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

This is VAERS ID 1507879



Case Details

VAERS ID: 1507879 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Unknown  
Vaccinated:2020-12-01
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-07-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNK / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthma, Depression, Epilepsy, Extrasystoles, Generalised tonic-clonic seizure, Hypoglycaemia, Impaired driving ability, Impaired work ability, Memory impairment, Suicidal ideation
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Suicide/self-injury (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Systemic lupus erythematosus (broad), Dementia (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Tachyarrhythmia terms, nonspecific (narrow), Depression (excl suicide and self injury) (narrow), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (broad), Hypoglycaemia (narrow), Hypokalaemia (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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20212

Write-up: can''t remember things like what day it is or if she''s taken her medicine; asthma; She''s unable to work or be left alone; Can''t drive; hypoglycemic; having seizures/grand mal seizures and she fell out of her chair; doesn''t want to live anymore/gone downhill ever since she''s received her first dose/unable to be left alone; diagnosed with epilepsy; depression; heart skipping a beat/trouble with her heart; This spontaneous case was reported by a consumer and describes the occurrence of GENERALISED TONIC-CLONIC SEIZURE (having seizures/grand mal seizures and she fell out of her chair), SUICIDAL IDEATION (doesn''t want to live anymore/gone downhill ever since she''s received her first dose/unable to be left alone) and EPILEPSY (diagnosed with epilepsy) in a 19-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. UNK) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. In December 2020, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) at an unspecified dose. On an unknown date, the patient experienced GENERALISED TONIC-CLONIC SEIZURE (having seizures/grand mal seizures and she fell out of her chair) (seriousness criterion medically significant), SUICIDAL IDEATION (doesn''t want to live anymore/gone downhill ever since she''s received her first dose/unable to be left alone) (seriousness criterion medically significant), EPILEPSY (diagnosed with epilepsy) (seriousness criterion medically significant), DEPRESSION (depression), EXTRASYSTOLES (heart skipping a beat/trouble with her heart), MEMORY IMPAIRMENT (can''t remember things like what day it is or if she''s taken her medicine), ASTHMA (asthma), HYPOGLYCAEMIA (hypoglycemic), IMPAIRED WORK ABILITY (She''s unable to work or be left alone) and IMPAIRED DRIVING ABILITY (Can''t drive). At the time of the report, GENERALISED TONIC-CLONIC SEIZURE (having seizures/grand mal seizures and she fell out of her chair), SUICIDAL IDEATION (doesn''t want to live anymore/gone downhill ever since she''s received her first dose/unable to be left alone), EPILEPSY (diagnosed with epilepsy), DEPRESSION (depression), EXTRASYSTOLES (heart skipping a beat/trouble with her heart), MEMORY IMPAIRMENT (can''t remember things like what day it is or if she''s taken her medicine), ASTHMA (asthma), HYPOGLYCAEMIA (hypoglycemic), IMPAIRED WORK ABILITY (She''s unable to work or be left alone) and IMPAIRED DRIVING ABILITY (Can''t drive) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown Route) was unknown. Concomitant medication information was not provided. Treatment information was not provided. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Company Comment Very limited information regarding the events has been provided at this time.; Sender''s Comments: Very limited information regarding the events has been provided at this time.


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