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This is VAERS ID 1344443

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1344443
VAERS Form:2
Age:92.0
Sex:Female
Location:Foreign
Vaccinated:2021-03-02
Onset:0000-00-00
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: Confusional state, Nasopharyngitis, Renal failure, Urinary tract infection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-21
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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FIMODERNATX, INC.MOD20211

Write-up: Confusional state; Renal failure; Urinary tract infection; Cold symptoms; This regulatory authority case was reported by a consumer and describes the occurrence of CONFUSIONAL STATE (Confusional state), RENAL FAILURE (Renal failure), URINARY TRACT INFECTION (Urinary tract infection) and NASOPHARYNGITIS (Cold symptoms) in a 92-year-old female patient who received mRNA-1273 (COVID 19 Vaccine Moderna) for COVID-19 vaccination. No Medical History information was reported. On 02-Mar-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced CONFUSIONAL STATE (Confusional state) (seriousness criterion death), RENAL FAILURE (Renal failure) (seriousness criteria death and medically significant), URINARY TRACT INFECTION (Urinary tract infection) (seriousness criterion death) and NASOPHARYNGITIS (Cold symptoms) (seriousness criterion death). The patient died on 21-Apr-2021. The reported cause of death was Confusional state, Renal failure, Urinary tract infection and Cold symptoms. It is unknown if an autopsy was performed. No concomitant medications were reported. No treatment information was reported. Action taken with mRNA-1273 in response to the drug was not applicable. Limited information regarding the events has been provided at this time and a causal relationship cannot be excluded. All events conservatively retained as resulting in death as this is how they are assessed by the Authority although it is unknown if an autopsy was performed and events such as confusional state and cold symptoms are unlikely to be fatal in and of themselves; Sender''s Comments: Limited information regarding the events has been provided at this time and a causal relationship cannot be excluded. All events conservatively retained as resulting in death as this is how they are assessed by the Authority although it is unknown if an autopsy was performed and events such as confusional state and cold symptoms are unlikely to be fatal in and of themselves; Reported Cause(s) of Death: Confusional state; Renal failure; Urinary tract infection; Cold symptoms

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