Adverse Event Reporting
| VAERS ID | 2013690 |
|---|---|
| Gender | Male |
| Age | 62 |
| StateCode | FR |
| Pharmaceutical Company | MODERNA |
| Lot Number | |
| Number of vaccinations | |
| Vaccinated | 2021-12-03 |
| Onset | 2021-12-03 |
| Condition | Hospitalized Died |
Symptoms
- Dizziness
- Blood pressure increased
Current Illness
Preexisting Conditions
Other Medications
Previous Vaccinations
Allergies
Laboratory Data
Write-up
Hypertension; Dizziness; This case was received via Regulatory Authority (Reference number: PH-PHFDA-300125910) 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 BLOOD PRESSURE INCREASED (Hypertension) and DIZZINESS (Dizziness) in a 62-year-old male patient who received mRNA-1273 (COVID-19 Vaccine Moderna) for an unknown indication.
No Medical History information was reported.
On 03-Dec-2021, the patient received dose of mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular) 1 dosage form.
On 03-Dec-2021 at 7:00 PM, the patient experienced BLOOD PRESSURE INCREASED (Hypertension) (seriousness criteria death and hospitalization) and DIZZINESS (Dizziness) (seriousness criteria death and hospitalization).
The reported cause of death was Elevated BP and Dizziness.
It is unknown if an autopsy was performed.
For mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments.
No concomitant medication information was mentioned by reporter No treatment medication information was mentioned by reporter This case concerns a 62-year-old male patient with no medical history, who experienced the unexpected serious events of Blood Pressure Increased and Dizziness, the events caused hospitalization and eventual demise of the patient as reported by the regulatory authority.
The event occurred on the same day after receiving an unspecified dose of mRNA-1273.
The patient died on an unknown date.
The reported cause of death was Elevated BP and Dizziness.
It is unknown if an autopsy was performed.
No other hospitalization or treatment details were disclosed.
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 no medical history, who experienced the unexpected serious events of Blood Pressure Increased and Dizziness, the events caused hospitalization and eventual demise of the patient as reported by the regulatory authority.
The event occurred on the same day after receiving an unspecified dose of mRNA-1273.
The patient died on an unknown date.
The reported cause of death was Elevated BP and Dizziness.
It is unknown if an autopsy was performed.
No other hospitalization or treatment details were disclosed.
The benefit-risk relationship of mRNA-1273 Vaccine is not affected by this report.
; Reported Cause(s) of Death: Elevated BP; Dizziness