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VAERS Report 2156639

Case Report Section

Détails du rapport Vaer

Âge: 66 ans

Genre: Male

Région : Outside US

Patient décédé?
Oui
Renseignements sur les vaccins

Nom: COVID19 (COVID19 (MODERNA))

Type : Coronavirus 2019 vaccine

Fabricant: MODERNA

Lot: unknown


Date de réception du rapport
2022-03-04
Date à laquelle le formulaire est complèté
Date de vaccination
2021-09-17
Date d’apparition
127
Nombre de jours (date d’apparition – date de vaccination)
127
Description de l’événement indésirable

this case was received via regulatory authority (reference number: gb-mhra-adr 26624216) on 27-feb-2022 and was forwarded to moderna on 27-feb-2022. this regulatory authority case was reported by a consumer and describes the occurrence of myocardial infarction (heart attack) and thrombosis (blood clot) in a 66-year-old male patient who received mrna-1273 (moderna covid-19 vaccine) for an unknown indication. no medical history information was reported. on 17-sep-2021, the patient received third dose of mrna-1273 (moderna covid-19 vaccine) (unknown route) 1 dosage form. on 22-jan-2022, after starting mrna-1273 (moderna covid-19 vaccine), the patient experienced thrombosis (blood clot) (seriousness criterion death). on 24-jan-2022, the patient experienced myocardial infarction (heart attack) (seriousness criterion death). the patient died on 24-jan-2022. the reported cause of death was clot blood and heart attack. it is unknown if an autopsy was performed. concomitant medications were not provided. it was reported that this reaction was not occurred as a result of a mistake made in the administration of the vaccine that was covid-19 vaccine moderna and the reason was not applicable. treatment information was not provided. company comment: this is a regulatory case concerning a 66-year-old male patient with no medical history reported, who experienced the fatal unexpected aesis of myocardial infarction and thrombosis (both reported as causes of death), approximately 4 months and 8 days after a dose of mrna-1273 vaccine, received as the third dose for covid-19 vaccination (no information disclosed on previous doses). it is unknown if an autopsy was done. patient�s age and gender remain as confounders for myocardial infarction. the benefit-risk relationship of mrna-1273 vaccine is not affected by this report. events seriousness assessed as reported. sender's comments: this is a regulatory case concerning a 66-year-old male patient with no medical history reported, who experienced the fatal unexpected aesis of myocardial infarction and thrombosis (both reported as causes of death), approximately 4 months and 8 days after a dose of mrna-1273 vaccine, received as the third dose for covid-19 vaccination (no information disclosed on previous doses). it is unknown if an autopsy was done. patient�s age and gender remain as confounders for myocardial infarction. the benefit-risk relationship of mrna-1273 vaccine is not affected by this report. events seriousness assessed as reported. reported cause(s) of death: clot blood; heart attack

Données de laboratoire
na
Liste des symptômes
myocardial infarction thrombosis
Patient décédé?
Oui
Date de décès
2022-01-24
Anomalie congénitale
false
Vaccin administré par :
Unknown
Vaccin acheté par :
Inconnu
Visite d’un patient à l’urgence?
Non
Patient hospitalisé?
Non
Séjour à l’hôpital
Non
Nombre de jours à l’hôpital
Non spécifié
Invalidité permanente?
Non
Allergies:
na
Maladie actuelle
na