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This is VAERS ID 1342802

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1342802
VAERS Form:2
Age:75.0
Sex:Male
Location:Foreign
Vaccinated:2021-03-22
Onset:2021-03-23
Submitted:0000-00-00
Entered:2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Death, Malaise

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-08
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:
Current Illness: Age-related macular degeneration; Glaucoma; Hypercholesteremia
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': CHMODERNATX, INC.MOD20211

Write-up: Malaise; This regulatory authority case was reported by a physician and describes the occurrence of DEATH and MALAISE (Malaise) in a 75-year-old male patient who received mRNA-1273 (COVID-19 Vaccine Moderna) for COVID-19 vaccination. Concurrent medical conditions included Hypercholesteremia, Age-related macular degeneration and Glaucoma. On 22-Mar-2021, the patient received first dose of mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 23-Mar-2021, after starting mRNA-1273 (COVID-19 Vaccine Moderna), the patient experienced MALAISE (Malaise) (seriousness criterion medically significant). The patient died on 08-Apr-2021. The cause of death was not reported. An autopsy was not performed. At the time of death, MALAISE (Malaise) outcome was unknown. The action taken with mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular) was unknown. For mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular), the reporter considered MALAISE (Malaise) to be possibly related and DEATH to be unlikely related. No concomitant medications were reported. Treatment details was not provided. Limited information regarding the events has been provided at this time and a causal relationship cannot be excluded. It is unclear if the reported malaise was associated with the death of the patient and cause of death is not provided. Two dates of death reported in SD and later one retained; Sender''s Comments: Limited information regarding the events has been provided at this time and a causal relationship cannot be excluded. It is unclear if the reported malaise was associated with the death of the patient and cause of death is not provided. Two dates of death reported in SD and later one retained; Reported Cause(s) of Death: Unknown cause of death

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