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This is VAERS ID 1757814

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/15/2021

VAERS ID: 1757814
VAERS Form:2
Age:19.0
Sex:Female
Location:Foreign
Vaccinated:2021-09-13
Onset:2021-09-14
Submitted:0000-00-00
Entered:2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Tachycardia

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: Medical History/Concurrent Conditions: Oestrone
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': ITMODERNATX, INC.MOD20213

Write-up: ; This case was received via Regulatory Authority (Reference number: IT-MINISAL02-788670) on 24-Sep-2021 and was forwarded to Moderna on 24-Sep-2021. This regulatory authority case was reported by a physician and describes the occurrence of TACHYCARDIA in a 19-year-old female patient who received mRNA-1273 (Spikevax) for COVID-19 vaccination. The patient''s past medical history included Oestrone. On 13-Sep-2021, the patient received first dose of mRNA-1273 (Spikevax) (Intramuscular) 1 dosage form. On 14-Sep-2021, the patient experienced TACHYCARDIA (seriousness criterion medically significant). On 14-Sep-2021, TACHYCARDIA had resolved. For mRNA-1273 (Spikevax) (Intramuscular), the reporter did not provide any causality assessments. Concomitant product use was not provided by reporter. Treatment information was not provided Patient was suspected TPSV Tachycardia the day after the administration of modern a vaccine. Patient was admitted to the emergency room, symptoms in remission . Company comment:: This case concerns a 19 year old female patient with no relevant medical history, who experienced the unexpected event of tachycardia. The event occurred approximately1 day after the first dose of the Moderna COVID-19 vaccine. The rechallenge was unknown. The benefit-risk relationship of the Moderna COVID-19 vaccine is not affected by this report. Most recent FOLLOW-UP information incorporated above includes: On 24-Sep-2021: Translation received on 29-Sep-2021 as live follow up and updated with event verbatim and Reporter''s comments; Sender''s Comments: This case concerns a 19 year old female patient with no relevant medical history, who experienced the unexpected event of tachycardia. The event occurred approximately1 day after the first dose of the Moderna COVID-19 vaccine. The rechallenge was unknown. The benefit-risk relationship of the Moderna COVID-19 vaccine is not affected by this report.

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