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This is VAERS ID 1245409

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1245409
VAERS Form:2
Age:36.0
Sex:Female
Location:Minnesota
Vaccinated:2021-04-11
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Abdominal pain upper, Headache, Hyperhidrosis, Loss of consciousness, Pain, Seizure, Vomiting

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)? Yes
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: seizure; passed out due to extreme vomiting as per doctor in ER; vomiting every 40 minutes; stomachaches; body pain; Sweating; Headache; This case was received via an unknown source no reference has been entered for a health authority or license partner on 15-Apr-2021 and was forwarded to Moderna on 15-Apr-2021. This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of SEIZURE (seizure) and LOSS OF CONSCIOUSNESS (passed out due to extreme vomiting as per doctor in ER) in a 36-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 027B21A) 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 medical history provided.). On 11-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 12-Apr-2021, the patient experienced SEIZURE (seizure) (seriousness criterion medically significant), LOSS OF CONSCIOUSNESS (passed out due to extreme vomiting as per doctor in ER) (seriousness criterion medically significant), HEADACHE (Headache), ABDOMINAL PAIN UPPER (stomachaches), VOMITING (vomiting every 40 minutes), PAIN (body pain) and HYPERHIDROSIS (Sweating). The patient was treated with IBUPROFEN at an unspecified dose and frequency. At the time of the report, SEIZURE (seizure), LOSS OF CONSCIOUSNESS (passed out due to extreme vomiting as per doctor in ER), HEADACHE (Headache), ABDOMINAL PAIN UPPER (stomachaches), VOMITING (vomiting every 40 minutes), PAIN (body pain) and HYPERHIDROSIS (Sweating) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No medical history or concomitant medications provided. Patient used ibuprofen for treatment of headache. 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.; Sender''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.


Changed on 5/7/2021

VAERS ID: 1245409 Before After
VAERS Form:2
Age:36.0
Sex:Female
Location:Minnesota
Vaccinated:2021-04-11
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Abdominal pain upper, Headache, Hyperhidrosis, Loss of consciousness, Pain, Seizure, Vomiting

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)? Yes
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: seizure; passed out due to extreme vomiting as per doctor in ER; vomiting every 40 minutes; stomachaches; body pain; Sweating; Headache; This case was received via an unknown source no reference has been entered for a health authority or license partner on 15-Apr-2021 and was forwarded to Moderna on 15-Apr-2021. This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of SEIZURE (seizure) and LOSS OF CONSCIOUSNESS (passed out due to extreme vomiting as per doctor in ER) in a 36-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 027B21A) 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 medical history provided.). On 11-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 12-Apr-2021, the patient experienced SEIZURE (seizure) (seriousness criterion medically significant), LOSS OF CONSCIOUSNESS (passed out due to extreme vomiting as per doctor in ER) (seriousness criterion medically significant), HEADACHE (Headache), ABDOMINAL PAIN UPPER (stomachaches), VOMITING (vomiting every 40 minutes), PAIN (body pain) and HYPERHIDROSIS (Sweating). The patient was treated with IBUPROFEN at an unspecified dose and frequency. At the time of the report, SEIZURE (seizure), LOSS OF CONSCIOUSNESS (passed out due to extreme vomiting as per doctor in ER), HEADACHE (Headache), ABDOMINAL PAIN UPPER (stomachaches), VOMITING (vomiting every 40 minutes), PAIN (body pain) and HYPERHIDROSIS (Sweating) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No medical history or concomitant medications provided. Patient used ibuprofen for treatment of headache. 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.; Sender''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.


Changed on 5/14/2021

VAERS ID: 1245409 Before After
VAERS Form:2
Age:36.0
Sex:Female
Location:Minnesota
Vaccinated:2021-04-11
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027B21A / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Abdominal pain upper, Headache, Hyperhidrosis, Loss of consciousness, Pain, Seizure, Vomiting

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)? Yes
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: seizure; passed out due to extreme vomiting as per doctor in ER; vomiting every 40 minutes; stomachaches; body pain; Sweating; Headache; This case was received via an unknown source no reference has been entered for a health authority or license partner on 15-Apr-2021 and was forwarded to Moderna on 15-Apr-2021. This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of SEIZURE (seizure) and LOSS OF CONSCIOUSNESS (passed out due to extreme vomiting as per doctor in ER) in a 36-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 027B21A) 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 medical history provided.). On 11-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 12-Apr-2021, the patient experienced SEIZURE (seizure) (seriousness criterion medically significant), LOSS OF CONSCIOUSNESS (passed out due to extreme vomiting as per doctor in ER) (seriousness criterion medically significant), HEADACHE (Headache), ABDOMINAL PAIN UPPER (stomachaches), VOMITING (vomiting every 40 minutes), PAIN (body pain) and HYPERHIDROSIS (Sweating). The patient was treated with IBUPROFEN at an unspecified dose and frequency. At the time of the report, SEIZURE (seizure), LOSS OF CONSCIOUSNESS (passed out due to extreme vomiting as per doctor in ER), HEADACHE (Headache), ABDOMINAL PAIN UPPER (stomachaches), VOMITING (vomiting every 40 minutes), PAIN (body pain) and HYPERHIDROSIS (Sweating) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No medical history or concomitant medications provided. Patient used ibuprofen for treatment of headache. 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.; Sender''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.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1245409&WAYBACKHISTORY=ON


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