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VAERS Report 2156947

Case Report Section

Détails du rapport Vaer

Âge: 63 ans

Genre: Female

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
2022-02-25
Date d’apparition
1
Nombre de jours (date d’apparition – date de vaccination)
1
Description de l’événement indésirable

sickness; headache; this case was received via regulatory authority (reference number: gb-mhra-adr 26657314) on 28-feb-2022 and was forwarded to moderna on 28-feb-2022. this regulatory authority case was reported by a consumer and describes the occurrence of illness (sickness) and headache (headache) in a 63-year-old female patient who received mrna-1273 (moderna covid-19 vaccine) for an unknown indication. concurrent medical conditions included suspected covid-19 since 28-oct-2020. concomitant products included covid-19 vaccine nrvv ad (chadox1 ncov-19) (covid-19 vaccine astrazeneca) for an unknown indication. on 25-feb-2022, the patient received third dose of mrna-1273 (moderna covid-19 vaccine) (unknown route) 1 dosage form. on 26-feb-2022, the patient experienced illness (sickness) (seriousness criterion medically significant) and headache (headache) (seriousness criterion medically significant). at the time of the report, illness (sickness) had not resolved and headache (headache) was resolving. diagnostic results (normal ranges are provided in parenthesis if available): on 30-oct-2020, sars-cov-2 test: positive covid-19 test (positive) positive covid-19 test. the action taken with mrna-1273 (moderna covid-19 vaccine) (unknown) was unknown. patient experienced sickness, nausea, severe body pain, blurred vision, sore arm at injection site, chills and fever. patient has not tested positive for covid-19 since having the vaccine. patient was not enrolled in clinical trial. it was reported that the report was not related to possible inflammation of the heart (myocarditis or pericarditis). company comment: this case concerns a 63-year-old female patient with no relevant medical history reported, who experienced the unexpected, serious (medically significant) events of illness and headache 1 day after the third dose of mrna-1273. additionally, the patient experienced nausea, severe body pain, blurred vision, vaccination site pain, chills, and pyrexia. seriousness assessment has been retained as per regulatory authority reporting, however there was no information in the source document supporting that the events resulted in a medically significant condition. the benefit-risk relationship of mrna-1273 is not affected by this report.; sender's comments: this case concerns a 63-year-old female patient with no relevant medical history reported, who experienced the unexpected, serious (medically significant) events of illness and headache 1 day after the third dose of mrna-1273. additionally, the patient experienced nausea, severe body pain, blurred vision, vaccination site pain, chills, and pyrexia. seriousness assessment has been retained as per regulatory authority reporting, however there was no information in the source document supporting that the events resulted in a medically significant condition. the benefit-risk relationship of mrna-1273 is not affected by this report

Données de laboratoire
test date: 20201030; test name: covid-19 virus test; test result: positive ; result unstructured data: positive covid-19 test
Liste des symptômes
headache sars-cov-2 test illness
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
suspected covid-19