National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/26/2021 release of VAERS data:

Found 107 cases where Age is 12-or-more-and-under-18 and Vaccine is COVID19 and Manufacturer is MODERNA and Standard-MedDRA-Query broadly-matches 'Anaphylactic reaction'

Government Disclaimer on use of this data



Case Details

This is page 4 out of 11

Result pages: prev   1 2 3 4 5 6 7 8 9 10 11   next


VAERS ID: 1614352 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-07
Onset:2021-04-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B21A / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac murmur, Dyspnoea, Echocardiogram, Physical examination, Product administered to patient of inappropriate age
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: APRI; VITAMIN D [COLECALCIFEROL]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anxiety (anxiety from schooling)
Allergies:
Diagnostic Lab Data: Test Date: 20210417; Test Name: Echocardiogram; Result Unstructured Data: 2 different readings for patient''s echocardiogram; Test Date: 20210417; Test Name: Physical checkup; Result Unstructured Data: heart murmur at physical checkup
CDC Split Type: USMODERNATX, INC.MOD20211

Write-up: shortness of breath which is on and off/shortness of breath can be from anxiety from schooling; heart murmur; 16 year old patient received 1st dose of Moderna COVID-19 vaccine; This spontaneous case was reported by a physician and describes the occurrence of PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (16 year old patient received 1st dose of Moderna COVID-19 vaccine), DYSPNOEA (shortness of breath which is on and off/shortness of breath can be from anxiety from schooling) and CARDIAC MURMUR (heart murmur) in a 16-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 018B21A) for COVID-19 vaccination. The patient''s past medical history included Anxiety (anxiety from schooling). Concomitant products included DESOGESTREL, ETHINYLESTRADIOL (APRI) for Birth control pill, COLECALCIFEROL (VITAMIN D [COLECALCIFEROL]) for Supplementation therapy. On 07-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 07-Apr-2021, the patient experienced PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (16 year old patient received 1st dose of Moderna COVID-19 vaccine). On 17-Apr-2021, the patient experienced CARDIAC MURMUR (heart murmur). On an unknown date, the patient experienced DYSPNOEA (shortness of breath which is on and off/shortness of breath can be from anxiety from schooling). On 07-Apr-2021, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (16 year old patient received 1st dose of Moderna COVID-19 vaccine) had resolved. At the time of the report, DYSPNOEA (shortness of breath which is on and off/shortness of breath can be from anxiety from schooling) and CARDIAC MURMUR (heart murmur) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 17-Apr-2021, Echocardiogram: abnormal (abnormal) 2 different readings for patient''s echocardiogram. On 17-Apr-2021, Physical examination: abnormal (abnormal) heart murmur at physical checkup. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments.


VAERS ID: 1657825 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-30
Onset:2021-04-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21N / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Dyspnoea, Nasal congestion, Product administered to patient of inappropriate age, Product dose omission issue, Pyrexia, Somnolence
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: 1st dose 30Apr2021; no 2nd dose; Sleeping the whole time; Congested; Trouble breathing; Low grade fever; 16 years old administered with the vaccine; This spontaneous case was reported by a consumer and describes the occurrence of SOMNOLENCE (Sleeping the whole time), NASAL CONGESTION (Congested), DYSPNOEA (Trouble breathing), PYREXIA (Low grade fever) and PRODUCT DOSE OMISSION ISSUE (1st dose 30Apr2021; no 2nd dose) in a 16-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 003C21N) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included COVID-19 in February 2021. On 30-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 30-Apr-2021, the patient experienced PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (16 years old administered with the vaccine). On 01-May-2021, the patient experienced SOMNOLENCE (Sleeping the whole time), NASAL CONGESTION (Congested), DYSPNOEA (Trouble breathing) and PYREXIA (Low grade fever). On 17-Aug-2021, the patient experienced PRODUCT DOSE OMISSION ISSUE (1st dose 30Apr2021; no 2nd dose). On 30-Apr-2021, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (16 years old administered with the vaccine) had resolved. On 01-May-2021, SOMNOLENCE (Sleeping the whole time), NASAL CONGESTION (Congested), DYSPNOEA (Trouble breathing) and PYREXIA (Low grade fever) had resolved. On 17-Aug-2021, PRODUCT DOSE OMISSION ISSUE (1st dose 30Apr2021; no 2nd dose) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant product use was not provided by the reporter. No treatment information was provided.


