National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/19/2021 release of VAERS data:

This is VAERS ID 1729175

Government Disclaimer on use of this data



Case Details

VAERS ID: 1729175 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3004225 / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Chills, Epistaxis, Feeling abnormal, Insomnia, Limb discomfort, Pyrexia, SARS-CoV-2 test, Vaccination complication
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Test Name: COVID-19 virus test; Test Result: Negative ; Result Unstructured Data: Negative
CDC Split Type: GBMODERNATX, INC.MOD20213

Write-up: Heavy arm; I felt really low; Struggled to sleep; Fuzzy head; Nose bleed; Fever; Chills; This case was received (Reference number: GB-MHRA-ADR 25937682) on 15-Sep-2021 and was forwarded to Moderna on 15-Sep-2021. This regulatory authority case was reported by a consumer and describes the occurrence of LIMB DISCOMFORT (Heavy arm), EPISTAXIS (Nose bleed), FEELING ABNORMAL (Fuzzy head), PYREXIA (Fever) and CHILLS (Chills) in a 34-year-old male patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) (batch no. 3004225) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 10-Sep-2021, the patient received second dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) 1 dosage form. On 10-Sep-2021, the patient experienced PYREXIA (Fever) (seriousness criterion medically significant) and CHILLS (Chills) (seriousness criterion medically significant). On 11-Sep-2021, the patient experienced EPISTAXIS (Nose bleed) (seriousness criterion medically significant). On 13-Sep-2021, the patient experienced FEELING ABNORMAL (Fuzzy head) (seriousness criterion medically significant). On an unknown date, the patient experienced LIMB DISCOMFORT (Heavy arm) (seriousness criterion medically significant), VACCINATION COMPLICATION (I felt really low) and INSOMNIA (Struggled to sleep). On 11-Sep-2021, EPISTAXIS (Nose bleed), PYREXIA (Fever) and CHILLS (Chills) had resolved. At the time of the report, LIMB DISCOMFORT (Heavy arm) was resolving, FEELING ABNORMAL (Fuzzy head) had not resolved and VACCINATION COMPLICATION (I felt really low) and INSOMNIA (Struggled to sleep) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, SARS-CoV-2 test: negative (Negative) Negative. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Unknown) was unknown. No relevant concomitant medications were reported. Patient noticed slight blood from nose and spilt as well, that indicated either he had a nose bleed or internal bleeding during sleep, felt really low, had heavy arm throughout next day and in night she struggled to sleep and she can''t think clearly. No treatment information was provided. Patient has not tested positive for COVID-19 since having the vaccine. Adverse reaction did not occur as a result of an exposure during pregnancy. Company comment: This case concerns a 34-year-old, male patient with no relevant medical history, who experienced the unexpected events of pyrexia, chills, epistaxis, feeling abnormal, and limb discomfort. The events occurred approximately 1-3 days after the second dose of mRNA-1273 (Moderna CoviD-19 Vaccine). The rechallenge was unknown since no information about the first dose was disclosed. The reporter assessed the events as related to the product. The benefit-risk relationship of mRNA-1273 (Moderna CoviD-19 Vaccine) in not affected by this report. Event seriousness assessed as per Regulatory Authority reporting, however there was no information in the source document supporting that the events resulted in a persistent or permanent incapacity.; Sender''s Comments: This case concerns a 34-year-old, male patient with no relevant medical history, who experienced the unexpected events of pyrexia, chills, epistaxis, feeling abnormal, and limb discomfort. The events occurred approximately 1-3 days after the second dose of mRNA-1273 (Moderna CoviD-19 Vaccine). The rechallenge was unknown since no information about the first dose was disclosed. The reporter assessed the events as related to the product. The benefit-risk relationship of mRNA-1273 (Moderna CoviD-19 Vaccine) in not affected by this report. Event seriousness assessed as per Regulatory Authority reporting, however there was no information in the source document supporting that the events resulted in a persistent or permanent incapacity.


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1729175


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166