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This is VAERS ID 1400942

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1400942
VAERS Form:2
Age:30.0
Sex:Female
Location:Foreign
Vaccinated:2021-05-31
Onset:2021-06-01
Submitted:0000-00-00
Entered:2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3002332 / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Abdominal distension, Back pain, Headache, Myalgia, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: Hay fever; Lactation decreased; Suspected COVID-19
Allergies:
Diagnostic Lab Data: Test Date: 20201214; Test Name: COVID-19 virus test; Test Result: Positive ; Result Unstructured Data: SARS-CoV-2 test
CDC 'Split Type': GBMODERNATX, INC.MOD20212

Write-up: Backache; bloating; Headache; Aching all over; Abdominal bloating; Backache; This regulatory authority case was reported by a consumer and describes the occurrence of ABDOMINAL DISTENSION (Abdominal bloating), the first episode of BACK PAIN (Backache), the second episode of BACK PAIN (Backache), ABDOMINAL DISTENSION (bloating) and HEADACHE (Headache) in a 30-year-old female patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) (batch no. 3002332) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included Lactation decreased and Suspected COVID-19 from 09-Dec-2020 to 28-Dec-2020. Concurrent medical conditions included Hay fever. On 31-May-2021, the patient received first dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (Intramuscular) 1 dosage form. On 01-Jun-2021, the patient experienced ABDOMINAL DISTENSION (Abdominal bloating) (seriousness criteria disability and medically significant), ABDOMINAL DISTENSION (bloating) (seriousness criteria disability and medically significant), HEADACHE (Headache) (seriousness criteria disability and medically significant) and MYALGIA (Aching all over). 01-Jun-2021, the patient experienced the first episode of BACK PAIN (Backache) (seriousness criteria disability and medically significant). On an unknown date, the patient experienced the second episode of BACK PAIN (Backache) (seriousness criteria disability and medically significant). At the time of the report, ABDOMINAL DISTENSION (Abdominal bloating) had not resolved, last episode of BACK PAIN (Backache) and ABDOMINAL DISTENSION (bloating) was resolving and HEADACHE (Headache) and MYALGIA (Aching all over) had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 14-Dec-2020, SARS-CoV-2 test: positive (Positive) SARS-CoV-2 test. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Intramuscular) was unknown. Concomitant medication information was not provided. Patient has not tested positive for COVID-19 since having the vaccine Treatment information was not provided. 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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