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This is VAERS ID 1332514

History of Changes from the VAERS Wayback Machine

First Appeared on 5/21/2021

VAERS ID: 1332514
VAERS Form:2
Age:86.0
Sex:Female
Location:New Jersey
Vaccinated:2021-04-14
Onset:2021-05-04
Submitted:0000-00-00
Entered:2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039B21A / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Dyspnoea, Small intestinal obstruction

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Emphysema
Preexisting Conditions: Medical History/Concurrent Conditions: Small bowel obstruction
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20211

Write-up: small bowel obstruction; shortness of breath; This spontaneous case was reported by an other caregiver and describes the occurrence of SMALL INTESTINAL OBSTRUCTION (small bowel obstruction) in an 86-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 039B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Small bowel obstruction. Concurrent medical conditions included Emphysema. On 14-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 04-May-2021, the patient experienced DYSPNOEA (shortness of breath). On an unknown date, the patient experienced SMALL INTESTINAL OBSTRUCTION (small bowel obstruction) (seriousness criteria hospitalization and medically significant). The patient was hospitalized on 04-May-2021 due to SMALL INTESTINAL OBSTRUCTION. At the time of the report, SMALL INTESTINAL OBSTRUCTION (small bowel obstruction) and DYSPNOEA (shortness of breath) outcome was unknown. Not Provided The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant medications included an unspecified inhaler for emphysema. Treatment for the events included use of a tube and relive the pressure of the small bowel obstruction without surgery and an unspecified steroid medication to treat the shortness of breath. 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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