National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/26/2021 release of VAERS data:

This is VAERS ID 1419850

Government Disclaimer on use of this data



Case Details

VAERS ID: 1419850 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Florida  
Vaccinated:2021-03-24
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 048A21A / 2 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chest pain, Chills, Dizziness, Epistaxis, Gastrointestinal disorder, Guillain-Barre syndrome, Headache, Pain in extremity, Pericarditis, Seizure, Syncope, Vaccination site pain
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Demyelination (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Chronic kidney disease (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Guillain-Barre syndrome; Pericarditis; Fainted once; Thought i had a seizure; Chest pain that went away as fast as it came; Gastrointestinal symptoms; Nosebleed; Dizziness; arm hurts; Arm pain in injection arm; Extreme headache; Chills all over the body; This spontaneous case was reported by a consumer and describes the occurrence of GUILLAIN-BARRE SYNDROME (Guillain-Barre syndrome), PERICARDITIS (Pericarditis), SYNCOPE (Fainted once) and SEIZURE (Thought i had a seizure) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 048A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 24-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 04-May-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced GUILLAIN-BARRE SYNDROME (Guillain-Barre syndrome) (seriousness criterion medically significant), PERICARDITIS (Pericarditis) (seriousness criterion medically significant), SYNCOPE (Fainted once) (seriousness criterion medically significant), SEIZURE (Thought i had a seizure) (seriousness criterion medically significant), CHEST PAIN (Chest pain that went away as fast as it came), GASTROINTESTINAL DISORDER (Gastrointestinal symptoms), EPISTAXIS (Nosebleed), DIZZINESS (Dizziness), PAIN IN EXTREMITY (arm hurts), VACCINATION SITE PAIN (Arm pain in injection arm), HEADACHE (Extreme headache) and CHILLS (Chills all over the body). At the time of the report, GUILLAIN-BARRE SYNDROME (Guillain-Barre syndrome), PERICARDITIS (Pericarditis), SYNCOPE (Fainted once), SEIZURE (Thought i had a seizure), GASTROINTESTINAL DISORDER (Gastrointestinal symptoms), EPISTAXIS (Nosebleed), DIZZINESS (Dizziness), PAIN IN EXTREMITY (arm hurts), VACCINATION SITE PAIN (Arm pain in injection arm), HEADACHE (Extreme headache) and CHILLS (Chills all over the body) outcome was unknown and CHEST PAIN (Chest pain that went away as fast as it came) had resolved. Concomitant medication and treatment information were not reported. It was reported that the patient went to the hospital three times. The patient can not walk now and has permanent issues Action taken with mRNA-1273 in response to the event was Not Applicable 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.


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1419850


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166