Adverse Event Reporting
| VAERS ID | 2013700 |
|---|---|
| Gender | Female |
| Age | |
| StateCode | FR |
| Pharmaceutical Company | MODERNA |
| Lot Number | 940667 |
| Number of vaccinations | |
| Vaccinated | 2021-12-03 |
| Onset | 2021-12-05 |
| Condition | Died |
Symptoms
- Cerebrovascular accident
Current Illness
Preexisting Conditions
Other Medications
Previous Vaccinations
Allergies
Laboratory Data
Write-up
CEREBROVASCULAR ACCIDENT; 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 CEREBROVASCULAR ACCIDENT (CEREBROVASCULAR ACCIDENT) in a female patient of an unknown age who received mRNA-1273 (COVID-19 Vaccine Moderna) (batch no.
940667) 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 05-Dec-2021 at 8:30 AM, the patient experienced CEREBROVASCULAR ACCIDENT (CEREBROVASCULAR ACCIDENT) (seriousness criteria death and medically significant).
The patient died on 05-Dec-2021.
The reported cause of death was Cerebrovascular accident.
It is unknown if an autopsy was performed.
For mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments.
Concomitant product use was not provided by the reporter.
No treatment information was provided.
Company Comment: This case concerns a female patient of an unknown age, with no reported medical history, who experienced the unexpected serious AESI event of Cerebrovascular accident.
The event occurred approximately 2 days after a dose of mRNA-1273 Vaccine which had a fatal outcome.
The cause of death was T/C Cerebrovascular accident.
It is unknown if an autopsy was performed.
The benefit-risk relationship of mRNA-1273 Vaccine is not affected by this report.
; Sender's Comments: This case concerns a female patient of an unknown age, with no reported medical history, who experienced the unexpected serious AESI event of Cerebrovascular accident.
The event occurred approximately 2 days after a dose of mRNA-1273 Vaccine which had a fatal outcome.
The cause of death was T/C Cerebrovascular accident.
It is unknown if an autopsy was performed.
The benefit-risk relationship of mRNA-1273 Vaccine is not affected by this report.
; Reported Cause(s) of Death: CEREBROVASCULAR ACCIDENT