National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1131182

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1131182
VAERS Form:2
Age:
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: 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 medical history provided)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: Pericarditis; A spontaneous report was received from a nurse concerning a patient of unknown age and gender who received Moderna''s COVID-19 Vaccine (mRNA-1273) and experienced pericarditis. No medical history was provided. No concomitant medications were reported. On an unknown date, one hour before the onset of events, the patient received their first of two planned doses of mRNA-1273 (Batch number: nor provided) intramuscularly for the prophylaxis of COVID-19 infection. An hour after vaccination, the patient had chest pain and "decided it was pericarditis" (medically significant). No treatment information was provided. Action taken with mRNA-1273 in response to the event was unknown. The outcome of the event of pericarditis was unknown. The reporter did not provide causality assessment for the event of pericarditis.; Reporter''s Comments: Based on the current available information and temporal association between the use of the product and the start date of these events, a causal relationship cannot be excluded.


Changed on 5/7/2021

VAERS ID: 1131182 Before After
VAERS Form:2
Age:
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: 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 medical history provided)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: Pericarditis; A spontaneous report was received from a nurse concerning a patient of unknown age and gender who received Moderna''s COVID-19 Vaccine (mRNA-1273) and experienced pericarditis. No medical history was provided. No concomitant medications were reported. On an unknown date, one hour before the onset of events, the patient received their first of two planned doses of mRNA-1273 (Batch number: nor provided) intramuscularly for the prophylaxis of COVID-19 infection. An hour after vaccination, the patient had chest pain and "decided it was pericarditis" (medically significant). No treatment information was provided. Action taken with mRNA-1273 in response to the event was unknown. The outcome of the event of pericarditis was unknown. The reporter did not provide causality assessment for the event of pericarditis.; Reporter''s Comments: Based on the current available information and temporal association between the use of the product and the start date of these events, a causal relationship cannot be excluded.


Changed on 5/14/2021

VAERS ID: 1131182 Before After
VAERS Form:2
Age:
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: 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 medical history provided)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: Pericarditis; A spontaneous report was received from a nurse concerning a patient of unknown age and gender who received Moderna''s COVID-19 Vaccine (mRNA-1273) and experienced pericarditis. No medical history was provided. No concomitant medications were reported. On an unknown date, one hour before the onset of events, the patient received their first of two planned doses of mRNA-1273 (Batch number: nor provided) intramuscularly for the prophylaxis of COVID-19 infection. An hour after vaccination, the patient had chest pain and "decided it was pericarditis" (medically significant). No treatment information was provided. Action taken with mRNA-1273 in response to the event was unknown. The outcome of the event of pericarditis was unknown. The reporter did not provide causality assessment for the event of pericarditis.; Reporter''s Comments: Based on the current available information and temporal association between the use of the product and the start date of these events, a causal relationship cannot be excluded.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1131182&WAYBACKHISTORY=ON


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