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This is VAERS ID 1333099

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1333099
VAERS Form:2
Age:56.0
Sex:Female
Location:Foreign
Vaccinated:2021-04-02
Onset:2021-04-03
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-12
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: 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

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