VAERS ID: 1665576 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-03
Onset:2021-03-12
   Days after vaccination:37
Submitted: 0000-00-00
Entered: 2021-09-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0077727399/012M / 2 LA / OT

Administered by: Private       Purchased by: ?
Symptoms: Body temperature, Dyspnoea, Oxygen saturation, Product administered to patient of inappropriate age, Pyrexia, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MELATONIN; MULTIVITAMINS [VITAMINS NOS]
Current Illness: Allergy (many Airborne allergy); Autism spectrum disorder; Food allergy (some food); Sulfonamide allergy (sulfa(rash))
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: Body temperature; Test Result: Inconclusive ; Result Unstructured Data: low grade fever; Test Date: 20210313; Test Name: oxygen saturation; Test Result: Inconclusive 92 %; Result Unstructured Data: 92 percent oxygen saturation per pulse oximeter
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: low grade fever; experienced pounding tachycardia; Shortness of breath; inappropriate age at the vaccination; This spontaneous case was reported by a consumer and describes the occurrence of TACHYCARDIA (experienced pounding tachycardia), DYSPNOEA (Shortness of breath), PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (inappropriate age at the vaccination) and PYREXIA (low grade fever) in a 17-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 0077727399/012M20A and 0077727399/031A21A) for COVID-19 vaccination. Concurrent medical conditions included Sulfonamide allergy (sulfa(rash)), Allergy (many Airborne allergy), Food allergy (some food) and Autism spectrum disorder since 23-Nov-2003. Concomitant products included MELATONIN and MULTIVITAMINS [VITAMINS NOS] for an unknown indication. On 03-Feb-2021 at 3:00 PM, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 12-Mar-2021 at 12:00 PM, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 12-Mar-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (inappropriate age at the vaccination). On 13-Mar-2021, the patient experienced TACHYCARDIA (experienced pounding tachycardia) and DYSPNOEA (Shortness of breath). On an unknown date, the patient experienced PYREXIA (low grade fever). On 13-Mar-2021, TACHYCARDIA (experienced pounding tachycardia) and DYSPNOEA (Shortness of breath) had resolved. At the time of the report, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (inappropriate age at the vaccination) had resolved and PYREXIA (low grade fever) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 13-Mar-2021, Oxygen saturation: 92 percent (Inconclusive) 92 percent oxygen saturation per pulse oximeter. On an unknown date, Body temperature: inconclusive (Inconclusive) low grade fever. No treatment medications were reported. This case was linked to MOD-2021-035571 (Patient Link).


VAERS ID: 1708829 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-08-19
Onset:2021-09-16
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-09-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043B21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Cough, Headache, Interchange of vaccine products, Pyrexia, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Medication errors (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient was mistakenly given Moderna Covid Vaccine. It was noticed by staff when patient was called for scheduling of second dose. Mom informed of med error and stated that patient developed the following symptoms after having received the first dose of the vaccine: fever (102 F), chills, headache, cough, runny nose for a couple of days after administration.


VAERS ID: 1711013 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2021-09-01
Onset:2021-09-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 RA / OT

