이상반응 보고

VAERS ID	2002658
성별	남성
나이	78세
주 코드	CA
제약회사	MODERNA
로트 번호	014F21A
예방접종 횟수	3
접종일	2021-10-29
발병일	2021-10-30
상태	사망

증상

• 죽음(Death)

이환 중 질병

unknown if patient had other illnesses leading up to time of vaccination.

지병

heartburn, high blood pressure, neuropathy, pain, heart arrhythmia, hypothyroidism

기타 의료

metolazone pregabalin cyclobenzaprine norco potassium clindamycin

이전 예방접종

알레르기

NKDA

임상 검사

unknown

증상 상세

daughter of Pt stopped by the pharmacy and reported to pharmacy staff that her father had passed away days after receiving the Moderna shot.
Tried calling Pt family back to obtain additional details but have not recd a response.
date of death as listed below is estimated and exact date is not known.