has been provided at this time insufficient for causality assessment.; Sender''s Comments: This case refers to a 29-year-old male patient who died 4 days after receiving the dose 1 of mRNA-1273. Cause of death was not reported. Very limited information regarding the event has been provided at this time insufficient for causality assessment.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1579851 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-08-02
Onset:2021-08-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3004220 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Acidosis, Cardiac death, Circulatory collapse, Computerised tomogram, Discoloured vomit, Hypersensitivity, SARS-CoV-2 test, Scan
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Angioedema (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Fruit allergy (kiwi); Obesity
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210802; Test Name: whole-body CT scan after death; Result Unstructured Data: Whole-body CT scan after death was performed to investigate the cause of the death, which revealed a ground-glass opacity/consolidation in both lungs.; Test Date: 20210802; Test Name: SARS CoV-2 antigen test; Test Result: Negative; Result Unstructured Data: negative; Test Date: 20210802; Test Name: scan; Result Unstructured Data: image findings showed a tendency of cardiac enlargement. The right heart strain was particularly suspected by the right-sided enlargement.
CDC Split Type: JPTAKEDA2021TJP069671

Write-up: cardiac death; Acute circulatory failure; Allergy; Acidosis; Discoloured vomit; This case was received via Regulatory Authority (Reference number: 2021TJP069671) on 05-Aug-2021 and was forwarded to Moderna on 13-Aug-2021. This case, reported by a physician via a medical representative, and reported to the Regulatory Authority by a physician, was received via the RA (Ref, v21122425). A patient had allergy to kiwi fruits and obesity. On an unknown date, body temperature before the vaccination: unknown. On 02-Aug-2021, around 18:00, the patient received the 1st dose of the vaccine. Around 19:30, the patient did not complain of any symptom. Around 20:00, a gurgling sound was heard from the bed, and a small amount of yellow colored vomit was noted. The patient did not respond to calls and had ill complexion. An emergency call was made, and cardiopulmonary resuscitation was started as instructed by the operations center. At 20:17, on arrival of the ambulance team, the patient was asystole and was transported with intubation and adrenaline administration by a physician. At 20:42, the patient arrived at the hospital. On arrival, JCS was 300, and the patient was asystole, had no spontaneous breathing, both dilated pupils of 6 mm in diameter, and coldness with poor skin tone of the whole body including the face. The patient was obese. Marked acidosis was found on the blood gas measurement. Resuscitation was continued thereafter , but there was no response. At 22:06, the patient was confirmed dead. The result of the SARS CoV-2 antigen test was negative. A whole-body CT scan after death was performed to investigate the cause of the death, which revealed a ground-glass opacity/consolidation in both lungs. However, there was a possibility that changes associated with cardiac massage, pulmonary congestion, or aspiration occurred. In addition, image findings showed a tendency of cardiac enlargement. The right heart strain was particularly suspected by the right sided enlargement. On 03-Aug-2021, the body was moved through the police to the university, and a legal autopsy was performed. The following were the details: 1) there were findings of acute circulatory failure such as congestion of the face, petechiae of the palpebral conjunctiva, cerebral edema, and pulmonary congestion. 2) reportedly, there were findings of suspected allergy such as edema of the epiglottis and submucosal petechiae of the larynx. The exact cause of death was unclear, but acute circulatory failure/acute cardiac death was suspected from the findings in the legal autopsy. The outcome of acute circulatory failure, acute cardiac death, allergy, acidosis, and yellow-colored vomit was reported as fatal. Follow-up investigation will be made.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. However, the patient''s underlying obesity is a confounder.; Reported Cause(s) of Death: Cardiac death; Acute circulatory failure; Allergy; Acidosis; Vomiting


VAERS ID: 1590108 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Unknown  
Location: Foreign  
Vaccinated:2021-07-26
Onset:2021-07-01
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Thrombosis
SMQs:, Anaphylactic reaction (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-07
   Days after onset: 37
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: KRMODERNATX, INC.MOD20212

Write-up: breathing difficulty; thrombosis; This spontaneous case was reported by a consumer and describes the occurrence of DYSPNOEA (breathing difficulty) and THROMBOSIS (thrombosis) in a 20-year-old patient of an unknown gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 26-Jul-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. In July 2021, the patient experienced THROMBOSIS (thrombosis) (seriousness criteria death, hospitalization and medically significant). On 31-Jul-2021, the patient experienced DYSPNOEA (breathing difficulty) (seriousness criteria death and hospitalization). The patient was hospitalized on 31-Jul-2021 due to DYSPNOEA and THROMBOSIS. The patient died on 07-Aug-2021. The reported cause of death was breathing difficulty and Thrombosis. It is unknown if an autopsy was performed. Concomitant products were not provided. Treatment medication were not reported. Very limited information regarding this event has been provided at this time. Further information has been requested.; Sender''s Comments: Very limited information regarding this event has been provided at this time. Further information has been requested.; Reported Cause(s) of Death: breathing difficulty; thrombosis


VAERS ID: 1592685 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-07-31
Onset:2021-08-01
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: FRMODERNATX, INC.MOD20212

Write-up: This case was received via Regulatory Authority (Reference number: MP20215979) on 12-Aug-2021 and was forwarded to Moderna on 12-Aug-2021. This regulatory authority case was reported by an other health care professional and describes the occurrence of DEATH in a 28-year-old male patient who received mRNA-1273 (Spikevax) for COVID-19 vaccination. No Medical History information was reported. On 31-Jul-2021, the patient received first dose of mRNA-1273 (Spikevax) (Intramuscular) 1 dosage form. Death occurred on August 2021 The patient died in August 2021. The cause of death was not reported. It is unknown if an autopsy was performed. For mRNA-1273 (Spikevax) (Intramuscular), the reporter did not provide any causality assessments. No treatment drug information provided. No concomitant drug information provided. Company comment: This is a case of Death Not Otherwise Specified in a 28-year-old male patient, that occurred at an unspecified number of days after receiving first dose of vaccine (Lot number unknown). Very limited information regarding the date of death and the clinical details pertaining to death, medical history, and concomitant medication was provided at this time. No further information is expected.; Sender''s Comments: This is a case of Death Not Otherwise Specified in a 28-year-old male patient, that occurred at an unspecified number of days after receiving first dose of vaccine (Lot number unknown). Very limited information regarding the date of death and the clinical details pertaining to death, medical history, and concomitant medication was provided at this time. No further information is expected.; Reported Cause(s) of Death: Unknown cause of Death


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