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This is VAERS ID 1261487

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1261487
VAERS Form:2
Age:55.0
Sex:Female
Location:New Jersey
Vaccinated:2021-04-11
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 1 LA / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Bell's palsy, Headache, Hypoaesthesia

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
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: similar to Bells Palsy; Very dull numbness in the left side of her face; slight headache; This spontaneous case was reported by a consumer and describes the occurrence of FACIAL PARALYSIS (similar to Bells Palsy) in a 55-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. On 11-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 FACIAL PARALYSIS (similar to Bells Palsy) (seriousness criterion medically significant), HYPOAESTHESIA (Very dull numbness in the left side of her face) and HEADACHE (slight headache). At the time of the report, FACIAL PARALYSIS (similar to Bells Palsy), HYPOAESTHESIA (Very dull numbness in the left side of her face) and HEADACHE (slight headache) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the onset date of the reported events, a causal relationship cannot be excluded.


Changed on 5/7/2021

VAERS ID: 1261487 Before After
VAERS Form:2
Age:55.0
Sex:Female
Location:New Jersey
Vaccinated:2021-04-11
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 1 LA / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Bell's palsy, Headache, Hypoaesthesia

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
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: similar to Bells Palsy; Very dull numbness in the left side of her face; slight headache; This spontaneous case was reported by a consumer and describes the occurrence of FACIAL PARALYSIS (similar to Bells Palsy) in a 55-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. On 11-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 FACIAL PARALYSIS (similar to Bells Palsy) (seriousness criterion medically significant), HYPOAESTHESIA (Very dull numbness in the left side of her face) and HEADACHE (slight headache). At the time of the report, FACIAL PARALYSIS (similar to Bells Palsy), HYPOAESTHESIA (Very dull numbness in the left side of her face) and HEADACHE (slight headache) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the onset date of the reported events, a causal relationship cannot be excluded.


Changed on 5/14/2021

VAERS ID: 1261487 Before After
VAERS Form:2
Age:55.0
Sex:Female
Location:New Jersey
Vaccinated:2021-04-11
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046A21A / 1 LA / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Bell's palsy, Headache, Hypoaesthesia

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
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: similar to Bells Palsy; Very dull numbness in the left side of her face; slight headache; This spontaneous case was reported by a consumer and describes the occurrence of FACIAL PARALYSIS (similar to Bells Palsy) in a 55-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. On 11-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 FACIAL PARALYSIS (similar to Bells Palsy) (seriousness criterion medically significant), HYPOAESTHESIA (Very dull numbness in the left side of her face) and HEADACHE (slight headache). At the time of the report, FACIAL PARALYSIS (similar to Bells Palsy), HYPOAESTHESIA (Very dull numbness in the left side of her face) and HEADACHE (slight headache) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the onset date of the reported events, a causal relationship cannot be excluded.

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