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From the 11/19/2021 release of VAERS data:

Found 19,249 cases where Vaccine targets COVID-19 (COVID19) and Patient Died

Government Disclaimer on use of this data



Case Details

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VAERS ID: 1332307 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-03-15
Onset:2021-03-25
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3000493 / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-25
   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: Medical History/Concurrent Conditions: Insulin-requiring type 2 diabetes mellitus; Ischaemic heart disease
Allergies:
Diagnostic Lab Data:
CDC Split Type: FRMODERNATX, INC.MOD20211

Write-up: Death NOS; This regulatory authority case was reported by a physician (subsequently medically confirmed) and describes the occurrence of DEATH (Death NOS) in a 75-year-old male patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. 3000493) for COVID-19 vaccination. The patient''s past medical history included Insulin-requiring type 2 diabetes mellitus and Ischaemic heart disease. On 15-Mar-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. Death occurred on 25-Mar-2021 The patient died on 25-Mar-2021. The cause of death was not reported. It is unknown if an autopsy was performed. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication reported. No treatment information was provided. Sender''s (Case) Safety Report Unique Identifier: FR-AFSSAPS-2021044924 Limited information regarding the death, including the cause of death, has been provided at this time and a causal relationship cannot be excluded. The patient''s underlying conditions may have contributed to their death; Sender''s Comments: Limited information regarding the death, including the cause of death, has been provided at this time and a causal relationship cannot be excluded. The patient''s underlying conditions may have contributed to their death; Reported Cause(s) of Death: unknown cause of death


VAERS ID: 1333061 (history)  
Form: Version 2.0  
Age: 78.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-03-31
Onset:2021-03-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 30042460 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Aneurysm ruptured, Blood pressure measurement, C-reactive protein, Fatigue, Glomerular filtration rate, Headache, Nausea, Procalcitonin, Pyrexia, Subarachnoid haemorrhage
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemorrhagic central nervous system vascular conditions (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-17
   Days after onset: 17
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ATACAND; ASPIRIN CARDIO; CALCIMAGON; ZANIDIP; TORASEMID; NEPHROTRANS
Current Illness: Arterial hypertension; Chronic renal insufficiency; Ischaemic heart disease; Penicillin allergy
Preexisting Conditions: Medical History/Concurrent Conditions: Acute myocardial infarction; Stroke
Allergies:
Diagnostic Lab Data: Test Date: 20210408; Test Name: Blood pressure; Result Unstructured Data: 197/68; Test Date: 20210403; Test Name: C-reactive protein; Test Result: Inconclusive ; Result Unstructured Data: 7.43 mmol/L; Test Date: 20210406; Test Name: C-reactive protein; Test Result: Inconclusive ; Result Unstructured Data: 167 mg/L; Test Date: 20210406; Test Name: Estimated glomerular filtration rate; Test Result: Inconclusive ; Result Unstructured Data: 7 ml/min/1.73m2; Test Date: 20210406; Test Name: Procalcitonin; Test Result: Inconclusive ; Result Unstructured Data: 2.26 microgram per litre
CDC Split Type: CHMODERNATX, INC.MOD20211