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Ageusia, Anosmia, Cough, Fatigue, Malaise, Nasal congestion, Nausea, Oropharyngeal pain, Product administered to patient of inappropriate age, Rhinorrhoea, SARS-CoV-2 test, Somnolence
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Medication errors (narrow), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ADDERALL
Current Illness: Drug allergy (Versed allergy); Penicillin allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210903; Test Name: COVID-19 test; Test Result: Negative ; Result Unstructured Data: Negative
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Throat hurts; Tired; Nauseous; smell loss; still sleeping a lot; 14 year old administered first dose; loss of taste; Congestion; Stomach pain; started to feel sick 6 hours after getting first dose/ sounds sick/not feeling well; runny nose; cough; This spontaneous case was reported by a consumer and describes the occurrence of AGEUSIA (loss of taste), NASAL CONGESTION (Congestion), ABDOMINAL PAIN UPPER (Stomach pain), MALAISE (started to feel sick 6 hours after getting first dose/ sounds sick/not feeling well) and RHINORRHOEA (runny nose) in a 14-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 052E21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Penicillin allergy and Drug allergy (Versed allergy). Concomitant products included AMFETAMINE ASPARTATE, AMFETAMINE SULFATE, DEXAMFETAMINE SACCHARATE, DEXAMFETAMINE SULFATE (ADDERALL) from December 2019 to an unknown date for ADHD. On 01-Sep-2021 at 4:00 PM, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 01-Sep-2021, the patient experienced AGEUSIA (loss of taste), NASAL CONGESTION (Congestion), ABDOMINAL PAIN UPPER (Stomach pain), MALAISE (started to feel sick 6 hours after getting first dose/ sounds sick/not feeling well), RHINORRHOEA (runny nose), COUGH (cough) and PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (14 year old administered first dose). On 02-Sep-2021, the patient experienced ANOSMIA (smell loss) and SOMNOLENCE (still sleeping a lot). On 03-Sep-2021, the patient experienced OROPHARYNGEAL PAIN (Throat hurts), FATIGUE (Tired) and NAUSEA (Nauseous). The patient was treated with CETIRIZINE HYDROCHLORIDE (ZYRTEC [CETIRIZINE HYDROCHLORIDE]) for Adverse event, at an unspecified dose and frequency. On 01-Sep-2021, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (14 year old administered first dose) had resolved. At the time of the report, AGEUSIA (loss of taste), NASAL CONGESTION (Congestion), ABDOMINAL PAIN UPPER (Stomach pain), MALAISE (started to feel sick 6 hours after getting first dose/ sounds sick/not feeling well), RHINORRHOEA (runny nose), COUGH (cough), ANOSMIA (smell loss), SOMNOLENCE (still sleeping a lot), OROPHARYNGEAL PAIN (Throat hurts), FATIGUE (Tired) and NAUSEA (Nauseous) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 03-Sep-2021, SARS-CoV-2 test: negative (Negative) Negative. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Treatment medications included OTC stomach medication Patient received Moderna accidentally instead of Pfizer Patient was advised to take over the counter pain medicine and cold medicine. Most recent FOLLOW-UP information incorporated above includes: On 07-Sep-2021: Vaccine lot number was added. On 13-Sep-2021: Patient demographics updated, Added allergy, Added dose 1 timing, added events runny nose, cough, loss of smell, throat pain, nose is stuffy, tired and nauseous


