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|History of Changes from the VAERS Wayback Machine|
|Vaccination / Manufacturer||Lot / Dose||Site / Route|
|COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA||CNK: 4301081 / 1||- / OT|
Administered by: Unknown Purchased by: ??
Life Threatening? No
Birth Defect? No
Permanent Disability? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Diagnostic Lab Data:
CDC 'Split Type': BEMODERNATX, INC.MOD20211
Write-up: Death; This regulatory authority case was reported by a physician and describes the occurrence of DEATH (Death) in an 80-year-old female patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. CNK: 4301081) for COVID-19 vaccination. No Medical History information was reported. On 28-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. Death occurred on 30-Apr-2021 The patient died on 30-Apr-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. Action taken with the mRNA-1273 in response to the event is 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. Cause of death and patient''s history and concurrent conditions not provided confounded assessment; Reporter''s Comments: Treatment. Evolution of the ADR; 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. Cause of death and patient''s history and concurrent conditions not provided confounded assessment; Reported Cause(s) of Death: unknown cause of death
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