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VAERS Report 2157225

Case Report Section

Détails du rapport Vaer

Âge: 67 ans

Genre: Male

Région : Outside US

Patient décédé?
Oui
Renseignements sur les vaccins

Nom: COVID19 (COVID19 (MODERNA))

Type : Coronavirus 2019 vaccine

Fabricant: MODERNA

Lot: 007g21a


Date de réception du rapport
2022-03-04
Date à laquelle le formulaire est complèté
Date de vaccination
2021-12-20
Date d’apparition
40
Nombre de jours (date d’apparition – date de vaccination)
40
Description de l’événement indésirable

diarrhea, vomiting, inappetite, extreme weakness, saturday evening. on sunday without eating or getting out of bed. monday morning death from cardiac arrest.; diarrhea, vomiting, inappetite, extreme weakness, saturday evening. on sunday without eating or getting out of bed. monday morning death from cardiac arrest.; diarrhea, vomiting, inappetite, extreme weakness, saturday evening. on sunday without eating or getting out of bed. monday morning death from cardiac arrest.; diarrhea, vomiting, inappetite, extreme weakness, saturday evening. on sunday without eating or getting out of bed. monday morning death from cardiac arrest.; diarrhea, vomiting, inappetite, extreme weakness, saturday evening. on sunday without eating or getting out of bed. monday morning death from cardiac arrest.; this case was received via agency (reference number: it-minisal02-840904) on 24-feb-2022 and was forwarded to moderna on 24-feb-2022. this regulatory authority case was reported by a consumer and describes the occurrence of cardiac arrest (diarrhea, vomiting, inappetite, extreme weakness, saturday evening. on sunday without eating or getting out of bed. monday morning death from cardiac arrest.), decreased appetite (diarrhea, vomiting, inappetite, extreme weakness, saturday evening. on sunday without eating or getting out of bed. monday morning death from cardiac arrest.), vomiting (diarrhea, vomiting, inappetite, extreme weakness, saturday evening. on sunday without eating or getting out of bed. monday morning death from cardiac arrest.), diarrhoea (diarrhea, vomiting, inappetite, extreme weakness, saturday evening. on sunday without eating or getting out of bed. monday morning death from cardiac arrest.) and asthenia (diarrhea, vomiting, inappetite, extreme weakness, saturday evening. on sunday without eating or getting out of bed. monday morning death from cardiac arrest.) in a 67-year-old male patient who received mrna-1273 (spikevax) (batch no. 007g21a) for covid-19 vaccination. healthy patient with mild hypertension. on 20-dec-2021, the patient received dose of mrna-1273 (spikevax) (intramuscular) .5 milliliter. on 29-jan-2022, the patient experienced cardiac arrest (diarrhea, vomiting, inappetite, extreme weakness, saturday evening. on sunday without eating or getting out of bed. monday morning death from cardiac arrest.) (seriousness criterion death), decreased appetite (diarrhea, vomiting, inappetite, extreme weakness, saturday evening. on sunday without eating or getting out of bed. monday morning death from cardiac arrest.) (seriousness criterion death), vomiting (diarrhea, vomiting, inappetite, extreme weakness, saturday evening. on sunday without eating or getting out of bed. monday morning death from cardiac arrest.) (seriousness criterion death), diarrhoea (diarrhea, vomiting, inappetite, extreme weakness, saturday evening. on sunday without eating or getting out of bed. monday morning death from cardiac arrest.) (seriousness criterion death) and asthenia (diarrhea, vomiting, inappetite, extreme weakness, saturday evening. on sunday without eating or getting out of bed. monday morning death from cardiac arrest.) (seriousness criterion death). it is unknown if an autopsy was performed. no concomitant medications were mentioned. no treatment details were reported. company comment: this regulatory authority case concerns a 67-year-old male patient with relevant medical history of mild hypertension, who experienced serious, fatal unexpected events of cardiac arrest, vomiting, diarrhoea, asthenia, decreased appetite, that occurred approximately 40 days after the dose of the mrna-1273. reportedly, the patient had diarrhea, vomiting, inappetence, extreme weakness on saturday evening. on sunday, the patient did not eat and could not get out of the bed. on monday morning, the patient passed away due to cardiac arrest. the patient's relevant medical history is a possible confounder for cardiac arrest. the benefit-risk relationship of mrna-1273 is not affected by this report. the events reported and seriousness assessment retained as per regulatory authority reporting. healthy patient with mild hypertension; reporter's comments: adrs received on 03/02/22: it was not possible to ask the signaller to modify profile. vaccine sum at 15.39; 1 lot dose 21c1003 sum on date 12/05/21 h 8.17. summed zone not available.; sender's comments: this regulatory authority case concerns a 67-year-old male patient with relevant medical history of mild hypertension, who experienced serious, fatal unexpected events of cardiac arrest, vomiting, diarrhoea, asthenia, decreased appetite, that occurred approximately 40 days after the dose of the mrna-1273. reportedly, the patient had diarrhea, vomiting, inappetence, extreme weakness on saturday evening. on sunday, the patient did not eat and could not get out of the bed. on monday morning, the patient passed away due to cardiac arrest. the patient's relevant medical history is a possible confounder for cardiac arrest. the benefit-risk relationship of mrna-1273 is not affected by this report. the events reported and seriousness assessment retained as per regulatory authority reporting

Données de laboratoire
na
Liste des symptômes
diarrhoea vomiting cardiac arrest decreased appetite asthenia
Patient décédé?
Oui
Date de décès
N/A
Anomalie congénitale
false
Vaccin administré par :
Unknown
Vaccin acheté par :
Inconnu
Visite d’un patient à l’urgence?
Non
Patient hospitalisé?
Non
Séjour à l’hôpital
Non
Nombre de jours à l’hôpital
Non spécifié
Invalidité permanente?
Non
Allergies:
na
Maladie actuelle
na