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This is VAERS ID 1348183

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1348183
VAERS Form:2
Age:79.0
Sex:Male
Location:Foreign
Vaccinated:2021-03-30
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3000493 / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Haemorrhagic stroke

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-18
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Peripheral arterial occlusive disease
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FRMODERNATX, INC.MOD20211

Write-up: Haemorrhagic stroke; This regulatory authority case was reported by a physician (subsequently medically confirmed) and describes the occurrence of HAEMORRHAGIC STROKE (Haemorrhagic stroke) in a 79-year-old male patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. 3000493) for COVID-19 vaccination. The patient''s past medical history included Peripheral arterial occlusive disease. On 30-Mar-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 12-Apr-2021, the patient experienced HAEMORRHAGIC STROKE (Haemorrhagic stroke) (seriousness criteria death, hospitalization and medically significant). The patient died on 18-Apr-2021. The reported cause of death was accident. An autopsy was not performed. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medication use was not reported. Treatment information was not reported. Limited information regarding the event has been provided at this time and a causal relationship cannot be excluded. Sender''s (Case) Safety Report Unique Identifier: FR-AFSSAPS-2021048327; Sender''s Comments: Limited information regarding the event has been provided at this time and a causal relationship cannot be excluded.; Reported Cause(s) of Death: Accident

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