Write-up: aneurysm rupture; headache; fever; Fatigue; Nausea; This regulatory authority case was reported by a pharmacist (subsequently medically confirmed) and describes the occurrence of SUBARACHNOID HAEMORRHAGE, ANEURYSM RUPTURED (aneurysm rupture), HEADACHE (headache), PYREXIA (fever), FATIGUE (Fatigue) and NAUSEA (Nausea) in a 78-year-old female patient who received mRNA-1273 (COVID-19 Vaccine Moderna) (batch no. 30042460) for COVID-19 vaccination. The patient''s past medical history included Acute myocardial infarction and Stroke. Concurrent medical conditions included Arterial hypertension, Ischaemic heart disease, Chronic renal insufficiency and Penicillin allergy. Concomitant products included CANDESARTAN CILEXETIL (ATACAND), ACETYLSALICYLIC ACID (ASPIRIN CARDIO) from 03-Apr-2021 to an unknown date, CALCIUM (CALCIMAGON [CALCIUM]), LERCANIDIPINE HYDROCHLORIDE (ZANIDIP), TORASEMIDE (TORASEMID) and SODIUM BICARBONATE (NEPHROTRANS) for an unknown indication. On 31-Mar-2021, the patient received first dose of mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 31-Mar-2021, the patient experienced HEADACHE (headache) (seriousness criteria medically significant and life threatening), PYREXIA (fever) (seriousness criterion medically significant), FATIGUE (Fatigue) (seriousness criterion medically significant) and NAUSEA (Nausea) (seriousness criterion medically significant). On 03-Apr-2021, the patient experienced SUBARACHNOID HAEMORRHAGE (seriousness criteria death and medically significant) and ANEURYSM RUPTURED (aneurysm rupture) (seriousness criteria death and medically significant). On 17-Apr-2021, PYREXIA (fever) and FATIGUE (Fatigue) outcome was unknown. The patient died on 17-Apr-2021. The cause of death was not reported. It is unknown if an autopsy was performed. At the time of death, HEADACHE (headache) and NAUSEA (Nausea) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 03-Apr-2021, C-reactive protein: 7.43 mmol/l (Inconclusive) 7.43 mmol/L. On 06-Apr-2021, C-reactive protein: 167 mg/l (Inconclusive) 167 mg/L. On 06-Apr-2021, Glomerular filtration rate: 7 ml/min/1.73m2 (Inconclusive) 7 ml/min/1.73m2. On 06-Apr-2021, Procalcitonin: 2.26 (Inconclusive) 2.26 microgram per litre. On 08-Apr-2021, Blood pressure measurement: 197/68 (High) 197/68. For mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular), the reporter considered HEADACHE (headache), PYREXIA (fever), FATIGUE (Fatigue) and NAUSEA (Nausea) to be probably related and SUBARACHNOID HAEMORRHAGE and ANEURYSM RUPTURED (aneurysm rupture) to be unlikely related. No treatment medications were reported. This is a case of death in a 78-year-old female subject with a medical history of Ischaemic heart disease, Chronic renal insufficiency and Penicillin allergy, who died 17 days after receiving the first dose of vaccine. Although a temporal association exists, based on the current available information, that the aneurysm rupture leading to subarachnoid hemorrhage and death, the events are assessed as unlikely related to mRNA-1273. Most recent FOLLOW-UP information incorporated above includes: On 06-May-2021: MAH causality and narrative updated according to the company comment. Serious criteria for some events changed.; Sender''s Comments: This is a case of death in a 78-year-old female subject with a medical history of Ischaemic heart disease, Chronic renal insufficiency and Penicillin allergy, who died 17 days after receiving the first dose of vaccine. Although a temporal association exists, based on the current available information, that the aneurysm rupture leading to subarachnoid hemorrhage and death, the events are assessed as unlikely related to mRNA-1273.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1333063 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-01-29
Onset:2021-03-09
   Days after vaccination:39
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Apraxia, Death, General physical health deterioration, Hypokinesia, Seizure
SMQs:, Systemic lupus erythematosus (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-10
   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: Medical History/Concurrent Conditions: COVID-19 (Reported no significant symptoms, no complications and with favorable progress.); Dementia
Allergies:
Diagnostic Lab Data:
CDC Split Type: CHMODERNATX, INC.MOD20211

