Adverse Event Reporting
| VAERS ID | 1011774 |
|---|---|
| Gender | Male |
| Age | 81 |
| StateCode | GA |
| Pharmaceutical Company | MODERNA |
| Lot Number | 013M20A |
| Number of vaccinations | 1 |
| Vaccinated | 2021-02-03 |
| Onset | 2021-02-06 |
| Condition | Died |
Symptoms
- Syncope
- Death
- Cardiac arrest
- Resuscitation
Current Illness
CAROTID ARTERY STENOSIS CORONARY ARTERY DISEASE PACEMAKER CABG, 4-VESSEL BPH
Preexisting Conditions
SAME AS ABOVE
Other Medications
ASPRIN CLOPIDOGREL LISINOPRIL NITROQUICK FINASTERIDE AMLODPINIE PRAVASTATIN TAMSULOSIN
Previous Vaccinations
Allergies
NONE KNOWN
Laboratory Data
NONE
Write-up
Cardiac arrest resulting in death on the third day post vaccine administration, 0224.
Reported syncopal event post toileting.
Rescue measures attempted but not successful.
Time of death 0358, 02/06/2021.