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This is VAERS ID 1614352

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First Appeared on 8/27/2021

VAERS ID: 1614352
VAERS Form:2
Age:16.0
Sex:Female
Location:New York
Vaccinated:2021-04-07
Onset:2021-04-07
Submitted:0000-00-00
Entered:2021-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 018B21A / 1 LA / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Cardiac murmur, Dyspnoea, Echocardiogram, Physical examination, Product administered to patient of inappropriate age

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: APRI; VITAMIN D [COLECALCIFEROL]
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anxiety (anxiety from schooling)
Allergies:
Diagnostic Lab Data: Test Date: 20210417; Test Name: Echocardiogram; Result Unstructured Data: 2 different readings for patient''s echocardiogram; Test Date: 20210417; Test Name: Physical checkup; Result Unstructured Data: heart murmur at physical checkup
CDC 'Split Type': USMODERNATX, INC.MOD20211

Write-up: shortness of breath which is on and off/shortness of breath can be from anxiety from schooling; heart murmur; 16 year old patient received 1st dose of Moderna COVID-19 vaccine; This spontaneous case was reported by a physician and describes the occurrence of PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (16 year old patient received 1st dose of Moderna COVID-19 vaccine), DYSPNOEA (shortness of breath which is on and off/shortness of breath can be from anxiety from schooling) and CARDIAC MURMUR (heart murmur) in a 16-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 018B21A) for COVID-19 vaccination. The patient''s past medical history included Anxiety (anxiety from schooling). Concomitant products included DESOGESTREL, ETHINYLESTRADIOL (APRI) for Birth control pill, COLECALCIFEROL (VITAMIN D [COLECALCIFEROL]) for Supplementation therapy. On 07-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 07-Apr-2021, the patient experienced PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (16 year old patient received 1st dose of Moderna COVID-19 vaccine). On 17-Apr-2021, the patient experienced CARDIAC MURMUR (heart murmur). On an unknown date, the patient experienced DYSPNOEA (shortness of breath which is on and off/shortness of breath can be from anxiety from schooling). On 07-Apr-2021, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (16 year old patient received 1st dose of Moderna COVID-19 vaccine) had resolved. At the time of the report, DYSPNOEA (shortness of breath which is on and off/shortness of breath can be from anxiety from schooling) and CARDIAC MURMUR (heart murmur) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 17-Apr-2021, Echocardiogram: abnormal (abnormal) 2 different readings for patient''s echocardiogram. On 17-Apr-2021, Physical examination: abnormal (abnormal) heart murmur at physical checkup. 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.

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