Write-up: Inability to swallow; Inability to move spontaneously; Gradual decline in her general conditions; Death; multiple epileptic Seizure; This regulatory authority case was reported by a consumer and describes the occurrence of DEATH (Death), SEIZURE (multiple epileptic Seizure), APRAXIA (Inability to swallow), HYPOKINESIA (Inability to move spontaneously) and GENERAL PHYSICAL HEALTH DETERIORATION (Gradual decline in her general conditions) in an 87-year-old female patient who received mRNA-1273 (COVID-19 Vaccine Moderna) for COVID-19 vaccination. The patient''s past medical history included Dementia in 2020 and COVID-19 (Reported no significant symptoms, no complications and with favorable progress.) in 2020. On 29-Jan-2021, the patient received first dose of mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 05-Mar-2021, received second dose of mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular) dosage was changed to 1 dosage form. On 09-Mar-2021, the patient experienced SEIZURE (multiple epileptic Seizure) (seriousness criterion medically significant). On an unknown date, the patient experienced APRAXIA (Inability to swallow) (seriousness criterion medically significant), HYPOKINESIA (Inability to move spontaneously) (seriousness criterion medically significant) and GENERAL PHYSICAL HEALTH DETERIORATION (Gradual decline in her general conditions) (seriousness criterion medically significant). The patient died on 10-Apr-2021. The cause of death was not reported. An autopsy was not performed. At the time of death, SEIZURE (multiple epileptic Seizure) had not resolved and APRAXIA (Inability to swallow), HYPOKINESIA (Inability to move spontaneously) and GENERAL PHYSICAL HEALTH DETERIORATION (Gradual decline in her general conditions) outcome was unknown. Patient experienced multiple epileptic seizures within a 24-hour period an event that to a gradual decline in her general conditions, including inability to swallow and inability to move spontaneously (from that moment, she could only move in a wheelchair). Swallowing was compromised to the point that would not eat anything other than blended food. Following the gradual decline, palliative care was set up. No investigations of any kind were carried out by the medical staff. Concomitant product use was not provided by the reporter. This case concerns an 87-year-old woman, residing in a care home for elderly people, known to have dementia and previous COVID-19 disease in 2020, with no significant symptoms, no complications and with favourable progress. Usual pharmacotherapy unknown. No known allergies. On 29-Jan-2021, the woman was vaccinated with the first dose of the Moderna Covid-19 vaccine. No adverse reactions were reported. Approximately one month later, on 05-Mar-2021, the woman was vaccinated with the second dose of the Moderna Covid-19 vaccine. On 09-Mar-2021, the woman experienced multiple epileptic seizures within a 24-hour period, an event that to a gradual decline in here general conditions, including inability to swallow and inability to move spontaneously (from that moment, she could only move in a wheelchair). Swallowing was compromised to the point that would not eat anything other than blended food. Following the gradual decline, palliative care was set up. The patient was confirmed deceased on 10-Apr-2021. No investigations of any kind were carried out by the medical staff. Action taken with m-RNA-1273 in response to the event was not applicable. Based on the current available information and temporal association between the use of the product and the events, a causal relationship cannot be excluded. Most recent FOLLOW-UP information incorporated above includes: On 06-May-2021: Translation received. Narrative updated.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the events, a causal relationship cannot be excluded.; Reported Cause(s) of Death: Unknown cause of death


VAERS ID: 1333066 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-03-01
Onset:2021-04-03
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain lower, Cardiac death, Chills, Fatigue, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-05
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BISOPROLOL; XARELTO; PERINDOPRIL; ATORVASTAX; XENALON
Current Illness: Atrial fibrillation; Drug allergy (Allergy to Acemetacin); Heart failure; Hypercholesterolemia; Hypertension
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CHMODERNATX, INC.MOD20211

