National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts.org
Search Results

This is VAERS ID 1703854

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 9/17/2021

VAERS ID: 1703854
VAERS Form:2
Age:14.0
Sex:Female
Location:Foreign
Vaccinated:2021-08-12
Onset:2021-08-12
Submitted:0000-00-00
Entered:2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Dizziness, Dyspnoea, Hypoaesthesia, Nausea, Pyrexia

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: Nausea; Dizziness; Breathing difficult; Numbness of extremities; Pyrexia; This case was received via (Reference number: FI-FIMEA-20214222) on 08-Sep-2021 and was forwarded to Moderna on 08-Sep-2021. This regulatory authority case was reported by a consumer and describes the occurrence of NAUSEA (Nausea), DIZZINESS (Dizziness), DYSPNOEA (Breathing difficult), HYPOAESTHESIA (Numbness of extremities) and PYREXIA (Pyrexia) in a 14-year-old female patient who received mRNA-1273 (Spikevax) for COVID-19 vaccination. No Medical History information was reported. On 12-Aug-2021, the patient received dose of mRNA-1273 (Spikevax) (unknown route) 1 dosage form. On 12-Aug-2021, the patient experienced NAUSEA (Nausea) (seriousness criterion life threatening), DIZZINESS (Dizziness) (seriousness criterion life threatening), DYSPNOEA (Breathing difficult) (seriousness criterion life threatening), HYPOAESTHESIA (Numbness of extremities) (seriousness criterion life threatening) and PYREXIA (Pyrexia) (seriousness criterion life threatening). At the time of the report, NAUSEA (Nausea), DIZZINESS (Dizziness), DYSPNOEA (Breathing difficult), HYPOAESTHESIA (Numbness of extremities) and PYREXIA (Pyrexia) was resolving. The action taken with mRNA-1273 (Spikevax) (Unknown) was unknown. 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.; 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.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1703854&WAYBACKHISTORY=ON


Copyright © 2022 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166