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This is VAERS ID 1270007

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1270007
VAERS Form:2
Age:60.0
Sex:Female
Location:Michigan
Vaccinated:2021-04-20
Onset:2021-04-21
Submitted:0000-00-00
Entered:2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 1 LA / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Bell's palsy, Lip swelling, Oral discomfort

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: METFORMIN
Current Illness: Diabetes mellitus
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: Bell''s Palsy, face twisted; Burning in the mouth; Lips swelling; This spontaneous case was reported by a consumer and describes the occurrence of FACIAL PARALYSIS (Bell''s Palsy, face twisted) in a 60-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 031B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Diabetes mellitus. Concomitant products included METFORMIN for Diabetes mellitus. On 20-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 21-Apr-2021, the patient experienced FACIAL PARALYSIS (Bell''s Palsy, face twisted) (seriousness criterion medically significant), ORAL DISCOMFORT (Burning in the mouth) and LIP SWELLING (Lips swelling). At the time of the report, FACIAL PARALYSIS (Bell''s Palsy, face twisted), ORAL DISCOMFORT (Burning in the mouth) and LIP SWELLING (Lips swelling) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Treatment information was not provided. Company comment: Based on current available information and the temporal association between product use and the start date of the events a causal relationship cannot be excluded.; Sender''s Comments: Based on current available information and the temporal association between product use and the start date of the events a causal relationship cannot be excluded.


Changed on 5/7/2021

VAERS ID: 1270007 Before After
VAERS Form:2
Age:60.0
Sex:Female
Location:Michigan
Vaccinated:2021-04-20
Onset:2021-04-21
Submitted:0000-00-00
Entered:2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 1 LA / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Bell's palsy, Lip swelling, Oral discomfort

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: METFORMIN
Current Illness: Diabetes mellitus
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: Bell''s Palsy, face twisted; Burning in the mouth; Lips swelling; This spontaneous case was reported by a consumer and describes the occurrence of FACIAL PARALYSIS (Bell''s Palsy, face twisted) in a 60-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 031B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Diabetes mellitus. Concomitant products included METFORMIN for Diabetes mellitus. On 20-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 21-Apr-2021, the patient experienced FACIAL PARALYSIS (Bell''s Palsy, face twisted) (seriousness criterion medically significant), ORAL DISCOMFORT (Burning in the mouth) and LIP SWELLING (Lips swelling). At the time of the report, FACIAL PARALYSIS (Bell''s Palsy, face twisted), ORAL DISCOMFORT (Burning in the mouth) and LIP SWELLING (Lips swelling) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Treatment information was not provided. Company comment: Based on current available information and the temporal association between product use and the start date of the events a causal relationship cannot be excluded.; Sender''s Comments: Based on current available information and the temporal association between product use and the start date of the events a causal relationship cannot be excluded.


Changed on 5/14/2021

VAERS ID: 1270007 Before After
VAERS Form:2
Age:60.0
Sex:Female
Location:Michigan
Vaccinated:2021-04-20
Onset:2021-04-21
Submitted:0000-00-00
Entered:2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031B21A / 1 LA / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Bell's palsy, Lip swelling, Oral discomfort

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: METFORMIN
Current Illness: Diabetes mellitus
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: Bell''s Palsy, face twisted; Burning in the mouth; Lips swelling; This spontaneous case was reported by a consumer and describes the occurrence of FACIAL PARALYSIS (Bell''s Palsy, face twisted) in a 60-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 031B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Diabetes mellitus. Concomitant products included METFORMIN for Diabetes mellitus. On 20-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 21-Apr-2021, the patient experienced FACIAL PARALYSIS (Bell''s Palsy, face twisted) (seriousness criterion medically significant), ORAL DISCOMFORT (Burning in the mouth) and LIP SWELLING (Lips swelling). At the time of the report, FACIAL PARALYSIS (Bell''s Palsy, face twisted), ORAL DISCOMFORT (Burning in the mouth) and LIP SWELLING (Lips swelling) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Treatment information was not provided. Company comment: Based on current available information and the temporal association between product use and the start date of the events a causal relationship cannot be excluded.; Sender''s Comments: Based on current available information and the temporal association between product use and the start date of the events a causal relationship cannot be excluded.

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