Write-up: found unconscious; cardiac death; considerable exhaustion; severe pain in the lower abdomen; chills; This regulatory authority case was reported by a physician (subsequently medically confirmed) and describes the occurrence of CARDIAC DEATH (cardiac death) and LOSS OF CONSCIOUSNESS (found unconscious) in a 79-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. Concurrent medical conditions included Atrial fibrillation, Hypertension, Hypercholesterolemia, Heart failure and Drug allergy (Allergy to Acemetacin). Concomitant products included BISOPROLOL from 29-Sep-2020 to an unknown date, RIVAROXABAN (XARELTO) from 26-Mar-2015 to an unknown date, PERINDOPRIL from 26-Mar-2014 to an unknown date, ATORVASTATIN CALCIUM (ATORVASTAX) from 29-Apr-2014 to an unknown date and SPIRONOLACTONE (XENALON) from 25-Jan-2019 to an unknown date for an unknown indication. In March 2021, the patient received first dose of mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 02-Apr-2021, received second dose of mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular) dosage was changed to 1 dosage form. On 03-Apr-2021, the patient experienced CHILLS (chills). On 04-Apr-2021, the patient experienced ABDOMINAL PAIN LOWER (severe pain in the lower abdomen). On 05-Apr-2021, the patient experienced CARDIAC DEATH (cardiac death) (seriousness criterion death) and FATIGUE (considerable exhaustion). On an unknown date, the patient experienced LOSS OF CONSCIOUSNESS (found unconscious) (seriousness criterion medically significant). On 05-Apr-2021, LOSS OF CONSCIOUSNESS (found unconscious) outcome was unknown. The patient died on 05-Apr-2021. The reported cause of death was suspected sudden cardiac death. It is unknown if an autopsy was performed. At the time of death, ABDOMINAL PAIN LOWER (severe pain in the lower abdomen), CHILLS (chills) and FATIGUE (considerable exhaustion) outcome was unknown. For mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular), the reporter considered CARDIAC DEATH (cardiac death) to be unlikely related. No further causality assessments were provided for LOSS OF CONSCIOUSNESS (found unconscious), ABDOMINAL PAIN LOWER (severe pain in the lower abdomen), CHILLS (chills) and FATIGUE (considerable exhaustion). Follow-up received on 13-May-2021 was significant and included the appended translation document and additional information based on the narrative was updated. On an unspecified date, it was reported that the patient developed severe pain in the lower abdomen two days after the second dose of covid-19 vaccine and made an emergency medical visit. No treatment information was provided, but it was reported that "nothing in particular" was found. It was reported that the pain improved, but the patient experienced considerable exhaustion. On an unspecified date, three days after the vaccination, it was reported that the patient was found unconscious and resuscitation was unsuccessful. Based on the current available information and temporal association between the use of the product and the death, a causal relationship cannot be excluded, although the patient''s concurrent conditions were likely related to their death. Awaiting translation for additional information. Sender''s Comment: Sudden cardiac death in a 79-year-old patient known to have heart disease 3 days after the second injection of the Moderna covid-19 vaccine. The countries monograph for the Moderna covid-19 vaccine does not list cases of death under the side effects (1). The database, in the Moderna covid-19 vaccine monograph (2), out of 49,811 reports, lists 1441 cases of death. In light of the literature data and information available to us, considering the cardiological comorbidities of the patient, despite the close temporal link, we consider a link between the sudden cardiac death and the Moderna covid-19 vaccine as unlikely. This view on causality cannot, however, entirely rule out the role/contribution of the vaccine. Company Comment: Limited information regarding the events has been provided at this time and a causal relationship cannot be excluded. Cause of death not provided, although the patient''s concurrent conditions were possibly related to their death. Most recent FOLLOW-UP information incorporated above includes: On 06-May-2021: Translated document received on 13 MAY 2021 with no new information; Sender''s Comments: Limited information regarding the events has been provided at this time and a causal relationship cannot be excluded. Cause of death not provided, although the patient''s concurrent conditions were possibly related to their death. .; Reported Cause(s) of Death: Suspected sudden cardiac death


VAERS ID: 1333071 (history)  
Form: Version 2.0  
Age: 96.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-04-02
Onset:2021-04-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Blood pressure measurement, COVID-19 pneumonia, Heart rate, Influenza like illness, Pyrexia, SARS-CoV-2 test
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-21
   Days after onset: 19
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Arterial hypertension (for 30 years); Benign prostatic hyperplasia; Ischemic heart disease (for 30 years); Large intestine carcinoma; Parkinson''s syndrome; Type II diabetes mellitus (for 30 years)
Preexisting Conditions: Medical History/Concurrent Conditions: Cholecystectomy; Skin malignant melanoma excision (on the back)
Allergies:
Diagnostic Lab Data: Test Date: 20210413; Test Name: COVID-19 PCR test; Test Result: Positive ; Result Unstructured Data: Positive; Test Date: 202104; Test Name: Blood pressure; Result Unstructured Data: normal; Test Date: 202104; Test Name: Heart rate; Result Unstructured Data: normal
CDC Split Type: CZMODERNATX, INC.MOD20211

Write-up: This regulatory authority case was reported by a physician and describes the occurrence of COVID-19 PNEUMONIA (oboustrann? covid-19 pneumonie) in a 96-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. The patient''s past medical history included Skin malignant melanoma excision (on the back) and Cholecystectomy. Concurrent medical conditions included Parkinson''s syndrome, Benign prostatic hyperplasia, Large intestine carcinoma since 2019, Arterial hypertension (for 30 years), Type II diabetes mellitus (for 30 years) and Ischemic heart disease (for 30 years). On 02-Apr-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 02-Apr-2021, after starting mRNA-1273 (COVID 19 Vaccine Moderna), the patient experienced INFLUENZA LIKE ILLNESS. On 15-Apr-2021, the patient experienced COVID-19 PNEUMONIA (seriousness criteria death, hospitalization, medically significant and life threatening). On an unknown date, the patient experienced PYREXIA. The patient died on 21-Apr-2021. The reported cause of death was COVID-19 pneumonia. An autopsy was not performed. At the time of death, INFLUENZA LIKE ILLNESS and PYREXIA outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 13-Apr-2021, SARS-CoV-2 test: positive Positive. In April 2021, Blood pressure measurement: normal normal. In April 2021, Heart rate: normal normal. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. The action taken with mRNA-1273 in response to the event was not applicable. Treatment for the events were not provided. No Concomitant medications were provided Company comment: The event of COVID 19 PNEUMONIA is assessed as unlikely related to mRNA-1273 while based on the current available information and temporal association between the use of the product and the start date of the other events, a causal relationship cannot be excluded. This case was linked to CZ-CZSUKL-21004569 (E2B Linked Report).; Sender''s Comments: The event of COVID 19 PNEUMONIA is assessed as unlikely related to mRNA-1273 while based on the current available information and temporal association between the use of the product and the start date of the other events, a causal relationship cannot be excluded. CZ-CZSUKL-21004569:; Reported Cause(s) of Death: COVID-19 pneumonia


