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This is VAERS ID 1416614

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1416614
VAERS Form:2
Age:35.0
Sex:Male
Location:Foreign
Vaccinated:2021-06-03
Onset:2021-06-03
Submitted:0000-00-00
Entered:2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3002332 / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Chills, Fatigue, Insomnia, Myalgia, Nausea, Pain in extremity, Testicular pain, Decreased appetite, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Glandular fever; Suspected COVID-19 (Unsure when symptoms stopped); Comments: Glandular fever 2007 Patient is not enrolled in clinical trial
Allergies:
Diagnostic Lab Data: Test Date: 20201223; Test Name: COVID-19 virus test; Test Result: Positive ; Result Unstructured Data: positive
CDC 'Split Type': GBMODERNATX, INC.MOD20212

Write-up: aches back of legs; Aches & pains in legs; Testicular pain; Fatigue; Nausea; Decreased appetite; Insomnia; Chills; This regulatory authority case was reported by a consumer and describes the occurrence of MYALGIA (aches back of legs), CHILLS (Chills), PAIN IN EXTREMITY (Aches & pains in legs), TESTICULAR PAIN (Testicular pain), FATIGUE (Fatigue), NAUSEA (Nausea), DECREASED APPETITE (Decreased appetite) and INSOMNIA (Insomnia) in a 35-year-old male patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) (batch no. 3002332) for COVID-19 vaccination. Glandular fever 2007 Patient is not enrolled in clinical trial. The patient''s past medical history included Glandular fever and Suspected COVID-19 (Unsure when symptoms stopped) on 21-Dec-2020. On 03-Jun-2021, the patient received first dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) 1 dosage form. On 03-Jun-2021, the patient experienced CHILLS (Chills) (seriousness criterion medically significant), FATIGUE (Fatigue) (seriousness criterion medically significant), NAUSEA (Nausea) (seriousness criterion medically significant), DECREASED APPETITE (Decreased appetite) (seriousness criterion medically significant) and INSOMNIA (Insomnia) (seriousness criterion medically significant). On 04-Jun-2021, the patient experienced PAIN IN EXTREMITY (Aches & pains in legs) (seriousness criterion medically significant) and TESTICULAR PAIN (Testicular pain) (seriousness criterion medically significant). On an unknown date, the patient experienced MYALGIA (aches back of legs) (seriousness criterion medically significant). On 04-Jun-2021, NAUSEA (Nausea) and INSOMNIA (Insomnia) had resolved. On 05-Jun-2021, CHILLS (Chills) and DECREASED APPETITE (Decreased appetite) had resolved. On 06-Jun-2021, PAIN IN EXTREMITY (Aches & pains in legs) and TESTICULAR PAIN (Testicular pain) had resolved. On 07-Jun-2021, MYALGIA (aches back of legs) and FATIGUE (Fatigue) had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 23-Dec-2020, SARS-CoV-2 test: positive positive (Positive) positive. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Unknown) was unknown. No concomitant medication was provided by the reporter. No treatment medication was provided by the reporter. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. 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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