VAERS ID: 2013700

AGE: | SEX: F|STATE: FR (Unknown)

Description

CEREBROVASCULAR ACCIDENT; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 23-Dec-2021 and was forwarded to Moderna on 23-Dec-2021. This regulatory authority case was reported by an other health care professional and describes the occurrence of CEREBROVASCULAR ACCIDENT (CEREBROVASCULAR ACCIDENT) in a female patient of an unknown age who received mRNA-1273 (COVID-19 Vaccine Moderna) (batch no. 940667) for an unknown indication. No Medical History information was reported. On 03-Dec-2021, the patient received dose of mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 05-Dec-2021 at 8:30 AM, the patient experienced CEREBROVASCULAR ACCIDENT (CEREBROVASCULAR ACCIDENT) (seriousness criteria death and medically significant). The patient died on 05-Dec-2021. The reported cause of death was Cerebrovascular accident. It is unknown if an autopsy was performed. For mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. Concomitant product use was not provided by the reporter. No treatment information was provided. Company Comment: This case concerns a female patient of an unknown age, with no reported medical history, who experienced the unexpected serious AESI event of Cerebrovascular accident. The event occurred approximately 2 days after a dose of mRNA-1273 Vaccine which had a fatal outcome. The cause of death was T/C Cerebrovascular accident. It is unknown if an autopsy was performed. The benefit-risk relationship of mRNA-1273 Vaccine is not affected by this report.; Sender's Comments: This case concerns a female patient of an unknown age, with no reported medical history, who experienced the unexpected serious AESI event of Cerebrovascular accident. The event occurred approximately 2 days after a dose of mRNA-1273 Vaccine which had a fatal outcome. The cause of death was T/C Cerebrovascular accident. It is unknown if an autopsy was performed. The benefit-risk relationship of mRNA-1273 Vaccine is not affected by this report.; Reported Cause(s) of Death: CEREBROVASCULAR ACCIDENT

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Symptoms

Cerebrovascular accident

Vaccines

VAX DATE: 12-03-2021| ONSET DATE: 12-05-2021| DAYS TO ONSET: 2
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 0 COVID19 MODERNA 940667 OT

RECVDATE:01-07-2022
RPT_DATE:
CAGE_YR:
CAGE_MO:
DIED:Y
DATEDIED:12-05-2021
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:
V_ADMINBY:
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:PHMODERNATX, INC.MOD20214
FORM_VERS:
TODAYS_DATE:01-05-2022
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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OpenVAERS is a private organization that posts publicly available CDC/FDA data of injuries reported post-vaccination. Reports are not proof of causality.