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This is VAERS ID 1657825

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First Appeared on 9/10/2021

VAERS ID: 1657825
VAERS Form:2
Age:16.0
Sex:Female
Location:New Jersey
Vaccinated:2021-04-30
Onset:2021-04-30
Submitted:0000-00-00
Entered:2021-08-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 003C21N / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Dyspnoea, Nasal congestion, Pyrexia, Somnolence, Product administered to patient of inappropriate age, Product dose omission issue

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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: COVID-19
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20212

Write-up: 1st dose 30Apr2021; no 2nd dose; Sleeping the whole time; Congested; Trouble breathing; Low grade fever; 16 years old administered with the vaccine; This spontaneous case was reported by a consumer and describes the occurrence of SOMNOLENCE (Sleeping the whole time), NASAL CONGESTION (Congested), DYSPNOEA (Trouble breathing), PYREXIA (Low grade fever) and PRODUCT DOSE OMISSION ISSUE (1st dose 30Apr2021; no 2nd dose) in a 16-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 003C21N) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. The patient''s past medical history included COVID-19 in February 2021. On 30-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 30-Apr-2021, the patient experienced PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (16 years old administered with the vaccine). On 01-May-2021, the patient experienced SOMNOLENCE (Sleeping the whole time), NASAL CONGESTION (Congested), DYSPNOEA (Trouble breathing) and PYREXIA (Low grade fever). On 17-Aug-2021, the patient experienced PRODUCT DOSE OMISSION ISSUE (1st dose 30Apr2021; no 2nd dose). On 30-Apr-2021, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (16 years old administered with the vaccine) had resolved. On 01-May-2021, SOMNOLENCE (Sleeping the whole time), NASAL CONGESTION (Congested), DYSPNOEA (Trouble breathing) and PYREXIA (Low grade fever) had resolved. On 17-Aug-2021, PRODUCT DOSE OMISSION ISSUE (1st dose 30Apr2021; no 2nd dose) had resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant product use was not provided by the reporter. No treatment information was provided.

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