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VAERS Report 2157252

Case Report Section

Détails du rapport Vaer

Âge: 63 ans

Genre: Male

Région : Outside US

Patient décédé?
Oui
Renseignements sur les vaccins

Nom: COVID19 (COVID19 (MODERNA))

Type : Coronavirus 2019 vaccine

Fabricant: MODERNA

Lot: 030g21a


Date de réception du rapport
2022-03-04
Date à laquelle le formulaire est complèté
Date de vaccination
2022-01-10
Date d’apparition
2
Nombre de jours (date d’apparition – date de vaccination)
2
Description de l’événement indésirable

from 12.01 headache, high blood pressure. 24.01 seizure. hospitalization brain hemorrhage, aneurysm.; from 12.01 headache, high blood pressure. 24.01 seizure. hospitalization brain hemorrhage, aneurysm.; this case was received via regulatory authority (reference number: it-minisal02-841384) on 25-feb-2022 and was forwarded to moderna on 25-feb-2022. this regulatory authority case was reported by a consumer and describes the occurrence of cerebral haemorrhage (from 12.01 headache, high blood pressure. 24.01 seizure. hospitalization brain hemorrhage, aneurysm.) and aneurysm (from 12.01 headache, high blood pressure. 24.01 seizure. hospitalization brain hemorrhage, aneurysm.) in a 63-year-old male patient who received mrna-1273 (spikevax) (batch no. 030g21a) for covid-19 vaccination. no medical history information was reported. on 10-jan-2022, the patient received dose of mrna-1273 (spikevax) (intramuscular) 1 dosage form. on 12-jan-2022, the patient experienced cerebral haemorrhage (from 12.01 headache, high blood pressure. 24.01 seizure. hospitalization brain hemorrhage, aneurysm.) (seriousness criterion death) and aneurysm (from 12.01 headache, high blood pressure. 24.01 seizure. hospitalization brain hemorrhage, aneurysm.) (seriousness criterion death). the patient died on 12-jan-2022. it is unknown if an autopsy was performed. no concomitant drug details were reported. no treatment details were reported. company comment: this regulatory authority case concerns a 63 year old male with no medical history reported, who experienced the seroius ( fatal ) , unexpected. event of cerebral hemorrhage and serious ( fatal ) , unexpected event of aneurysm which occurred two days post vaccination with an unknown dose number of mrna-1273 vaccine. the patient died two days post vaccination and it is unknown if an autopsy was done. the cause of death was not reported. other details surrounding the events were not reported. the benefit -risk relationship of mrna -1273 ( moderna covid 19 vaccine) is not affected by this report.; reporter's comments: information requests.; sender's comments: this regulatory authority case concerns a 63 year old male with no medical history reported, who experienced the seroius ( fatal ) , unexpected. event of cerebral hemorrhage and serious ( fatal ) , unexpected event of aneurysm which occurred two days post vaccination with an unknown dose number of mrna-1273 vaccine. the patient died two days post vaccination and it is unknown if an autopsy was done. the cause of death was not reported. other details surrounding the events were not reported. the benefit -risk relationship of mrna -1273 ( moderna covid 19 vaccine) is not affected by this report

Données de laboratoire
na
Liste des symptômes
aneurysm cerebral haemorrhage
Patient décédé?
Oui
Date de décès
2022-01-12
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