National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/19/2021 release of VAERS data:

This is VAERS ID 1773526

Government Disclaimer on use of this data



Case Details

VAERS ID: 1773526 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Unknown  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-09-30
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Body temperature, Fatigue, Illness, Interchange of vaccine products, Nasopharyngitis, Pain, Pyrexia, SARS-CoV-2 test, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Medication errors (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), COVID-19 (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: Test Date: 20210930; Test Name: body temperature; Result Unstructured Data: 103 Degree F; Test Date: 20211001; Test Name: body temperature; Result Unstructured Data: 100 Degree F; Test Date: 20210930; Test Name: COVID-19 test; Test Result: Negative ; Result Unstructured Data: negative
CDC Split Type: USMODERNATX, INC.MOD20213

Write-up: Sleepy; Achy; Felt a little bit sick; Got a J&J vaccine a couple of months ago and then got the Moderna first dose; Tired; Fever of 103?F/temperature dropped to 100?F; Felt they had a cold; This spontaneous case was reported by a consumer and describes the occurrence of SOMNOLENCE (Sleepy), PAIN (Achy), ILLNESS (Felt a little bit sick), NASOPHARYNGITIS (Felt they had a cold) and INTERCHANGE OF VACCINE PRODUCTS (Got a J&J vaccine a couple of months ago and then got the Moderna first dose) in a 23-year-old patient of an unknown gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Previously administered products included for an unreported indication: COVID-19 VACCINE NRVV AD26 (J&J vaccine a couple of months ago). On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 30-Sep-2021, the patient experienced NASOPHARYNGITIS (Felt they had a cold) and PYREXIA (Fever of 103?F/temperature dropped to 100?F). On an unknown date, the patient experienced SOMNOLENCE (Sleepy), PAIN (Achy), ILLNESS (Felt a little bit sick), INTERCHANGE OF VACCINE PRODUCTS (Got a J&J vaccine a couple of months ago and then got the Moderna first dose) and FATIGUE (Tired). The patient was treated with PARACETAMOL (TYLENOL) on 30-Sep-2021 at an unspecified dose and frequency. At the time of the report, SOMNOLENCE (Sleepy), PAIN (Achy) and FATIGUE (Tired) had not resolved, ILLNESS (Felt a little bit sick), NASOPHARYNGITIS (Felt they had a cold) and PYREXIA (Fever of 103?F/temperature dropped to 100?F) outcome was unknown and INTERCHANGE OF VACCINE PRODUCTS (Got a J&J vaccine a couple of months ago and then got the Moderna first dose) had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 30-Sep-2021, Body temperature: 103 deg f 103 Degree F. On 30-Sep-2021, SARS-CoV-2 test: negative (Negative) negative. On 01-Oct-2021, Body temperature: 100 degree f 100 Degree F. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications were mentioned since Patient 1(Reporter) was not aware of any medication Patient 2 may be taking regularly. Patient''s historical vaccine included J&J vaccine taken a couple of months ago with No indication mentioned.


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1773526


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