VAERS ID: 2013704

AGE: 51| SEX: M|STATE: FR (Unknown)

Description

SUDDEN DEATH; This regulatory authority case was reported by an other health care professional and describes the occurrence of SUDDEN DEATH (SUDDEN DEATH) in a 51-year-old male patient who received mRNA-1273 (COVID-19 Vaccine Moderna) (batch no. 020G21A) for an unknown indication. No Medical History information was reported. On 18-Nov-2021, the patient received dose of mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular) 1 dosage form. The patient died on 19-Nov-2021. The cause of death was not reported. It is unknown if an autopsy was performed. Not Provided For mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medication information was provided. No treatment medication were provided; Sender's Comments: This is a regulatory case concerning a 51-year-old male patient with no medical history provided, who experienced the unexpected serious fatal event of Sudden death. The patient received dose of mRNA-1273 (COVID-19 Vaccine Moderna) on 18-Nov-2021 and died the following day. It is unknown if an autopsy was performed. The rechallenge was unknown since there's only information about one dose. . The benefit-risk relationship of mRNA-1273 Vaccine is not affected by this report. Event seriousness assessed as per Regulatory Authority reporting.; Reported Cause(s) of Death: Unknown cause of death

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Symptoms

Sudden death

Vaccines

VAX DATE: 11-18-2021| ONSET DATE: 11-18-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 0 COVID19 MODERNA 020G21A OT

RECVDATE:01-07-2022
RPT_DATE:
CAGE_YR:
CAGE_MO:
DIED:Y
DATEDIED:11-19-2021
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.