VAERS ID: 1333099 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-04-02
Onset:2021-04-03
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA G26761A / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Fatigue
SMQs:, Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-12
   Days after onset: 9
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MEDROL; APO-FAMOTIDIN; XETER; SALAZOPYRIN
Current Illness: Rheumatoid arthritis
Preexisting Conditions: Medical History/Concurrent Conditions: GERD; Hypercholesteraemia
Allergies:
Diagnostic Lab Data:
CDC Split Type: HUMODERNATX, INC.MOD20211

Write-up: This regulatory authority case was reported by a physician and describes the occurrence of FATIGUE and ASTHENIA in a 56-year-old female patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. G26761A) for COVID-19 vaccination. The patient''s past medical history included GERD and Hypercholesteraemia. Concurrent medical conditions included Rheumatoid arthritis. Concomitant products included FAMOTIDINE (APO-FAMOTIDIN) for GERD, ROSUVASTATIN CALCIUM (XETER) from 02-Feb-2021 to an unknown date for Hypercholesteraemia, methylprednisolone (MEDROL) and SULFASALAZINE (SALAZOPYRIN) for Rheumatoid arthritis. On 02-Apr-2021, the patient received dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) .5 milliliter. On 03-Apr-2021, the patient experienced FATIGUE (seriousness criterion death) and ASTHENIA (seriousness criterion death). The patient died on 12-Apr-2021. The reported cause of death was Fatigue and Weakness. An autopsy was performed, but no results were provided. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter considered FATIGUE and ASTHENIA to be possibly related. No treatment information was provided. This is a case of death in a 56-year-old female subject with a medical history of GERD, Hypercholesteraemia and Rheumatoid arthritis, who died 10 days after receiving the vaccine. Very limited information has been provided at this time. No follow up is possible.; Sender''s Comments: This is a case of death in a 56-year-old female subject with a medical history of GERD, Hypercholesteraemia and Rheumatoid arthritis, who died 10 days after receiving the vaccine. Very limited information has been provided at this time. No follow up is possible.; Reported Cause(s) of Death: Fatigue; weakness


VAERS ID: 1333104 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-04-01
Onset:2021-04-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3001442 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Oxygen saturation, Tachycardia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-02
   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:
Preexisting Conditions: Medical History/Concurrent Conditions: Disease Parkinson''s; Hypercholesterolaemia; Hypertension; Lung neoplasm surgery; Radiotherapy
Allergies:
Diagnostic Lab Data: Test Date: 20210402; Test Name: Oxygen saturation
CDC Split Type: ITMODERNATX, INC.MOD20211

Write-up: This regulatory authority case was reported by a pharmacist and describes the occurrence of TACHYCARDIA in a 91-year-old female patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. 3001442) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Hypercholesterolaemia, Disease Parkinson''s, Hypertension, Lung neoplasm surgery and Radiotherapy. Previously administered products included for an unreported indication: ATORVASTATINA EG, NITROGLICERINA ZENTIVA, AXAGON [ESOMEPRAZOLE MAGNESIUM], LEXOTAN, DIURESIX [TORASEMIDE], TARGIN, ESKIM and PLAVIX. On 01-Apr-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 02-Apr-2021, the patient experienced TACHYCARDIA (seriousness criterion death) and VOMITING. The patient died on 02-Apr-2021. The reported cause of death was Vomiting, Oxygen saturation low and Tachycardia. It is unknown if an autopsy was performed. At the time of death, VOMITING, outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 02-Apr-2021, Oxygen saturation: low. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. Treatment information was not provided. Concomitant product use was not provided by the reporter. 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. Most recent FOLLOW-UP information incorporated above includes: On 06-May-2021: FU added On 10-May-2021: Vaccine Dose number added; Reported Cause(s) of Death: Vomiting; Oxygen saturation low; Tachycardia


