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This is VAERS ID 1732862

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First Appeared on 10/15/2021

VAERS ID: 1732862
VAERS Form:2
Age:20.0
Sex:Male
Location:Foreign
Vaccinated:2021-09-02
Onset:2021-09-04
Submitted:0000-00-00
Entered:2021-09-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Myocarditis

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': FRMODERNATX, INC.MOD20213

Write-up: Myopericarditis; This case was received via a regulatory authority (Reference number: FR-AFSSAPS-ST20213373) on 17-Sep-2021 and was forwarded to Moderna on 17-Sep-2021. This regulatory authority case was reported by a pharmacist and describes the occurrence of MYOCARDITIS (Myopericarditis) in a 20-year-old male patient who received mRNA-1273 (Spikevax) for COVID-19 vaccination. No Medical History information was reported. On 02-Sep-2021, the patient received first dose of mRNA-1273 (Spikevax) (Intramuscular) .5 milliliter. On 04-Sep-2021, the patient experienced MYOCARDITIS (Myopericarditis) (seriousness criteria hospitalization, medically significant and life threatening). At the time of the report, MYOCARDITIS (Myopericarditis) had not resolved. The action taken with mRNA-1273 (Spikevax) (Intramuscular) was unknown. For mRNA-1273 (Spikevax) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medications were not reported. Treatment information was not reported. Company comment: This case concerns a 20-year-old, male patient with no relevant medical history, who experienced the expected event of Myocarditis. The event Myocarditis occurred approximately 3 days after the first dose of Spikevax. The rechallenge was not applicable since only information about the first dose was disclosed. The event is consistent with the current understanding of the mechanism of action of the vaccine. The benefit-risk relationship of Spikevax is not affected by this report. Most recent FOLLOW-UP information incorporated above includes: On 17-Sep-2021: Translation Received on 21-SEP-2021, Dosage text translation was updated.; Sender''s Comments: This case concerns a 20-year-old, male patient with no relevant medical history, who experienced the expected event of Myocarditis. The event Myocarditis occurred approximately 3 days after the first dose of Spikevax. The rechallenge was not applicable since only information about the first dose was disclosed. The event is consistent with the current understanding of the mechanism of action of the vaccine. The benefit-risk relationship of Spikevax is not affected by this report.

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