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This is VAERS ID 1329626

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1329626
VAERS Form:2
Age:81.0
Sex:Female
Location:Foreign
Vaccinated:2021-04-07
Onset:2021-04-10
Submitted:0000-00-00
Entered:2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Cerebrovascular accident

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-15
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: Medical History/Concurrent Conditions: Atrial fibrillation
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': DEMODERNATX, INC.MOD20211

Write-up: This regulatory authority case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of CEREBROVASCULAR ACCIDENT in an 81-year-old female patient who received mRNA-1273 (COVID 19 Vaccine Moderna) for COVID-19 vaccination. The patient''s past medical history included Atrial fibrillation. On 07-Apr-2021, the patient received second dose of mRNA-1273 (COVID 19 Vaccine Moderna) (unknown route) 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 10-Apr-2021, the patient experienced CEREBROVASCULAR ACCIDENT (seriousness criteria death, hospitalization and medically significant). The patient died on 15-Apr-2021. The reported cause of death was Stroke. It is unknown if an autopsy was performed. Concomitant product use was not provided by the reporter. No treatment information was provided. Company comment: This is a case of death in a 81-year-old female subject with a medical history of Atrial fibrillation, who died 8 days after receiving the second dose of 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 81-year-old female subject with a medical history of Atrial fibrillation, who died 8 days after receiving the second dose of vaccine. Very limited information has been provided at this time. No follow up is possible.; Reported Cause(s) of Death: Stroke

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