Adverse Event Reporting
| VAERS ID | 2013331 |
|---|---|
| Gender | Male |
| Age | 62 |
| StateCode | FR |
| Pharmaceutical Company | MODERNA |
| Lot Number | |
| Number of vaccinations | 3 |
| Vaccinated | 2021-04-01 |
| Onset | 2021-12-18 |
| Condition | Died |
Symptoms
- Cardiac arrest
Current Illness
Preexisting Conditions
Other Medications
Previous Vaccinations
Allergies
Laboratory Data
Write-up
Cardiac arrest; This spontaneous case was reported by a consumer and describes the occurrence of CARDIAC ARREST (Cardiac arrest) in a 62-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination.
Co-suspect product included non-company product COVID-19 VACCINE NRVV AD26 (JNJ 78436735) (JANSSEN COVID-19 VACCINE) for COVID-19 vaccination.
No Medical History information was reported.
In April 2021, the patient received first dose of COVID-19 VACCINE NRVV AD26 (JNJ 78436735) (JANSSEN COVID-19 VACCINE) (unknown route) at an unspecified dose.
On 26-Nov-2021, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form.
On 18-Dec-2021, the patient experienced CARDIAC ARREST (Cardiac arrest) (seriousness criteria death and medically significant).
The patient died on 18-Dec-2021.
The reported cause of death was cardiac arrest for unknown cause.
An autopsy was not performed.
No concomitant and treatment medications were reported.
It was reported that the patient had no early warning signs of myocardial infarction.
On 18-DEC-2021, before noon, the patient died due to cardiac arrest.
The patient was diagnosed with death due to cardiac arrest of unknown cause.
Company Comment: This case concerns a 62-year-old male patient, with relevant medical history of vaccination with Janssen COVID-19 vaccine, who experienced the unexpected serious fatal event of Cardiac arrest.
The event occurred approximately 23 days after the booster dose of mRNA-1273 Vaccine.
The patient was diagnosed with death due to cardiac arrest of unknown cause.
It was reported that an autopsy had not been performed.
The patient's medical history of vaccination with Janssen COVID-19 vaccine remain a confounder for the occurrence of the event.
The benefit-risk relationship of mRNA-1273 Vaccine is not affected by this report.
; Sender's Comments: This case concerns a 62-year-old male patient, with relevant medical history of vaccination with Janssen COVID-19 vaccine, who experienced the unexpected serious fatal event of Cardiac arrest.
The event occurred approximately 23 days after the booster dose of mRNA-1273 Vaccine.
The patient was diagnosed with death due to cardiac arrest of unknown cause.
It was reported that an autopsy had not been performed.
The patient's medical history of vaccination with Janssen COVID-19 vaccine remain a confounder for the occurrence of the event.
The benefit-risk relationship of mRNA-1273 Vaccine is not affected by this report.
; Reported Cause(s) of Death: cardiac arrest for unknown cause