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This is VAERS ID 1221171

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1221171
VAERS Form:2
Age:34.0
Sex:Female
Location:Texas
Vaccinated:2021-04-10
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Body temperature, Chills, Fatigue, Feeling cold, Loss of consciousness, Malaise, Pain, Pain in extremity, Pyrexia, Seizure, Peripheral swelling

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LEXAPRO
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No reported medical history)
Allergies:
Diagnostic Lab Data: Test Date: 20210411; Test Name: body temperature; Result Unstructured Data: 99.5
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: Went into a seizure; Completely unconscious; Extreme arm pain; Arm swelling; Woke up freezing; Did not feel well; Body aches; Felt tiredness; Felt like fever; Chills; This spontaneous case was reported by a consumer and describes the occurrence of SEIZURE (Went into a seizure) and LOSS OF CONSCIOUSNESS (Completely unconscious) in a 34-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 046A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included No adverse event (No reported medical history). Concomitant products included ESCITALOPRAM OXALATE (LEXAPRO) for an unknown indication. On 10-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 11-Apr-2021, the patient experienced SEIZURE (Went into a seizure) (seriousness criteria hospitalization and medically significant), LOSS OF CONSCIOUSNESS (Completely unconscious) (seriousness criteria hospitalization and medically significant), PAIN IN EXTREMITY (Extreme arm pain), PERIPHERAL SWELLING (Arm swelling), FEELING COLD (Woke up freezing), MALAISE (Did not feel well), PAIN (Body aches), FATIGUE (Felt tiredness), PYREXIA (Felt like fever) and CHILLS (Chills). At the time of the report, SEIZURE (Went into a seizure), LOSS OF CONSCIOUSNESS (Completely unconscious), PAIN IN EXTREMITY (Extreme arm pain), PERIPHERAL SWELLING (Arm swelling), FEELING COLD (Woke up freezing), MALAISE (Did not feel well), PAIN (Body aches), FATIGUE (Felt tiredness), PYREXIA (Felt like fever) and CHILLS (Chills) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 11-Apr-2021, Body temperature: 99.5 (High) 99.5. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Treatment medication included paracetamol. 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.; Sender''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: 1221171 Before After
VAERS Form:2
Age:34.0
Sex:Female
Location:Texas
Vaccinated:2021-04-10
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Body temperature, Chills, Fatigue, Feeling cold, Loss of consciousness, Malaise, Pain, Pain in extremity, Pyrexia, Seizure, Peripheral swelling

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LEXAPRO
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No reported medical history)
Allergies:
Diagnostic Lab Data: Test Date: 20210411; Test Name: body temperature; Result Unstructured Data: 99.5
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: Went into a seizure; Completely unconscious; Extreme arm pain; Arm swelling; Woke up freezing; Did not feel well; Body aches; Felt tiredness; Felt like fever; Chills; This spontaneous case was reported by a consumer and describes the occurrence of SEIZURE (Went into a seizure) and LOSS OF CONSCIOUSNESS (Completely unconscious) in a 34-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 046A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included No adverse event (No reported medical history). Concomitant products included ESCITALOPRAM OXALATE (LEXAPRO) for an unknown indication. On 10-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 11-Apr-2021, the patient experienced SEIZURE (Went into a seizure) (seriousness criteria hospitalization and medically significant), LOSS OF CONSCIOUSNESS (Completely unconscious) (seriousness criteria hospitalization and medically significant), PAIN IN EXTREMITY (Extreme arm pain), PERIPHERAL SWELLING (Arm swelling), FEELING COLD (Woke up freezing), MALAISE (Did not feel well), PAIN (Body aches), FATIGUE (Felt tiredness), PYREXIA (Felt like fever) and CHILLS (Chills). At the time of the report, SEIZURE (Went into a seizure), LOSS OF CONSCIOUSNESS (Completely unconscious), PAIN IN EXTREMITY (Extreme arm pain), PERIPHERAL SWELLING (Arm swelling), FEELING COLD (Woke up freezing), MALAISE (Did not feel well), PAIN (Body aches), FATIGUE (Felt tiredness), PYREXIA (Felt like fever) and CHILLS (Chills) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 11-Apr-2021, Body temperature: 99.5 (High) 99.5. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Treatment medication included paracetamol. 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.; Sender''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: 1221171 Before After
VAERS Form:2
Age:34.0
Sex:Female
Location:Texas
Vaccinated:2021-04-10
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Body temperature, Chills, Fatigue, Feeling cold, Loss of consciousness, Malaise, Pain, Pain in extremity, Pyrexia, Seizure, Peripheral swelling

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: LEXAPRO
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No reported medical history)
Allergies:
Diagnostic Lab Data: Test Date: 20210411; Test Name: body temperature; Result Unstructured Data: 99.5
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: Went into a seizure; Completely unconscious; Extreme arm pain; Arm swelling; Woke up freezing; Did not feel well; Body aches; Felt tiredness; Felt like fever; Chills; This spontaneous case was reported by a consumer and describes the occurrence of SEIZURE (Went into a seizure) and LOSS OF CONSCIOUSNESS (Completely unconscious) in a 34-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 046A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included No adverse event (No reported medical history). Concomitant products included ESCITALOPRAM OXALATE (LEXAPRO) for an unknown indication. On 10-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 11-Apr-2021, the patient experienced SEIZURE (Went into a seizure) (seriousness criteria hospitalization and medically significant), LOSS OF CONSCIOUSNESS (Completely unconscious) (seriousness criteria hospitalization and medically significant), PAIN IN EXTREMITY (Extreme arm pain), PERIPHERAL SWELLING (Arm swelling), FEELING COLD (Woke up freezing), MALAISE (Did not feel well), PAIN (Body aches), FATIGUE (Felt tiredness), PYREXIA (Felt like fever) and CHILLS (Chills). At the time of the report, SEIZURE (Went into a seizure), LOSS OF CONSCIOUSNESS (Completely unconscious), PAIN IN EXTREMITY (Extreme arm pain), PERIPHERAL SWELLING (Arm swelling), FEELING COLD (Woke up freezing), MALAISE (Did not feel well), PAIN (Body aches), FATIGUE (Felt tiredness), PYREXIA (Felt like fever) and CHILLS (Chills) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 11-Apr-2021, Body temperature: 99.5 (High) 99.5. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Treatment medication included paracetamol. 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.; Sender''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.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1221171&WAYBACKHISTORY=ON


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