National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1129558

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1129558
VAERS Form:2
Age:
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Atrial flutter, Blood iron, Blood iron decreased, Chills, Night sweats, Pericarditis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No reported medical history)
Allergies:
Diagnostic Lab Data: Test Name: blood iron; Result Unstructured Data: low
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: Pericarditis; A-flutter; Severe night sweats; blood iron decreased; Nightly Chills; A spontaneous report was received from a consumer for a male patient (unspecified age)(reporter father) who experienced atrial flutter, pericarditis, chills and sweats. The patient''s medical history was not provided. No relevant concomitant medications were reported. On an unspecified date, prior to the onset of the events the patient received second of two planned doses of mRNA-1273 (lot/batch: not provided) intramuscularly for prophylaxis of COVID-19 infection. On an unspecified date within few hours after receiving the vaccine, the reporter stated that his/her father came down with pericarditis as a vaccination side effect. Three weeks later patient still had it along with nightly chills and severe night sweats. The patient also developed atrial flutter and his iron levels dropped in his blood. No treatment details were provided. The seriousness criteria for the event pericarditis was medically significant. Action taken with mRNA-1273 in response to the events was not applicable. The outcome of events, pericarditis, chills, and night sweats, was not resolved. The outcome of the events, atrial flutter and blood iron decreased, was unknown.; Reporter''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events a causal relationship cannot be excluded. Further information has been requested.


Changed on 5/7/2021

VAERS ID: 1129558 Before After
VAERS Form:2
Age:
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Atrial flutter, Blood iron, Blood iron decreased, Chills, Night sweats, Pericarditis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No reported medical history)
Allergies:
Diagnostic Lab Data: Test Name: blood iron; Result Unstructured Data: low
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: Pericarditis; A-flutter; Severe night sweats; blood iron decreased; Nightly Chills; A spontaneous report was received from a consumer for a male patient (unspecified age)(reporter father) who experienced atrial flutter, pericarditis, chills and sweats. The patient''s medical history was not provided. No relevant concomitant medications were reported. On an unspecified date, prior to the onset of the events the patient received second of two planned doses of mRNA-1273 (lot/batch: not provided) intramuscularly for prophylaxis of COVID-19 infection. On an unspecified date within few hours after receiving the vaccine, the reporter stated that his/her father came down with pericarditis as a vaccination side effect. Three weeks later patient still had it along with nightly chills and severe night sweats. The patient also developed atrial flutter and his iron levels dropped in his blood. No treatment details were provided. The seriousness criteria for the event pericarditis was medically significant. Action taken with mRNA-1273 in response to the events was not applicable. The outcome of events, pericarditis, chills, and night sweats, was not resolved. The outcome of the events, atrial flutter and blood iron decreased, was unknown.; Reporter''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events a causal relationship cannot be excluded. Further information has been requested.


Changed on 5/14/2021

VAERS ID: 1129558 Before After
VAERS Form:2
Age:
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Atrial flutter, Blood iron, Blood iron decreased, Chills, Night sweats, Pericarditis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No reported medical history)
Allergies:
Diagnostic Lab Data: Test Name: blood iron; Result Unstructured Data: low
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: Pericarditis; A-flutter; Severe night sweats; blood iron decreased; Nightly Chills; A spontaneous report was received from a consumer for a male patient (unspecified age)(reporter father) who experienced atrial flutter, pericarditis, chills and sweats. The patient''s medical history was not provided. No relevant concomitant medications were reported. On an unspecified date, prior to the onset of the events the patient received second of two planned doses of mRNA-1273 (lot/batch: not provided) intramuscularly for prophylaxis of COVID-19 infection. On an unspecified date within few hours after receiving the vaccine, the reporter stated that his/her father came down with pericarditis as a vaccination side effect. Three weeks later patient still had it along with nightly chills and severe night sweats. The patient also developed atrial flutter and his iron levels dropped in his blood. No treatment details were provided. The seriousness criteria for the event pericarditis was medically significant. Action taken with mRNA-1273 in response to the events was not applicable. The outcome of events, pericarditis, chills, and night sweats, was not resolved. The outcome of the events, atrial flutter and blood iron decreased, was unknown.; Reporter''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events a causal relationship cannot be excluded. Further information has been requested.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1129558&WAYBACKHISTORY=ON


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