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This is VAERS ID 1645332

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/3/2021

VAERS ID: 1645332
VAERS Form:2
Age:
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-08-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Chest pain, Carditis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20212

Write-up: Heart inflammation; Heart pain; This spontaneous case was reported by a consumer and describes the occurrence of CARDITIS (Heart inflammation) and CHEST PAIN (Heart pain) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced CARDITIS (Heart inflammation) (seriousness criterion medically significant) and CHEST PAIN (Heart pain) (seriousness criterion medically significant). At the time of the report, CARDITIS (Heart inflammation) and CHEST PAIN (Heart pain) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication details was reported. No treatment medication details was reported. Company Comment Very limited information regarding this event has been provided at this time. Further information regarding temporal association is necessary. Further information has been requested. This case was linked to MOD-2021-292102 (Patient Link).; Sender''s Comments: Very limited information regarding this event has been provided at this time. Further information regarding temporal association is necessary. Further information has been requested.


Record is removed as of 11/26/2021

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