VAERS ID: 1333110 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-04-08
Onset:2021-04-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3001442 / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-17
   Days after onset: 8
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: APROVEL; DOXAZOSIN; CATAPRESAN TTS-2; CELLCEPT [MYCOPHENOLATE MOFETIL HYDROCHLORIDE]; PROGRAF; DIDROGYL; EUTIROX; PANTOPRAZOLE; ACARBOSE; METFORMIN; MEDROL [METHYLPREDNISOLONE]; ROCALTROL
Current Illness: Diabetes; Hypertension arterial; Hypothyroidism
Preexisting Conditions: Medical History/Concurrent Conditions: Renal transplant
Allergies:
Diagnostic Lab Data:
CDC Split Type: ITMODERNATX, INC.MOD20211

Write-up: (8 APRILE 2021 1^ DOSE) (8 APRILE 2021 1^ DOSE); This regulatory authority case was reported by a physician and describes the occurrence of CHEST PAIN ((8 APRILE 2021 1^ DOSE)) and MYALGIA ((8 APRILE 2021 1^ DOSE) ) in a 63-year-old female patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. 3001442) for COVID-19 vaccination. The patient''s past medical history included Renal transplant. Concurrent medical conditions included Diabetes, Hypertension arterial and Hypothyroidism. Concomitant products included ACARBOSE and METFORMIN for Diabetes, IRBESARTAN (APROVEL), DOXAZOSIN and CLONIDINE (CATAPRESAN TTS-2) for Hypertension arterial, LEVOTHYROXINE SODIUM (EUTIROX) for Hypothyroidism, MYCOPHENOLATE MOFETIL HYDROCHLORIDE (CELLCEPT [MYCOPHENOLATE MOFETIL HYDROCHLORIDE]), TACROLIMUS (PROGRAF) and METHYLPREDNISOLONE (MEDROL [METHYLPREDNISOLONE]) for Renal transplant, CALCIFEDIOL (DIDROGYL), PANTOPRAZOLE and CALCITRIOL (ROCALTROL) for an unknown indication. On 08-Apr-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 09-Apr-2021, the patient experienced CHEST PAIN ((8 APRILE 2021 1^ DOSE)) (seriousness criterion death) and MYALGIA ((8 APRILE 2021 1^ DOSE)) (seriousness criterion death). The patient died on 17-Apr-2021. The reported cause of death was Pain retrosternal and Pain muscle. It is unknown if an autopsy was performed. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. Treatment information was not provided. Action taken with mRNA-1273 with respect to the events was not applicable. This is a case of death in a 63-year-old female subject with a medical history of Renal transplant, Diabetes, Hypertension arterial and Hypothyroidism, who died 9 days after receiving the first dose of vaccine. Very limited information has been provided at this time. Death report is not available. No follow up is possible. Most recent FOLLOW-UP information incorporated above includes: On 14-May-2021: Narrative updated.; Sender''s Comments: This is a case of death in a 63-year-old female subject with a medical history of Renal transplant, Diabetes, Hypertension arterial and Hypothyroidism, who died 9 days after receiving the first dose of vaccine. Very limited information has been provided at this time. Death report is not available. No follow up is possible.; Reported Cause(s) of Death: pain retrosternal; pain muscle


VAERS ID: 1333116 (history)  
Form: Version 2.0  
Age: 87.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-02-25
Onset:2021-03-25
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Chest pain, Confusional state, Death
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-06
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Chronic kidney disease (Chronic renal insufficiency)
Preexisting Conditions: Medical History/Concurrent Conditions: Arterial hypertension; COVID-19; Dyslipidemia; End ileostomy (under palliative care); Gastritis chronic; Hysterectomy; Ileocecal resection; Microvascular angina; Sigmoid diverticulitis; Syncope; Type II diabetes mellitus
Allergies:
Diagnostic Lab Data:
CDC Split Type: ITMODERNATX, INC.MOD20210