VAERS ID: 1755806 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-08-27
Onset:2021-08-27
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 035E21A / UNK RA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Arthralgia, Burning sensation, C-reactive protein, Chest pain, Dizziness, Electrocardiogram QT prolonged, Fatigue, Feeling abnormal, Feeling cold, Oropharyngeal pain, Product administered to patient of inappropriate age, Pyrexia, Rhinorrhoea, SARS-CoV-2 test, Sneezing
SMQs:, Torsade de pointes/QT prolongation (narrow), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Conduction defects (narrow), Torsade de pointes, shock-associated conditions (narrow), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad), Arthritis (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Asthma
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19
Allergies:
Diagnostic Lab Data: Test Date: 20210830; Test Name: C-reactive protein; Result Unstructured Data: should be under 8.; Test Date: 202011; Test Name: Covid-19 test; Test Result: Positive ; Result Unstructured Data: Positive
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: sneezing; runny nose; developed an extreme sore throat that lasted 30 hours/sore throat came back; too tired; EKG borderline QT prolongation; heartburn after eating a biscuit; chest hurt; felt very cold; lightheaded; sore right knee; did not feel good; slight fever; Give Moderna vaccine at 13 years of agee; This spontaneous case was reported by a consumer and describes the occurrence of ELECTROCARDIOGRAM QT PROLONGED (EKG borderline QT prolongation) in a 13-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 035E21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included COVID-19 in November 2020. Concurrent medical conditions included Asthma. On 27-Aug-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 27-Aug-2021, the patient experienced PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (Give Moderna vaccine at 13 years of agee). On 28-Aug-2021, the patient experienced FEELING ABNORMAL (did not feel good), ARTHRALGIA (sore right knee) and PYREXIA (slight fever). On 30-Aug-2021, the patient experienced ELECTROCARDIOGRAM QT PROLONGED (EKG borderline QT prolongation) (seriousness criterion medically significant), BURNING SENSATION (heartburn after eating a biscuit), CHEST PAIN (chest hurt), FEELING COLD (felt very cold), DIZZINESS (lightheaded) and FATIGUE (too tired). On 01-Sep-2021, the patient experienced OROPHARYNGEAL PAIN (developed an extreme sore throat that lasted 30 hours/sore throat came back). On 09-Sep-2021, the patient experienced SNEEZING (sneezing) and RHINORRHOEA (runny nose). On 30-Aug-2021, FEELING ABNORMAL (did not feel good), ARTHRALGIA (sore right knee) and PYREXIA (slight fever) had resolved. On 13-Sep-2021, OROPHARYNGEAL PAIN (developed an extreme sore throat that lasted 30 hours/sore throat came back), SNEEZING (sneezing) and RHINORRHOEA (runny nose) had resolved. At the time of the report, ELECTROCARDIOGRAM QT PROLONGED (EKG borderline QT prolongation) outcome was unknown, BURNING SENSATION (heartburn after eating a biscuit), CHEST PAIN (chest hurt), FEELING COLD (felt very cold), DIZZINESS (lightheaded) and FATIGUE (too tired) was resolving and PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (Give Moderna vaccine at 13 years of agee) had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In November 2020, SARS-CoV-2 test: positive (Positive) Positive. On 30-Aug-2021, C-reactive protein: 20.2 (High) should be under 8.. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant medications were not reported. Treatment medications were not reported. The reporter stated that patient was given Moderna vaccine instead of the Pfizer vaccine and noticed it after injection when they handed their vaccination card It was on 27August 2021 in right arm and patient had been exposed to Covid-19 in November of 2020 and was positive for it. On 28Aug2021 patient woke up and said right knee was hurting and patient did not feel good all weekend and had a small fever. On 30August 2021 patient had heartburn after eating a biscuit at school and said chest hurt, patient used asthma inhaler twice instead of once and became lightheaded and felt very cold. Patient was too tired to go in the house when they got home and took him to the doctor that afternoon and they did bloodwork and then went to a hospital for an EKG. The results of the bloodwork were a CRP of 20.2 which should be under 8 and they wanted to repeat the bloodwork on 1 September 2021 and patient developed an extreme sore throat that lasted 30 hours and then his asthma started acting up. On 9 September 2021 the sore throat came back, sneezing, and very runny nose these lasted until 13 September 2021, Patient is now started feeling better. Company Comment: This is a case of ''Product administered to patient of inappropriate age'' for this 13-year-old, male with a medical history of asthma, who experienced the unexpected serious event of ECG QT prolonged; unexpected non-serious events of feeling abnormal, chest pain, feeling cold, oropharyngeal pain, sneezing, rhinorrhea and dizziness; expected non-serious events of pyrexia arthralgia and fatigue. The events occurred 3 days after receiving Moderna mRNA-1273 Vaccine (dose number unknown). The rechallenge is not applicable as the events were reported after a single dose. The reporter did not provide the causality assessment. The benefit-risk relationship of mRNA-1273 is not affected by this report.; Sender''s Comments: This is a case of ''Product administered to patient of inappropriate age'' for this 13-year-old, male with a medical history of asthma, who experienced the unexpected serious event of ECG QT prolonged; unexpected non-serious events of feeling abnormal, chest pain, feeling cold, oropharyngeal pain, sneezing, rhinorrhea and dizziness; expected non-serious events of pyrexia arthralgia and fatigue. The events occurred 3 days after receiving Moderna mRNA-1273 Vaccine (dose number unknown). The rechallenge is not applicable as the events were reported after a single dose. The reporter did not provide the causality assessment. The benefit-risk relationship of mRNA-1273 is not affected by this report. (Further information is requested).


VAERS ID: 1830710 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Maryland  
Vaccinated:2021-04-22
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 2 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Fatigue, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Tightness of chest; Wheezing; Fatigue; This spontaneous case was reported by a consumer and describes the occurrence of CHEST DISCOMFORT (Tightness of chest), WHEEZING (Wheezing) and FATIGUE (Fatigue) in a 15-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 009C21A and 022C21A) for COVID-19 vaccination. No Medical History information was reported. On 22-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 20-May-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient experienced CHEST DISCOMFORT (Tightness of chest), WHEEZING (Wheezing) and FATIGUE (Fatigue). At the time of the report, CHEST DISCOMFORT (Tightness of chest), WHEEZING (Wheezing) and FATIGUE (Fatigue) outcome was unknown. No concomitant medication was mentioned. No treatment medication was mentioned. This case was linked to MOD-2021-359055 (Patient Link).


VAERS ID: 1842818 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Male  
Location: California  
Vaccinated:2021-06-21
Onset:2021-06-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Movement disorder
SMQs:, Anaphylactic reaction (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe Chest pain and pressure for about 20 minutes , breathing was normal but unable to move.


