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This is VAERS ID 1245484

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1245484
VAERS Form:2
Age:56.0
Sex:Male
Location:Florida
Vaccinated:2021-03-24
Onset:2021-04-19
Submitted:0000-00-00
Entered:2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Pneumonia, X-ray

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: AMLODIPINE; LEVOTHYROXINE; IRBESARTAN; LANSOPRAZOLE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No reported medical history)
Allergies:
Diagnostic Lab Data: Test Date: 2021; Test Name: X-RAY; Result Unstructured Data: pneumonia
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: Pneumonia; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of PNEUMONIA (Pneumonia) in a 56-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included No adverse event (No reported medical history). Concomitant products included AMLODIPINE, LEVOTHYROXINE, IRBESARTAN and LANSOPRAZOLE for an unknown indication. On 24-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 19-Apr-2021, the patient experienced PNEUMONIA (Pneumonia) (seriousness criterion hospitalization). At the time of the report, PNEUMONIA (Pneumonia) outcome was unknown. Not Provided DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In 2021, X-ray: pneumonia pneumonia. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. The patient went to hospital on an unspecified date and x-ray exam showed that he had pneumonia. The patient was prescribed with antibiotics and cough medicine. The patient was to check if doxycycline and promethazine medicine will effect on his second dose schedules on 21-APR-2012. The reporter did not provide an assessment for the event , pneumonia. Company Comment: Based on the current available information and temporal association between the use of the product and the start date of the event, 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 event, a causal relationship cannot be excluded.


Changed on 5/7/2021

VAERS ID: 1245484 Before After
VAERS Form:2
Age:56.0
Sex:Male
Location:Florida
Vaccinated:2021-03-24
Onset:2021-04-19
Submitted:0000-00-00
Entered:2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Pneumonia, X-ray

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: AMLODIPINE; LEVOTHYROXINE; IRBESARTAN; LANSOPRAZOLE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No reported medical history)
Allergies:
Diagnostic Lab Data: Test Date: 2021; Test Name: X-RAY; Result Unstructured Data: pneumonia
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: Pneumonia; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of PNEUMONIA (Pneumonia) in a 56-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included No adverse event (No reported medical history). Concomitant products included AMLODIPINE, LEVOTHYROXINE, IRBESARTAN and LANSOPRAZOLE for an unknown indication. On 24-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 19-Apr-2021, the patient experienced PNEUMONIA (Pneumonia) (seriousness criterion hospitalization). At the time of the report, PNEUMONIA (Pneumonia) outcome was unknown. Not Provided DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In 2021, X-ray: pneumonia pneumonia. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. The patient went to hospital on an unspecified date and x-ray exam showed that he had pneumonia. The patient was prescribed with antibiotics and cough medicine. The patient was to check if doxycycline and promethazine medicine will effect on his second dose schedules on 21-APR-2012. The reporter did not provide an assessment for the event , pneumonia. Company Comment: Based on the current available information and temporal association between the use of the product and the start date of the event, 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 event, a causal relationship cannot be excluded.


Changed on 5/14/2021

VAERS ID: 1245484 Before After
VAERS Form:2
Age:56.0
Sex:Male
Location:Florida
Vaccinated:2021-03-24
Onset:2021-04-19
Submitted:0000-00-00
Entered:2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Pneumonia, X-ray

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: AMLODIPINE; LEVOTHYROXINE; IRBESARTAN; LANSOPRAZOLE
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No reported medical history)
Allergies:
Diagnostic Lab Data: Test Date: 2021; Test Name: X-RAY; Result Unstructured Data: pneumonia
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: Pneumonia; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of PNEUMONIA (Pneumonia) in a 56-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included No adverse event (No reported medical history). Concomitant products included AMLODIPINE, LEVOTHYROXINE, IRBESARTAN and LANSOPRAZOLE for an unknown indication. On 24-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 19-Apr-2021, the patient experienced PNEUMONIA (Pneumonia) (seriousness criterion hospitalization). At the time of the report, PNEUMONIA (Pneumonia) outcome was unknown. Not Provided DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In 2021, X-ray: pneumonia pneumonia. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. The patient went to hospital on an unspecified date and x-ray exam showed that he had pneumonia. The patient was prescribed with antibiotics and cough medicine. The patient was to check if doxycycline and promethazine medicine will effect on his second dose schedules on 21-APR-2012. The reporter did not provide an assessment for the event , pneumonia. Company Comment: Based on the current available information and temporal association between the use of the product and the start date of the event, 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 event, a causal relationship cannot be excluded.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1245484&WAYBACKHISTORY=ON


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