Write-up: Death; Aggravated chronic kidney disease; Thoracic pain; This regulatory authority case was reported by a physician and describes the occurrence of DEATH (Death), ACUTE KIDNEY INJURY (Aggravated chronic kidney disease), CONFUSIONAL STATE and CHEST PAIN (Thoracic pain) in an 87-year-old female patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. 3001442) for COVID-19 vaccination. The patient''s past medical history included Dyslipidemia, Arterial hypertension, Syncope, Type II diabetes mellitus, Microvascular angina, Gastritis chronic, COVID-19, Ileocecal resection, Sigmoid diverticulitis, End ileostomy (under palliative care) on 25-Mar-2021 and Hysterectomy. Concurrent medical conditions included Chronic kidney disease (Chronic renal insufficiency). On 25-Feb-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (unknown route) at an unspecified dose. On 25-Mar-2021, received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) dosage was changed to .5 ml in total. On 25-Mar-2021, the patient experienced ACUTE KIDNEY INJURY (Aggravated chronic kidney disease) (seriousness criterion medically significant), CONFUSIONAL STATE (seriousness criterion medically significant) and CHEST PAIN (Thoracic pain) (seriousness criterion medically significant). The patient died on 06-Apr-2021. The reported cause of death was Chronic renal insufficiency. It is unknown if an autopsy was performed. At the time of death, ACUTE KIDNEY INJURY (Aggravated chronic kidney disease) and CONFUSIONAL STATE outcome was unknown and CHEST PAIN (Thoracic pain) had not resolved. For mRNA-1273 (COVID 19 Vaccine Moderna) (Unknown), the reporter did not provide any causality assessments. No concomitant medications were reported. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not applicable. It was reported that patient was already under palliative care due to kidney disease and having rejected dialysis. Per MR - End ileostomy removed from events and added to medical history. This is a case of death in a 87-year-old female subject with a medical history of ileostomy (under palliative care) and Chronic kidney disease, who died 12 days after receiving the second dose of vaccine. Very limited information has been provided at this time. No follow up is possible. Company Comment: This is a case of death in a 87-year-old female subject with a medical history of HTN, DM, CKD, Syncope, Angina, Gastritis, Sigmoid diverticulitis with resection, Covid-19 and Hysterectomy, who died 12 days after receiving the first dose of vaccine. Very limited information has been provided at this time. No follow up is possible. Most recent FOLLOW-UP information incorporated above includes: On 28-Apr-2021: Translated document received on 04 May 2021 has no new information. On 11-May-2021: Follow-up provide medical history and an additional event.; Reported Cause(s) of Death: Chronic renal insufficiency


VAERS ID: 1333122 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-03-28
Onset:2021-04-13
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3001442 / 1 - / OT

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-13
   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: HYDROXYCARBAMIDE CAPSULE 500MG / Brand name not specified; PANTOPRAZOL TABLET MSR 20MG / Brand name not specified; ACETYLSALICYLZUUR TABLET 80MG / Brand name not specified
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: NLMODERNATX, INC.MOD20211

Write-up: Unknown cause of death; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 12-May-2021 and was forwarded to Moderna on 12-May-2021. This regulatory authority case was reported by a physician (subsequently medically confirmed) and describes the occurrence of DEATH (Unknown cause of death) in a 70-year-old male patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. 3001442) for COVID-19 vaccination. Concomitant products included HYDROXYCARBAMIDE CAPSULE 500MG / Brand name not specified from 04-Mar-2021 to an unknown date, PANTOPRAZOL TABLET MSR 20MG / Brand name not specified and ACETYLSALICYLZUUR TABLET 80MG / Brand name not specified for an unknown indication. On 28-Mar-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (unknown route) 1 dosage form. Death occurred on 13-Apr-2021 The patient died on 13-Apr-2021. The cause of death was not reported. An autopsy was not performed. The action taken with mRNA-1273 (COVID 19 Vaccine Moderna) (Unknown) was unknown. For mRNA-1273 (COVID 19 Vaccine Moderna) (Unknown), the reporter did not provide any causality assessments. This is a case of death in a 70-year-old male subject with a possible medical history of chronic myelogenous leukemia (because of concomitant HYDROXYCARBAMIDE), who died 16 days after receiving the first dose of vaccine. Very limited information has been provided at this time. No follow up is possible. Most recent FOLLOW-UP information incorporated above includes: On 13-May-2021: A follow up received on 13 May 2021 has no new information; Sender''s Comments: This is a case of death in a 70-year-old male subject with a possible medical history of chronic myelogenous leukemia (because of concomitant HYDROXYCARBAMIDE), who died 16 days after receiving the first dose of vaccine. Very limited information has been provided at this time. No follow up is possible.; Reported Cause(s) of Death: unknown cause of death


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