Adverse Event Reporting
| VAERS ID | 2013682 |
|---|---|
| Gender | Male |
| Age | 23 |
| StateCode | FR |
| Pharmaceutical Company | MODERNA |
| Lot Number | |
| Number of vaccinations | |
| Vaccinated | 2021-08-01 |
| Onset | 2021-09-15 |
| Condition | Died |
Symptoms
- Pyrexia
- Cough
- Night sweats
- Weight decreased
Current Illness
Preexisting Conditions
Other Medications
Previous Vaccinations
Allergies
Laboratory Data
Write-up
Fever; Night sweats; Weight loss; Cough; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 23-Dec-2021 and was forwarded to Moderna on 23-Dec-2021.
This regulatory authority case was reported by an other health care professional and describes the occurrence of COUGH (Cough), PYREXIA (Fever), NIGHT SWEATS (Night sweats) and WEIGHT DECREASED (Weight loss) in a 23-year-old male patient who received mRNA-1273 (COVID-19 Vaccine Moderna) for an unknown indication.
No Medical History information was reported.
In August 2021, the patient received dose of mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular) 1 dosage form.
On 11-Sep-2021, received dose of mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular) dosage was changed to 1 dosage form.
On 15-Sep-2021, the patient experienced COUGH (Cough) (seriousness criterion death).
In November 2021, the patient experienced PYREXIA (Fever) (seriousness criterion death), NIGHT SWEATS (Night sweats) (seriousness criterion death) and WEIGHT DECREASED (Weight loss) (seriousness criterion death).
The reported cause of death was Cough, Fever, Night sweats and Weight loss.
It is unknown if an autopsy was performed.
Related For mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments.
On 15-SEP-2021 Patient had cough.
In OCT-2021 Patient was still with cough, consulted, X-ray done and started levofloxacin, nac x 7 days.
In NOV-2021 Patient had night sweats, fever, weight loss.
Patient experienced exertional dyspnea.
Company comment:This case concerns a 23-year-old, male patient with no medical history reported, who experienced the unexpected events of cough, pyrexia, night sweats and weight decreased.
The events occurred approximately between 4 days (cough) and two months (rest of the events) after the administration of mRNA-1273 and had a fatal outcome.
The date of death was not reported, and it is unknown if an autopsy was performed.
The benefit-risk relationship of mRNA-1273 is not affected by this report.
; Sender's Comments: This case concerns a 23-year-old, male patient with no medical history reported, who experienced the unexpected events of cough, pyrexia, night sweats and weight decreased.
The events occurred approximately between 4 days (cough) and two months (rest of the events) after the administration of mRNA-1273 and had a fatal outcome.
The date of death was not reported, and it is unknown if an autopsy was performed.
The benefit-risk relationship of mRNA-1273 is not affected by this report.
; Reported Cause(s) of Death: Cough; Fever; Night sweats; Weight loss