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This is VAERS ID 1428705

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First Appeared on 7/2/2021

VAERS ID: 1428705
VAERS Form:2
Age:66.0
Sex:Male
Location:Foreign
Vaccinated:2021-05-01
Onset:2021-05-08
Submitted:0000-00-00
Entered:2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3001939 / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Heart rate, Heart rate increased, Hemiparesis, Hypertension, Vaccination failure, Blood pressure measurement

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-21
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Hypertension; Joint pain
Allergies:
Diagnostic Lab Data: Test Date: 20210508; Test Name: Blood pressure; Result Unstructured Data: Increased; Test Date: 20210508; Test Name: Pulse rate; Result Unstructured Data: Rapid pulse
CDC 'Split Type': HUMODERNATX, INC.MOD20212

Write-up: (209/120 Hgmm); (115/min); This regulatory authority case was reported by a physician and describes the occurrence of HEMIPARESIS (hemiparesis), HYPERTENSION (209/120 Hgmm), HEART RATE INCREASED (115/min) and VACCINATION FAILURE in a 66-year-old male patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. 3001939) for COVID-19 vaccination. The patient''s past medical history included Hypertension and Joint pain. On 01-May-2021, the patient received first dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) .5 milliliter. On 08-May-2021, the patient experienced HEMIPARESIS (hemiparesis) (seriousness criteria death, hospitalization and medically significant), HYPERTENSION (209/120 Hgmm) (seriousness criteria death and hospitalization) and HEART RATE INCREASED (115/min) (seriousness criteria death and hospitalization). On 21-May-2021, the patient experienced VACCINATION FAILURE (seriousness criteria death and hospitalization). The patient died on 21-May-2021. The cause of death was not reported. It is unknown if an autopsy was performed. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 08-May-2021, Blood pressure measurement: 209/120 mmhg (High) Increased. On 08-May-2021, Heart rate: 115 (High) Rapid pulse. mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) dosing remained unchanged. For mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medications reported. No treatment details provided. This fatal case concerns a 66-year-old male with serious unexpected events of hemiparesis, hypertension, heart rate increased, and vaccination failure. Event latency 8 days after first dose mRNA-1273. Outcome death. Based on current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.; Sender''s Comments: This fatal case concerns a 66-year-old male with serious unexpected events of hemiparesis, hypertension, heart rate increased, and vaccination failure. Event latency 8 days after first dose mRNA-1273. Outcome death. Based on current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.; Reported Cause(s) of Death: Unknown cause of death

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