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This is VAERS ID 1261938

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1261938
VAERS Form:2
Age:48.0
Sex:Male
Location:Florida
Vaccinated:2021-04-20
Onset:2021-04-21
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Feeling abnormal, Haematochezia, Pyrexia

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

Write-up: a lot of blood in his stool twice in the morning; Felt "really bad"; Fever; This spontaneous case was reported by a consumer and describes the occurrence of HAEMATOCHEZIA (a lot of blood in his stool twice in the morning) in a 48-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 046B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 20-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 21-Apr-2021, the patient experienced FEELING ABNORMAL (Felt "really bad") and PYREXIA (Fever). On 23-Apr-2021, the patient experienced HAEMATOCHEZIA (a lot of blood in his stool twice in the morning) (seriousness criterion medically significant). At the time of the report, HAEMATOCHEZIA (a lot of blood in his stool twice in the morning), FEELING ABNORMAL (Felt "really bad") and PYREXIA (Fever) outcome was unknown. Concomitant product use was not provided. Treatment included Ibuprofen and Tylenol. Action taken with mRNA-1273 in response to the events was not Applicable. Company comment: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: 1261938 Before After
VAERS Form:2
Age:48.0
Sex:Male
Location:Florida
Vaccinated:2021-04-20
Onset:2021-04-21
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Feeling abnormal, Haematochezia, Pyrexia

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

Write-up: a lot of blood in his stool twice in the morning; Felt "really bad"; Fever; This spontaneous case was reported by a consumer and describes the occurrence of HAEMATOCHEZIA (a lot of blood in his stool twice in the morning) in a 48-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 046B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 20-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 21-Apr-2021, the patient experienced FEELING ABNORMAL (Felt "really bad") and PYREXIA (Fever). On 23-Apr-2021, the patient experienced HAEMATOCHEZIA (a lot of blood in his stool twice in the morning) (seriousness criterion medically significant). At the time of the report, HAEMATOCHEZIA (a lot of blood in his stool twice in the morning), FEELING ABNORMAL (Felt "really bad") and PYREXIA (Fever) outcome was unknown. Concomitant product use was not provided. Treatment included Ibuprofen and Tylenol. Action taken with mRNA-1273 in response to the events was not Applicable. Company comment: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: 1261938 Before After
VAERS Form:2
Age:48.0
Sex:Male
Location:Florida
Vaccinated:2021-04-20
Onset:2021-04-21
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 046B21A / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Feeling abnormal, Haematochezia, Pyrexia

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

Write-up: a lot of blood in his stool twice in the morning; Felt "really bad"; Fever; This spontaneous case was reported by a consumer and describes the occurrence of HAEMATOCHEZIA (a lot of blood in his stool twice in the morning) in a 48-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 046B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 20-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 21-Apr-2021, the patient experienced FEELING ABNORMAL (Felt "really bad") and PYREXIA (Fever). On 23-Apr-2021, the patient experienced HAEMATOCHEZIA (a lot of blood in his stool twice in the morning) (seriousness criterion medically significant). At the time of the report, HAEMATOCHEZIA (a lot of blood in his stool twice in the morning), FEELING ABNORMAL (Felt "really bad") and PYREXIA (Fever) outcome was unknown. Concomitant product use was not provided. Treatment included Ibuprofen and Tylenol. Action taken with mRNA-1273 in response to the events was not Applicable. Company comment: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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