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This is VAERS ID 1333110

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First Appeared on 7/9/2021

VAERS ID: 1333110
VAERS Form:2
Age:63.0
Sex:Female
Location:Foreign
Vaccinated:2021-04-08
Onset:2021-04-09
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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-17
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: 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

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