National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1752911

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 10/15/2021

VAERS ID: 1752911
VAERS Form:2
Age:29.0
Sex:Female
Location:Foreign
Vaccinated:2021-06-20
Onset:2021-09-14
Submitted:0000-00-00
Entered:2021-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Fatigue, Headache, Pyrexia, Tremor, Peripheral swelling, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Name: SARS-CoV-2 test; Test Result: Negative ; Result Unstructured Data: Negative
CDC 'Split Type': GBMODERNATX, INC.MOD20213

Write-up: Shaking; Swollen arm; Throbbing headache; Fever; Fatigue; This case was received via RA (Reference number: RA-ADR 25976603) on 22-Sep-2021 and was forwarded to Moderna on 22-Sep-2021. This regulatory authority case was reported by a consumer and describes the occurrence of TREMOR (Shaking), PERIPHERAL SWELLING (Swollen arm), HEADACHE (Throbbing headache), PYREXIA (Fever) and FATIGUE (Fatigue) in a 29-year-old female patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 20-Jun-2021, the patient received first dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) 1 dosage form. On 14-Sep-2021, received second dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 14-Sep-2021, the patient experienced TREMOR (Shaking) (seriousness criterion medically significant), PERIPHERAL SWELLING (Swollen arm) (seriousness criterion medically significant), HEADACHE (Throbbing headache) (seriousness criterion medically significant), PYREXIA (Fever) (seriousness criterion medically significant) and FATIGUE (Fatigue) (seriousness criterion medically significant). On 15-Sep-2021, TREMOR (Shaking) had resolved. On 16-Sep-2021, PERIPHERAL SWELLING (Swollen arm), HEADACHE (Throbbing headache) and PYREXIA (Fever) had resolved. On 17-Sep-2021, FATIGUE (Fatigue) had resolved. 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. The concomitant medications were not reported. The treatment information was not provided. Patient experienced uncontrollable shaking about 5 hours after the vaccine and could barely walk and had intense fever, painful sore arm. The next day patient fatigued, slept all day with fever. Company Comment : This case concerns a 29-year-old, female patient with no reported medical history. Reportedly, the second dose of the vaccine was given 2 months and 25 days after the first dose which is considered to be Inappropriate schedule of product administration. The patient experienced serious (Medically significant) events Pain in extremity, Gait disturbance, Tremor, Peripheral swelling, Headache, Pyrexia and Fatigue during the same day after the second dose of Moderna CoviD-19 Vaccine. The outcome of events was recovered, except for the events of Pain in extremity and Gait disturbance for which the outcome was not specified. Causality was not provided by reporter. Although the action taken was captured as per RA source document, the patient experienced AEs after the second dose, therefore the rechallenge is not applicable. The company causality for the Inappropriate schedule of product administration is not applicable. The benefit-risk relationship of Moderna CoviD-19 Vaccine is not affected by this report.; Sender''s Comments: This case concerns a 29-year-old, female patient with no reported medical history. Reportedly, the second dose of the vaccine was given 2 months and 25 days after the first dose which is considered to be Inappropriate schedule of product administration. The patient experienced serious (Medically significant) events Pain in extremity, Gait disturbance, Tremor, Peripheral swelling, Headache, Pyrexia and Fatigue during the same day after the second dose of Moderna CoviD-19 Vaccine. The outcome of events was recovered, except for the events of Pain in extremity and Gait disturbance for which the outcome was not specified. Causality was not provided by reporter. Although the action taken was captured as per RA source document, the patient experienced AEs after the second dose, therefore the rechallenge is not applicable. The company causality for the Inappropriate schedule of product administration is not applicable. The benefit-risk relationship of Moderna CoviD-19 Vaccine is not affected by this report.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1752911&WAYBACKHISTORY=ON


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