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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1445775



Case Details

VAERS ID: 1445775 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-12
Onset:2021-04-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040B21A / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain upper, Arthralgia, Chest pain, Feeling abnormal, Hallucination, auditory, Myalgia, Nervousness, Pain in extremity, Scan brain, Suicidal ideation
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Suicide/self-injury (narrow), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: OXCARBAZEPIN
Current Illness: Convulsions; Down''s syndrome; Hydrocephalus
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 2021; Test Name: Head scan; Result Unstructured Data: normal
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: Mentioned wanting to kill himself; three voices in his head; Completely lost, he would not know who he was, where he was; Chest pain; Stomach pain; Hand pain/feet pain; Shaky feelings; Knee pain; Body ache; This spontaneous case was reported by a consumer and describes the occurrence of SUICIDAL IDEATION (Mentioned wanting to kill himself) and HALLUCINATION, AUDITORY (three voices in his head) in a 23-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 040B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Hydrocephalus, Down''s syndrome and Convulsions. Concomitant products included OXCARBAZEPINE (OXCARBAZEPIN) for an unknown indication. On 12-Apr-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 12-Apr-2021, the patient experienced SUICIDAL IDEATION (Mentioned wanting to kill himself) (seriousness criterion medically significant), HALLUCINATION, AUDITORY (three voices in his head) (seriousness criterion medically significant), FEELING ABNORMAL (Completely lost, he would not know who he was, where he was), CHEST PAIN (Chest pain), ABDOMINAL PAIN UPPER (Stomach pain), PAIN IN EXTREMITY (Hand pain/feet pain), NERVOUSNESS (Shaky feelings), ARTHRALGIA (Knee pain) and MYALGIA (Body ache). The patient was treated with IBUPROFEN (MOTRIN [IBUPROFEN]) for Pain, at an unspecified dose and frequency and PARACETAMOL (TYLENOL) for Pain, at an unspecified dose and frequency. At the time of the report, SUICIDAL IDEATION (Mentioned wanting to kill himself), HALLUCINATION, AUDITORY (three voices in his head), FEELING ABNORMAL (Completely lost, he would not know who he was, where he was), CHEST PAIN (Chest pain), ABDOMINAL PAIN UPPER (Stomach pain), PAIN IN EXTREMITY (Hand pain/feet pain), NERVOUSNESS (Shaky feelings), ARTHRALGIA (Knee pain) and MYALGIA (Body ache) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In 2021, Scan brain: normal (normal) normal. Patient prescribed anxiety and sleeping pills that the physician did not recommend that he take. 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. Unlikely, that the events are related to the vaccine due to existing comorbidities. This case was linked to MOD-2021-235268 (Patient Link).; 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. Unlikely, that the events are related to the vaccine due to existing comorbidities.


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