Adverse Event Reporting

VAERS ID	2013704
Gender	Male
Age	51
StateCode	FR
Pharmaceutical Company	MODERNA
Lot Number	020G21A
Number of vaccinations
Vaccinated	2021-11-18
Onset	2021-11-18
Condition	Died

Symptoms

• Sudden death

Current Illness

Preexisting Conditions

Other Medications

Previous Vaccinations

Allergies

Laboratory Data

Write-up

SUDDEN DEATH; This regulatory authority case was reported by an other health care professional and describes the occurrence of SUDDEN DEATH (SUDDEN DEATH) in a 51-year-old male patient who received mRNA-1273 (COVID-19 Vaccine Moderna) (batch no.
020G21A) for an unknown indication.
No Medical History information was reported.
On 18-Nov-2021, the patient received dose of mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular) 1 dosage form.
The patient died on 19-Nov-2021.
The cause of death was not reported.
It is unknown if an autopsy was performed.
Not Provided For mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments.
No concomitant medication information was provided.
No treatment medication were provided; Sender's Comments: This is a regulatory case concerning a 51-year-old male patient with no medical history provided, who experienced the unexpected serious fatal event of Sudden death.
The patient received dose of mRNA-1273 (COVID-19 Vaccine Moderna) on 18-Nov-2021 and died the following day.
It is unknown if an autopsy was performed.
The rechallenge was unknown since there's only information about one dose.
.
The benefit-risk relationship of mRNA-1273 Vaccine is not affected by this report.
Event seriousness assessed as per Regulatory Authority reporting.
; Reported Cause(s) of Death: Unknown cause of death