VAERS ID: 1857386 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Colorado  
Vaccinated:2021-11-05
Onset:2021-11-06
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-11-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 32030BD / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Heart rate increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ibuprofen
Current Illness: None
Preexisting Conditions: Back pain, pectus carinatum
Allergies: Azithromycin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Heart rate sustained between 125-132 for two days. Chest tightness. Chest pain day after injection for about four hours. Pain upon inhalation during morning of chest pain.


VAERS ID: 1901096 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Utah  
Vaccinated:2021-11-15
Onset:2021-11-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-11-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 013F21A / 3 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Chills, Flushing, Inappropriate schedule of product administration, Influenza like illness, Injection site pain, Muscular weakness, Myalgia, Pain, Product administered to patient of inappropriate age, Pyrexia, Vaccination complication, Vaccination site pain
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Flush; Extreme flu like symptoms; Weakness; Other body aches; chills; Tenderness at inection site; Muscle pain; Local pain at injection site; Fever; Severe reaction/significant side effects; Muscle weakness; Achiness; Inappropriate schedule of vaccine administered; 13 year old given Moderna booster; This spontaneous case was reported by a pharmacist and describes the occurrence of VACCINATION COMPLICATION (Severe reaction/significant side effects), MUSCULAR WEAKNESS (Muscle weakness), PAIN (Achiness), FLUSHING (Flush) and INFLUENZA LIKE ILLNESS (Extreme flu like symptoms) in a 13-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 013F21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Previously administered products included for COVID-19 vaccination: Pfizer from 22-Jul-2021 to 13-Aug-2021. Past adverse reactions to the above products included No adverse event with Pfizer. On 15-Nov-2021 at 9:00 PM, the patient received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 15-Nov-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Inappropriate schedule of vaccine administered). 15-Nov-2021, the patient experienced PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (13 year old given Moderna booster). On 16-Nov-2021, the patient experienced VACCINATION COMPLICATION (Severe reaction/significant side effects), MUSCULAR WEAKNESS (Muscle weakness), INJECTION SITE PAIN (Tenderness at inection site), MYALGIA (Muscle pain), VACCINATION SITE PAIN (Local pain at injection site) and PYREXIA (Fever). 16-Nov-2021, the patient experienced PAIN (Achiness). 16-Nov-2021, the patient experienced CHILLS (chills). On 16-Nov-2021 at 1:00 PM, the patient experienced INFLUENZA LIKE ILLNESS (Extreme flu like symptoms), ASTHENIA (Weakness) and PAIN (Other body aches). On 17-Nov-2021, the patient experienced FLUSHING (Flush). The patient was treated with IBUPROFEN at an unspecified dose and frequency. On 15-Nov-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Inappropriate schedule of vaccine administered) and PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (13 year old given Moderna booster) had resolved. On 18-Nov-2021, INFLUENZA LIKE ILLNESS (Extreme flu like symptoms), ASTHENIA (Weakness), PAIN (Other body aches) and PYREXIA (Fever) had resolved. At the time of the report, VACCINATION COMPLICATION (Severe reaction/significant side effects), MUSCULAR WEAKNESS (Muscle weakness), PAIN (Achiness), CHILLS (chills), MYALGIA (Muscle pain) and VACCINATION SITE PAIN (Local pain at injection site) was resolving and FLUSHING (Flush) and INJECTION SITE PAIN (Tenderness at inection site) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medication were provided. Patient was supposed to get a flu shot but was given with the Moderna Booster .25mLs instead. On 16Nov2021 Patient had significant side effects about 16 hours after vaccination. Patient reported that ,felt like bones were disintegrating. Most recent FOLLOW-UP information incorporated above includes: On 18-Nov-2021: Significant Follow-up received on 18-NOV-2021 contains events i.e. local pain at injection site, achiness,severe reaction/severe normal, fever, chills, bones were disintegrating ,muscle weakness and pain,ocal pain at injection site,flush were added and treatment drug Ibuprofen added On 19-Nov-2021: Significant follow-up received on 19-NOV-2021,contains patient ethic details and race information, and events i.e.extreme flu like symptoms, body ache were added and event outcome for chills, fever, weakness were updated to recovered


Result pages: prev   1 2 3 4 5 6 7 8 9 10 11   next

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?EVENTS=ON&PAGENO=4&SYMPTOMSSMQ=21&VAX=COVID19&VAXMAN=MODERNA&WhichAge=range&LOWAGE=(12)&HIGHAGE=(18)


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166