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VAERS Report 2156664

Case Report Section

Détails du rapport Vaer

Âge: 73 ans

Genre: Female

Région : Outside US

Patient décédé?
Non
Renseignements sur les vaccins

Nom: COVID19 (COVID19 (MODERNA))

Type : Coronavirus 2019 vaccine

Fabricant: MODERNA

Lot: 000014a


Date de réception du rapport
2022-03-04
Date à laquelle le formulaire est complèté
Date de vaccination
2021-12-15
Date d’apparition
0
Nombre de jours (date d’apparition – date de vaccination)
0
Description de l’événement indésirable

hair loss; this case was received via regulatory authority (reference number: gb-mhra-adr 26653460) on 27-feb-2022 and was forwarded to moderna on 27-feb-2022. this regulatory authority case was reported by a physician and describes the occurrence of alopecia (hair loss) in a 73-year-old female patient who received mrna-1273 (moderna covid-19 vaccine) (batch no. 000014a) for an unknown indication. concurrent medical conditions included hypertension and type 2 diabetes mellitus (diet controlled). concomitant products included amlodipine for hypertension, simvastatin for an unknown indication. on 15-dec-2021, the patient received dose of mrna-1273 (moderna covid-19 vaccine) (unknown route) 1 dosage form. on 15-dec-2021, the patient experienced alopecia (hair loss) (seriousness criterion medically significant). at the time of the report, alopecia (hair loss) had not resolved. mrna-1273 (moderna covid-19 vaccine) (unknown) dosing remained unchanged. for mrna-1273 (moderna covid-19 vaccine) (unknown), the reporter did not provide any causality assessments. no treatment medication was provided. company comment: this is a regulatory authority case concerning a 73-year-old female patient, with no relevant medical history, who experienced the unexpected and serious (medically significant) event of alopecia. the event occurred the same day after a dose of mrna-1273 vaccine. at the time of the report, the event had not resolved. the benefit-risk relationship of mrna-1273 vaccine is not affected by this report.; sender's comments: this is a regulatory authority case concerning a 73-year-old female patient, with no relevant medical history, who experienced the unexpected and serious (medically significant) event of alopecia. the event occurred the same day after a dose of mrna-1273 vaccine. at the time of the report, the event had not resolved. the benefit-risk relationship of mrna-1273 vaccine is not affected by this report

Données de laboratoire
na
Liste des symptômes
alopecia
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?
Non
Allergies:
na
Maladie actuelle
hypertension; type 2 diabetes mellitus (diet controlled)