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This is VAERS ID 1404392

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1404392
VAERS Form:2
Age:33.0
Sex:Male
Location:Foreign
Vaccinated:2021-05-28
Onset:2021-06-01
Submitted:0000-00-00
Entered:2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Abdominal pain upper, Diarrhoea, Pyrexia, Illness

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': GBMODERNATX, INC.MOD20212

Write-up: Diarrhea; Sickness; Fever; Stomach pain; This regulatory authority case was reported by a consumer and describes the occurrence of ABDOMINAL PAIN UPPER (Stomach pain), DIARRHOEA (Diarrhea), ILLNESS (Sickness) and PYREXIA (Fever) in a 33-year-old male patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 28-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 PAIN UPPER (Stomach pain) (seriousness criterion medically significant) and PYREXIA (Fever) (seriousness criterion medically significant). On 02-Jun-2021, the patient experienced ILLNESS (Sickness) (seriousness criterion medically significant). On 03-Jun-2021, the patient experienced DIARRHOEA (Diarrhea) (seriousness criterion medically significant). At the time of the report, ABDOMINAL PAIN UPPER (Stomach pain) and DIARRHOEA (Diarrhea) had not resolved and ILLNESS (Sickness) and PYREXIA (Fever) was resolving. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Intramuscular) was unknown. Concomitant product use was not provided by the reporter. Treatment information was unknown. 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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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1404392&WAYBACKHISTORY=ON


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