VAERS ID: 1931745

AGE: 45| SEX: M|STATE: FR (Unknown)

Description

Dizziness; This case was received via Drug Safety (Reference number: PH-PHFDA-300121807) on 02-Dec-2021 and was forwarded to Moderna on 02-Dec-2021. This regulatory authority case was reported by an other health care professional and describes the occurrence of DIZZINESS (Dizziness) in a 45-year-old male patient who received mRNA-1273 (COVID-19 Vaccine Moderna) (batch no. 046G21A) for an unknown indication. No Medical History information was reported. On 16-Nov-2021, the patient received dose of mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 16-Nov-2021, the patient experienced DIZZINESS (Dizziness) (seriousness criterion death). The reported cause of death was Dizziness. It is unknown if an autopsy was performed. The action taken with mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular) was unknown. For mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. No Concomitant medication was provided. No Treatment medication was provided. Patient experienced Dizziness on 16 Nov 2021 at 05:20 and ended on 16 Nov 2021 at 05:22. The Nurse did not saw any abnormal breathing or any untoward symptoms thus he allowed the patient to be vaccinated. The patient was observed for any AEFI for 15minutes only due to undeclared co-morbidities then was sent home. On 300 meters away from Vaccination Site, the patient declared dizziness, nausea, vomiting, palpitations and difficulty of breathing then relative call for help. The Nurse Vaccinator saw that patient was unresponsive, noted foaming of mouth with initial GCS of 3/15 thus the Nurse activated emergency response and started continuous chest compression and the midwife manually removed oral secretions. The nurse continue chest compression at ambulance after 8mins the patient regained pulse and vomited. The Vaccinator Nurse position patient in Left lateral recumbent position. The patient was sent at Emergency Room in Hospital in adjacent city. This case concerns a 45-year-old male patient who received mRNA-1273 (COVID-19 Vaccine Moderna) with no relevant medical history who experience the serious fatal unexpected event of dizziness one day after a dose of the vaccine. Rechallenge is not applicable, since no further dosing is expected. The benefit-risk relationship is not affected by this report; Sender's Comments: This case concerns a 45-year-old male patient who received mRNA-1273 (COVID-19 Vaccine Moderna) with no relevant medical history who experience the serious fatal unexpected event of dizziness one day after a dose of the vaccine. Rechallenge is not applicable, since no further dosing is expected. The benefit-risk relationship is not affected by this report; Reported Cause(s) of Death: Dizziness

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Symptoms

Dizziness

Vaccines

VAX DATE: 11-16-2021| ONSET DATE: 11-16-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 0 COVID19 MODERNA 046G21A OT

RECVDATE:12-08-2021
RPT_DATE:
CAGE_YR:
CAGE_MO:
DIED:Y
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:
V_ADMINBY:
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:PHMODERNATX, INC.MOD20214
FORM_VERS:
TODAYS_DATE:12-08-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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