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This is VAERS ID 1711013

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/24/2021

VAERS ID: 1711013
VAERS Form:2
Age:14.0
Sex:Female
Location:Arkansas
Vaccinated:2021-09-01
Onset:2021-09-01
Submitted:0000-00-00
Entered:2021-09-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 052E21A / 1 RA / OT

Administered by: Private      Purchased by: ??
Symptoms: Abdominal pain upper, Ageusia, Anosmia, Cough, Fatigue, Malaise, Nasal congestion, Nausea, Rhinorrhoea, Somnolence, Oropharyngeal pain, Product administered to patient of inappropriate age, SARS-CoV-2 test

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: ADDERALL
Current Illness: Drug allergy (Versed allergy); Penicillin allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210903; Test Name: COVID-19 test; Test Result: Negative ; Result Unstructured Data: Negative
CDC 'Split Type': USMODERNATX, INC.MOD20213

Write-up: Throat hurts; Tired; Nauseous; smell loss; still sleeping a lot; 14 year old administered first dose; loss of taste; Congestion; Stomach pain; started to feel sick 6 hours after getting first dose/ sounds sick/not feeling well; runny nose; cough; This spontaneous case was reported by a consumer and describes the occurrence of AGEUSIA (loss of taste), NASAL CONGESTION (Congestion), ABDOMINAL PAIN UPPER (Stomach pain), MALAISE (started to feel sick 6 hours after getting first dose/ sounds sick/not feeling well) and RHINORRHOEA (runny nose) in a 14-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 052E21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Penicillin allergy and Drug allergy (Versed allergy). Concomitant products included AMFETAMINE ASPARTATE, AMFETAMINE SULFATE, DEXAMFETAMINE SACCHARATE, DEXAMFETAMINE SULFATE (ADDERALL) from December 2019 to an unknown date for ADHD. On 01-Sep-2021 at 4:00 PM, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 01-Sep-2021, the patient experienced AGEUSIA (loss of taste), NASAL CONGESTION (Congestion), ABDOMINAL PAIN UPPER (Stomach pain), MALAISE (started to feel sick 6 hours after getting first dose/ sounds sick/not feeling well), RHINORRHOEA (runny nose), COUGH (cough) and PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (14 year old administered first dose). On 02-Sep-2021, the patient experienced ANOSMIA (smell loss) and SOMNOLENCE (still sleeping a lot). On 03-Sep-2021, the patient experienced OROPHARYNGEAL PAIN (Throat hurts), FATIGUE (Tired) and NAUSEA (Nauseous). The patient was treated with CETIRIZINE HYDROCHLORIDE (ZYRTEC [CETIRIZINE HYDROCHLORIDE]) for Adverse event, at an unspecified dose and frequency. On 01-Sep-2021, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (14 year old administered first dose) had resolved. At the time of the report, AGEUSIA (loss of taste), NASAL CONGESTION (Congestion), ABDOMINAL PAIN UPPER (Stomach pain), MALAISE (started to feel sick 6 hours after getting first dose/ sounds sick/not feeling well), RHINORRHOEA (runny nose), COUGH (cough), ANOSMIA (smell loss), SOMNOLENCE (still sleeping a lot), OROPHARYNGEAL PAIN (Throat hurts), FATIGUE (Tired) and NAUSEA (Nauseous) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 03-Sep-2021, SARS-CoV-2 test: negative (Negative) Negative. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Treatment medications included OTC stomach medication Patient received Moderna accidentally instead of Pfizer Patient was advised to take over the counter pain medicine and cold medicine. Most recent FOLLOW-UP information incorporated above includes: On 07-Sep-2021: Vaccine lot number was added. On 13-Sep-2021: Patient demographics updated, Added allergy, Added dose 1 timing, added events runny nose, cough, loss of smell, throat pain, nose is stuffy, tired and nauseous

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