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VAERS Report 2156658

Case Report Section

Détails du rapport Vaer

Âge: 49 ans

Genre: Male

Région : Outside US

Patient décédé?
Non
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
2021-12-12
Date d’apparition
21
Nombre de jours (date d’apparition – date de vaccination)
21
Description de l’événement indésirable

medication error; chronic urticaria; this case was received via the regulatory authority (reference number: gb-mhra-adr 26649690) 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 medication error (medication error) and urticaria chronic (chronic urticaria) in a 49-year-old male patient who received mrna-1273 (moderna covid-19 vaccine) for adverse drug reaction nos. no medical history information was reported. on 12-dec-2021, the patient received dose of mrna-1273 (moderna covid-19 vaccine) (unknown route) 1 dosage form. on 02-jan-2022, the patient experienced urticaria chronic (chronic urticaria) (seriousness criteria disability and medically significant). on an unknown date, the patient experienced medication error (medication error) (seriousness criteria disability and medically significant). at the time of the report, medication error (medication error) outcome was unknown and urticaria chronic (chronic urticaria) had not resolved. the action taken with mrna-1273 (moderna covid-19 vaccine) (unknown) was unknown. no concomitant medications were reported. patient experienced rash from neck down back front lower torso, hips, calves ankles, swelling lips. patient thought that this reaction occurred as a result of a mistake made in the administration of the vaccine. patient had 2 phiser jabs all ok, then on 12.12.2021 had moderna booster then got delayed massive eruptive urticaria on 02.01.2022. no treatment drugs were reported. company comment: this regulatory authority case concerns a 49-year-old female patient with no relevant medical history, who experienced the unexpected serious event of urticaria chronic (seriousness criteria disability and medically significant) which occurred 21 days after the third dose mrna- 1273 vaccine. medication error is also reported as an additional event. the patient was noted to have received two doses from pfizer prior to current vaccination with mrna1273 (interchange of vaccine products). the benefit-risk relationship of mrna- 1273 vaccine is not affected by this report. event seriousness assessed as per regulatory authority report.; sender's comments: this regulatory authority case concerns a 49-year-old female patient with no relevant medical history, who experienced the unexpected serious event of urticaria chronic (seriousness criteria disability and medically significant) which occurred 21 days after the third dose mrna- 1273 vaccine. medication error is also reported as an additional event. the patient was noted to have received two doses from pfizer prior to current vaccination with mrna1273 (interchange of vaccine products). the benefit-risk relationship of mrna- 1273 vaccine is not affected by this report. event seriousness assessed as per regulatory authority report

Données de laboratoire
na
Liste des symptômes
medication error urticaria chronic
Patient décédé?
Non
Date de décès
N/A
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?
Oui
Allergies:
na
Maladie actuelle
na