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

This is VAERS ID 1721775

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Case Details

VAERS ID: 1721775 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Unknown  
Vaccinated:2021-02-18
Onset:2021-02-22
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Myocarditis
SMQs:, Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
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: USMODERNATX, INC.MOD20213

Write-up: did have mycarditis og the heart; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of MYOCARDITIS (did have mycarditis og the heart) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 18-Feb-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 22-Feb-2021, the patient experienced MYOCARDITIS (did have mycarditis og the heart) (seriousness criterion medically significant). At the time of the report, MYOCARDITIS (did have mycarditis og the heart) outcome was unknown. No concomitant medication details was provided. No treatment medication details was provided. Action taken was not applicable. This case concerns a patient of unknown age and gender with no relevant medical history reported, who experienced serious expected event of myocarditis. The events occurred approximately 4 days after the second dose of Spikevax with first symptom reported as dyspnoea. Rechallenge was not applicable. The benefit-risk relationship of drug is not affected by this report.; Sender''s Comments: This case concerns a patient of unknown age and gender with no relevant medical history reported, who experienced serious expected event of myocarditis. The events occurred approximately 4 days after the second dose of Spikevax with first symptom reported as dyspnoea. Rechallenge was not applicable. The benefit-risk relationship of drug is not affected by this report


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