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This is VAERS ID 1703853

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First Appeared on 9/17/2021

VAERS ID: 1703853
VAERS Form:2
Age:15.0
Sex:Female
Location:Foreign
Vaccinated:2021-08-17
Onset:2021-08-17
Submitted:0000-00-00
Entered:2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3004952 / UNK - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Asthenia, Dyspnoea, Erythema, Malaise, Vision blurred, Wheezing, Sensation of foreign body

Life Threatening? Yes
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': FIMODERNATX, INC.MOD20213

Write-up: Wheezing; Localised erythema; Vision blurred; Asthenia; Lump feeling in throat; Dyspnoea; Malaise; This case was received via (Reference number: FI-FIMEA-20214214) on 08-Sep-2021 and was forwarded to Moderna on 08-Sep-2021. This regulatory authority case was reported by a physician and describes the occurrence of WHEEZING (Wheezing), ERYTHEMA (Localised erythema), VISION BLURRED (Vision blurred), ASTHENIA (Asthenia), SENSATION OF FOREIGN BODY (Lump feeling in throat), DYSPNOEA (Dyspnoea) and MALAISE (Malaise) in a 15-year-old female patient who received mRNA-1273 (Spikevax) (batch no. 3004952) for COVID-19 vaccination. No Medical History information was reported. On 17-Aug-2021, the patient received dose of mRNA-1273 (Spikevax) (Intramuscular) 1 dosage form. On 17-Aug-2021, the patient experienced WHEEZING (Wheezing) (seriousness criterion life threatening), ERYTHEMA (Localised erythema) (seriousness criterion life threatening), VISION BLURRED (Vision blurred) (seriousness criterion life threatening), ASTHENIA (Asthenia) (seriousness criterion life threatening), SENSATION OF FOREIGN BODY (Lump feeling in throat) (seriousness criterion life threatening), DYSPNOEA (Dyspnoea) (seriousness criterion life threatening) and MALAISE (Malaise) (seriousness criterion life threatening). At the time of the report, WHEEZING (Wheezing), ERYTHEMA (Localised erythema), VISION BLURRED (Vision blurred), ASTHENIA (Asthenia), SENSATION OF FOREIGN BODY (Lump feeling in throat), DYSPNOEA (Dyspnoea) and MALAISE (Malaise) was resolving. The action taken with mRNA-1273 (Spikevax) (Intramuscular) was unknown. For mRNA-1273 (Spikevax) (Intramuscular), the reporter did not provide any causality assessments. Concomitant product use was not provided by the reporter. Treatment information was not provided. Company Comment - 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. The seriousness criteria are maintained for consistency with the RA report.; 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. The seriousness criteria are maintained for consistency with the RA report.

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