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This is VAERS ID 1342830

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1342830
VAERS Form:2
Age:75.0
Sex:Female
Location:Foreign
Vaccinated:2021-04-28
Onset:2021-04-28
Submitted:0000-00-00
Entered:2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3001651 / UNK - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Cardiac failure, Dyspnoea, Oxygen saturation decreased

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-28
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: Aortic valve stenosis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': DEPEI202100056376

Write-up: Acute dyspnea; Oxygen saturation decreased; Decompensation cardiac; This regulatory authority case was reported by a physician and describes the occurrence of DYSPNOEA (Acute dyspnea), OXYGEN SATURATION DECREASED (Oxygen saturation decreased) and CARDIAC FAILURE (Decompensation cardiac) in a 75-year-old female patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. 3001651) for COVID-19 vaccination. Concurrent medical conditions included Aortic valve stenosis. On 28-Apr-2021, the patient received dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 28-Apr-2021, the patient experienced DYSPNOEA (Acute dyspnea) (seriousness criterion death), OXYGEN SATURATION DECREASED (Oxygen saturation decreased) (seriousness criterion death) and CARDIAC FAILURE (Decompensation cardiac) (seriousness criteria death and medically significant). The patient died on 28-Apr-2021. The cause of death was not reported. It is unknown if an autopsy was performed. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. Resuscitation was done on 28-apr-2021. Based on the current available information and temporal association between the use of the product and the events, a causal relationship cannot be excluded. Events conservatively all retained as resulting in death per Authority assessment / reporting in SD although it is unknown if an autopsy was performed and the captured decreased oxygen saturation and dyspnea are likely effects of the also captured heart failure; 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. Events conservatively all retained as resulting in death per Authority assessment / reporting in SD although it is unknown if an autopsy was performed and the captured decreased oxygen saturation and dyspnea are likely effects of the also captured heart failure; Reported Cause(s) of Death: unknown cause of death

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