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This is VAERS ID 1770466

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1770466
VAERS Form:2
Age:
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / OT

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

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:
Current Illness:
Preexisting Conditions: Comments: No medical history was provided by the reporter
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20213

Write-up: Vaccine gave him Myocarditis; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of MYOCARDITIS (Vaccine gave him Myocarditis) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No medical history was provided by the reporter. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced MYOCARDITIS (Vaccine gave him Myocarditis) (seriousness criterion medically significant). At the time of the report, MYOCARDITIS (Vaccine gave him Myocarditis) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant medications was not provided by the reporter Treatment information was not provided. Company Comment: This case concerns a patient of unknown age and gender with no relevant medical history reportedwho experienced serious expected event of myocarditis. The event occurred after an unknown dose. Rechallenge was unknown due to lack of information regarding number of doses administered and reoccurrence of the event. The benefit-risk relationship of drug is not affected by this report; Sender''s Comments: This case concerns a patient of unknown age and gender with no relevant medical history reportedwho experienced serious expected event of myocarditis. The event occurred after an unknown dose. Rechallenge was unknown due to lack of information regarding number of doses administered and reoccurrence of the event. The benefit-risk relationship of drug is not affected by this report

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