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This is VAERS ID 1739003

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First Appeared on 10/15/2021

VAERS ID: 1739003
VAERS Form:2
Age:39.0
Sex:Female
Location:Foreign
Vaccinated:2021-09-13
Onset:2021-09-14
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: Fatigue, Lip swelling, Pain, SARS-CoV-2 test

Life Threatening? No
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? No
Previous Vaccinations:
Other Medications: ESOMEPRAZOLE
Current Illness: Gastritis chronic
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Test Result: Negative ; Result Unstructured Data: Negative; Comments: negative
CDC 'Split Type': GBMODERNATX, INC.MOD20213

Write-up: fatigue; aches; Lip swelling; This case was received via the regulatory authority RA (Reference number: GB-MHRA-ADR 25962564) 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 FATIGUE (fatigue), PAIN (aches) and LIP SWELLING (Lip swelling) in a 39-year-old female patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) for COVID-19 vaccination. Concurrent medical conditions included Gastritis chronic. Concomitant products included ESOMEPRAZOLE for Gastritis chronic. On 13-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 LIP SWELLING (Lip swelling) (seriousness criterion medically significant). On an unknown date, the patient experienced FATIGUE (fatigue) (seriousness criterion medically significant) and PAIN (aches) (seriousness criterion medically significant). At the time of the report, FATIGUE (fatigue), PAIN (aches) and LIP SWELLING (Lip swelling) was resolving. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, SARS-CoV-2 test: no - negative covid-19 test (Negative) Negative. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Unknown) was unknown. Patient had dermal fillers in lips 12 months prior to vaccine. she had zero side effects to first Moderna jab but 2nd absolutely floored her. Aches, pain, fatigue. However, the dramatic lip swelling was absolutely terrifying. lips are almost back to normal now. Company Comment: This case concerns a 39-year-old, female patient with relevant medical history of gastritis chronic, who experienced the unexpected events of pain, lip swelling and fatigue. The events occurred approximately 1 day after the second dose of Moderna CoviD-19 Vaccine. The rechallenge was unknown since no information about the first dose was disclosed. The benefit-risk relationship of Moderna CoviD-19 Vaccine is 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 39-year-old, female patient with relevant medical history of gastritis chronic, who experienced the unexpected events of pain, lip swelling and fatigue. The events occurred approximately 1 day after the second dose of Moderna CoviD-19 Vaccine. The rechallenge was unknown since no information about the first dose was disclosed. The benefit-risk relationship of Moderna CoviD-19 Vaccine is 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.

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