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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1738985

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Case Details

VAERS ID: 1738985 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Foreign  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain lower, Blood urine present, Headache, Loss of consciousness, Myalgia, Pyrexia
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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:
CDC Split Type: GBMODERNATX, INC.MOD20213

Write-up: passed out; lower abdominal pain; headache; high temperature; Achy muscles; Blood in urine; unconscious; This case was received via Regulatory Authority RA (Reference number: GB-MHRA-ADR 25959792) on 19-Sep-2021 and was forwarded to Moderna on 19-Sep-2021. This regulatory authority case was reported by a consumer and describes the occurrence of LOSS OF CONSCIOUSNESS (unconscious), LOSS OF CONSCIOUSNESS (passed out), ABDOMINAL PAIN LOWER (lower abdominal pain), BLOOD URINE PRESENT (Blood in urine), HEADACHE (headache) and PYREXIA (high temperature) in a 28-year-old female patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 14-Sep-2021, the patient received second dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) 1 dosage form. On 14-Sep-2021, the patient experienced BLOOD URINE PRESENT (Blood in urine) (seriousness criterion medically significant). On an unknown date, the patient experienced LOSS OF CONSCIOUSNESS (unconscious) (seriousness criterion medically significant), LOSS OF CONSCIOUSNESS (passed out) (seriousness criterion medically significant), ABDOMINAL PAIN LOWER (lower abdominal pain) (seriousness criterion medically significant), HEADACHE (headache) (seriousness criterion medically significant), PYREXIA (high temperature) (seriousness criterion medically significant) and MYALGIA (Achy muscles). At the time of the report, LOSS OF CONSCIOUSNESS (unconscious), LOSS OF CONSCIOUSNESS (passed out), ABDOMINAL PAIN LOWER (lower abdominal pain), HEADACHE (headache), PYREXIA (high temperature) and MYALGIA (Achy muscles) outcome was unknown and BLOOD URINE PRESENT (Blood in urine) was resolving. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Unknown) was unknown. Patient had a lot of blood in urine in the morning. Lower abdominal pain similar to a UTI. High temperature and headache. Achy muscles. Passed out in the afternoon after having the vaccine. Unconscious for approximately 2 minutes. Concomitant medication of the patient was not reported. No treatment information was provided by the reporter. This case concerns a 28 year-old, female patient with no previous relevant medical history who experienced the unexpected events of loss of consciousness, abdominal pain lower, blood urine present, headache and pyrexia. The events occurred on the same day of the second dose of COVID-19 Vaccine Moderna (mRNA-1273) and on unknown dates. The rechallenge was unknown since no information about the first dose was disclosed. The events are consistent with the current understanding of the mechanism of action of the vaccine. The benefit-risk relationship of COVID-19 Vaccine Moderna (mRNA-1273) is not affected by this report. Events seriousness was assessed as per Regulatory Authority reporting, however there was no information in the source document supporting that the events seemed to be serious by medical judgement and from a clinical or regulatory standpoint.; Sender''s Comments: This case concerns a 28 year-old, female patient with no previous relevant medical history who experienced the unexpected events of loss of consciousness, abdominal pain lower, blood urine present, headache and pyrexia. The events occurred on the same day of the second dose of COVID-19 Vaccine Moderna (mRNA-1273) and on unknown dates. The rechallenge was unknown since no information about the first dose was disclosed. The events are consistent with the current understanding of the mechanism of action of the vaccine. The benefit-risk relationship of COVID-19 Vaccine Moderna (mRNA-1273) is not affected by this report. Events seriousness was assessed as per Regulatory Authority reporting, however there was no information in the source document supporting that the events seemed to be serious by medical judgement and from a clinical or regulatory standpoint.


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