이상반응 보고

VAERS ID 923993
성별 남성
나이 62세
주 코드 NC
제약회사 MODERNA
로트 번호 039K20A
예방접종 횟수 1
접종일 2020-12-30
발병일 2021-01-02
상태 사망
증상
  • 죽음(Death)

이환 중 질병

No

지병

History of stage II (T3N0) appendiceal carcinoma - s/p resection Dec 2014. CAD s/p stenting Diabetes Mellitus Hyperlipidemia Hypertension Glaucoma

기타 의료

Unknown

이전 예방접종

알레르기

Hay fever

임상 검사

증상 상세

Patient was vaccinated Dec 30, 2020.
Prime dose of Moderna vaccine.
Observed for full 15 minutes post-injection.
No complaints when asked during observation.
Released.
Subsequently, vaccine clinic staff learned from the patient's supervisor that on Jan 4, 2021 that the patient had expired on Jan 2, 2021.
By report from the supervisor, the patient was found dead at his home.
The patient's primary care provider was unaware of his death when contacted by this reporter today (Jan 6, 2021).
Electronic Medical Record without any information since the vaccination.