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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1720572

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Case Details

VAERS ID: 1720572 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-08-19
Onset:2021-08-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 214016 / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Accidental underdose, Angioedema, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: ESMODERNATX, INC.MOD20213

Write-up: Angioedema; Urticaria; Accidental underdose; This case was received via Medicines Agency (Reference number: ES-AEMPS-992998 ) on 13-Sep-2021 and was forwarded to Moderna on 13-Sep-2021. This regulatory authority case was reported by an other health care professional and describes the occurrence of ANGIOEDEMA (Angioedema) and URTICARIA (Urticaria) in a 13-year-old female patient who received mRNA-1273 (Spikevax) (batch no. 214016) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 19-Aug-2021, the patient received dose of mRNA-1273 (Spikevax) (Intramuscular) .3 milliliter. On 19-Aug-2021, the patient experienced ANGIOEDEMA (Angioedema) (seriousness criterion medically significant), URTICARIA (Urticaria) (seriousness criterion medically significant) and ACCIDENTAL UNDERDOSE (Accidental underdose). On 19-Aug-2021, ACCIDENTAL UNDERDOSE (Accidental underdose) had resolved. At the time of the report, ANGIOEDEMA (Angioedema) and URTICARIA (Urticaria) outcome was unknown. mRNA-1273 (Spikevax) (Intramuscular) was withdrawn on 19-Aug-2021. For mRNA-1273 (Spikevax) (Intramuscular), the reporter did not provide any causality assessments. No Treatment medication was provided by the reporter. No Concomitant medication was provided by the reporter. Company Comment: This case involves a 13-year-old female (adolescent) patient with unknown medical history who experienced the unexpected serious AEs Angioedema and Urticaria (both medically significant) on the same day she received her first dose of Spikevax(19-August-2021). As a result, the drug was withdrawn. No reporter causality was provided. The benefit risk relationship of the drug.mRNA-1273 is not affected by this report. this case also reports an "accidental underdose". Sender''s Comments: This case involves a 13-year-old female (adolescent) patient with unknown medical history who experienced the unexpected serious AEs Angioedema and Urticaria (both medically significant) on the same day she received her first dose of Spikevax(19-August-2021). As a result, the drug was withdrawn. No reporter causality was provided. The benefit risk relationship of the drug.mRNA-1273 is not affected by this report. this case also reports an "accidental underdose"


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