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This is VAERS ID 1344568

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1344568
VAERS Form:2
Age:69.0
Sex:Male
Location:Foreign
Vaccinated:2021-02-18
Onset:2021-04-18
Submitted:0000-00-00
Entered:2021-05-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Intestinal ischaemia

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: Retardation mental; Sleep apnea
Preexisting Conditions: Medical History/Concurrent Conditions: Alcoholic gastritis; Anxiety; Enlarged prostate; Esophagitis; Volvulus of bowel
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FRMODERNATX, INC.MOD20211

Write-up: Mesenteric ischemia; This regulatory authority case was reported by a pharmacist and describes the occurrence of INTESTINAL ISCHAEMIA (Mesenteric ischemia) in a 69-year-old male patient who received mRNA-1273 (COVID 19 Vaccine Moderna) for COVID-19 vaccination. Co-suspect products included non-company products TROPATEPINE HYDROCHLORIDE (LEPTICUR) for Parkinson''s syndrome and CYAMEMAZINE (TERCIAN [CYAMEMAZINE]) for Agitation. The patient''s past medical history included Alcoholic gastritis, Volvulus of bowel, Anxiety, Enlarged prostate and Esophagitis. Concurrent medical conditions included Retardation mental and Sleep apnea. On 18-Feb-2021, the patient received second dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 16-Apr-2021, the patient started TROPATEPINE HYDROCHLORIDE (LEPTICUR) (unknown route) 10 milligram once a day. On an unknown date, the patient started CYAMEMAZINE (TERCIAN [CYAMEMAZINE]) (Oral) 1 dosage form. On 18-Apr-2021, the patient experienced INTESTINAL ISCHAEMIA (Mesenteric ischemia) (seriousness criteria death and medically significant). The patient died on 21-Apr-2021. It is unknown if an autopsy was performed. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. There is no treatment medication reported. Limited information regarding the event has been provided at this time and a causal relationship cannot be excluded. Intestinal ischemia captured as cause of death as per Authority assessment of event in SD although it is unknown if an autopsy occurred.; Sender''s Comments: Limited information regarding the event has been provided at this time and a causal relationship cannot be excluded. Intestinal ischemia captured as cause of death as per Authority assessment of event in SD although it is unknown if an autopsy occurred.

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