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From the 6/4/2021 release of VAERS data:

This is VAERS ID 1249656



Case Details

VAERS ID: 1249656 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: North Carolina  
Vaccinated:0000-00-00
Onset:2021-04-19
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Bronchospasm, Dyspnoea, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Penicillin allergy (did not have previous diagnosis of covid-19.)
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of WHEEZING (Wheezing), BRONCHOSPASM (Had Broncospasms) and DYSPNOEA (Couldn''t Control Breathing) in a 55-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Penicillin allergy (did not have previous diagnosis of covid-19.). On 19-Apr-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 19-Apr-2021, the patient experienced WHEEZING (Wheezing) (seriousness criterion hospitalization), BRONCHOSPASM (Had Broncospasms) (seriousness criterion hospitalization) and DYSPNOEA (Couldn''t Control Breathing) (seriousness criterion hospitalization). The patient was hospitalized from 19-Apr-2021 to 19-Apr-2021 due to BRONCHOSPASM, DYSPNOEA and WHEEZING. At the time of the report, WHEEZING (Wheezing), BRONCHOSPASM (Had Broncospasms) and DYSPNOEA (Couldn''t Control Breathing) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) and mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Patient did not experience any events with 1st dose of the vaccine. Patient was treated with albuterol. He was discharged 3 hours later and given prednisone and albuterol. He was advised to take prednisone if required. 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 Most recent FOLLOW-UP information incorporated above includes: On 20-Apr-2021: Additional document received on 20 Apr 2021 included seriousness criteria updated to serious; 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. Further information has been requested


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