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This is VAERS ID 1261535

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1261535
VAERS Form:2
Age:41.0
Sex:Male
Location:Texas
Vaccinated:2021-03-21
Onset:2021-04-21
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Hyperhidrosis, Loss of consciousness, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: Passed out; Sweaty; Slightly feverish; This spontaneous case was reported by a consumer and describes the occurrence of LOSS OF CONSCIOUSNESS (Passed out) in a 41-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 045B21A and 045A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 21-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 21-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 21-Apr-2021, the patient experienced LOSS OF CONSCIOUSNESS (Passed out) (seriousness criterion medically significant), HYPERHIDROSIS (Sweaty) and PYREXIA (Slightly feverish). At the time of the report, LOSS OF CONSCIOUSNESS (Passed out), HYPERHIDROSIS (Sweaty) and PYREXIA (Slightly feverish) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medications were not reported. Description: The patient felt sweaty and slightly feverish all night on 21 April 2021. When he got up to urinate he actually passed out (medically significant) and was on the floor for a few seconds. Later last night, on the same day, he went to drink some water, and passed out again for a few seconds. The patient did not seek any medical attention, and stated that he felt fine now. No treatment information provided. The patient received both scheduled doses of mRNA-1273 prior to the event, therefore action taken with the drug in response to the event is not applicable. 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: 1261535 Before After
VAERS Form:2
Age:41.0
Sex:Male
Location:Texas
Vaccinated:2021-03-21
Onset:2021-04-21
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Hyperhidrosis, Loss of consciousness, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: Passed out; Sweaty; Slightly feverish; This spontaneous case was reported by a consumer and describes the occurrence of LOSS OF CONSCIOUSNESS (Passed out) in a 41-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 045B21A and 045A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 21-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 21-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 21-Apr-2021, the patient experienced LOSS OF CONSCIOUSNESS (Passed out) (seriousness criterion medically significant), HYPERHIDROSIS (Sweaty) and PYREXIA (Slightly feverish). At the time of the report, LOSS OF CONSCIOUSNESS (Passed out), HYPERHIDROSIS (Sweaty) and PYREXIA (Slightly feverish) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medications were not reported. Description: The patient felt sweaty and slightly feverish all night on 21 April 2021. When he got up to urinate he actually passed out (medically significant) and was on the floor for a few seconds. Later last night, on the same day, he went to drink some water, and passed out again for a few seconds. The patient did not seek any medical attention, and stated that he felt fine now. No treatment information provided. The patient received both scheduled doses of mRNA-1273 prior to the event, therefore action taken with the drug in response to the event is not applicable. 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: 1261535 Before After
VAERS Form:2
Age:41.0
Sex:Male
Location:Texas
Vaccinated:2021-03-21
Onset:2021-04-21
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 045A21A / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Hyperhidrosis, Loss of consciousness, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: Passed out; Sweaty; Slightly feverish; This spontaneous case was reported by a consumer and describes the occurrence of LOSS OF CONSCIOUSNESS (Passed out) in a 41-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 045B21A and 045A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 21-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 21-Apr-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 21-Apr-2021, the patient experienced LOSS OF CONSCIOUSNESS (Passed out) (seriousness criterion medically significant), HYPERHIDROSIS (Sweaty) and PYREXIA (Slightly feverish). At the time of the report, LOSS OF CONSCIOUSNESS (Passed out), HYPERHIDROSIS (Sweaty) and PYREXIA (Slightly feverish) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medications were not reported. Description: The patient felt sweaty and slightly feverish all night on 21 April 2021. When he got up to urinate he actually passed out (medically significant) and was on the floor for a few seconds. Later last night, on the same day, he went to drink some water, and passed out again for a few seconds. The patient did not seek any medical attention, and stated that he felt fine now. No treatment information provided. The patient received both scheduled doses of mRNA-1273 prior to the event, therefore action taken with the drug in response to the event is not applicable. 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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