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This is VAERS ID 1788766

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First Appeared on 10/22/2021

VAERS ID: 1788766
VAERS Form:2
Age:17.0
Sex:Female
Location:Foreign
Vaccinated:2021-05-18
Onset:2021-04-01
Submitted:0000-00-00
Entered:2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3001943 / 2 RA / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Abdominal pain, Angioedema, Bronchitis, Bronchospasm, Chills, Cough, Diarrhoea, Dyspnoea, Lung disorder, Nausea, Pain in extremity, Pneumonia, Pyrexia, Respiratory disorder, Rhinorrhoea, Sneezing, Vomiting, Wheezing, Bronchial disorder, Product administered to patient of inappropriate age

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: Anaphylaxis; Hypersensitivity reaction; Immunodeficiency
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': ATMODERNATX, INC.MOD20213

Write-up: Bronchitis; Problems with bronchi; Problems with lungs; respiratory diseases; Inappropriate age at vaccine administration; vomiting; Nausea; Fever; Chills; Angioedema; Difficulty breathing; Abdominal cramps; Pain in the hand; Diarrhea; Sneezing; runny nose; Bronchospasm; wheezing; Cough; Difficulty breathing (repeatedly); Cough; Budding pneumonia; This case was initially received via an unknown source (no reference has been entered for a health authority or license partner) on 14-Sep-2021. The most recent information was received on 07-Oct-2021 and was forwarded to Moderna on 07-Oct-2021. This spontaneous case was reported by a consumer and describes the occurrence of PNEUMONIA (Budding pneumonia) and ANGIOEDEMA (Angioedema) in a 17-year-old female patient who received mRNA-1273 (Spikevax) (batch nos. 3001943 and 214001) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Anaphylaxis, Hypersensitivity reaction and Immunodeficiency. On 18-May-2021 at 12:00 PM, the patient received first dose of mRNA-1273 (Spikevax) (unknown route) 1 dosage form. On 29-Jun-2021 at 12:00 PM, received second dose of mRNA-1273 (Spikevax) (unknown route) dosage was changed to 1 dosage form. In April 2021, the patient experienced PNEUMONIA (Budding pneumonia) (seriousness criterion medically significant), DYSPNOEA (Difficulty breathing (repeatedly)) and the first episode of COUGH (Cough). On 18-May-2021, the patient experienced ANGIOEDEMA (Angioedema) (seriousness criterion medically significant), DYSPNOEA (Difficulty breathing), ABDOMINAL PAIN (Abdominal cramps), PAIN IN EXTREMITY (Pain in the hand), DIARRHOEA (Diarrhea), SNEEZING (Sneezing), RHINORRHOEA (runny nose), BRONCHOSPASM (Bronchospasm), WHEEZING (wheezing), the second episode of COUGH (Cough), PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (Inappropriate age at vaccine administration), VOMITING (vomiting), NAUSEA (Nausea), PYREXIA (Fever) and CHILLS (Chills). On an unknown date, the patient experienced BRONCHITIS (Bronchitis), BRONCHIAL DISORDER (Problems with bronchi), LUNG DISORDER (Problems with lungs) and RESPIRATORY DISORDER (respiratory diseases). The patient was treated with FLUTICASONE PROPIONATE, SALMETEROL XINAFOATE (SALMECOMP) on 28-Sep-2021 for Adverse event, at an unspecified dose and frequency; AZITHROMYCIN from 28-Sep-2021 to 30-Sep-2021 for Adverse event, at an unspecified dose and frequency and PREDNISOLONE on 28-Sep-2021 for Adverse event, at an unspecified dose and frequency. On 18-May-2021, PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (Inappropriate age at vaccine administration) had resolved. At the time of the report, PNEUMONIA (Budding pneumonia), DYSPNOEA (Difficulty breathing (repeatedly)), BRONCHITIS (Bronchitis), BRONCHIAL DISORDER (Problems with bronchi), LUNG DISORDER (Problems with lungs) and RESPIRATORY DISORDER (respiratory diseases) outcome was unknown and ANGIOEDEMA (Angioedema), DYSPNOEA (Difficulty breathing), ABDOMINAL PAIN (Abdominal cramps), PAIN IN EXTREMITY (Pain in the hand), DIARRHOEA (Diarrhea), SNEEZING (Sneezing), RHINORRHOEA (runny nose), BRONCHOSPASM (Bronchospasm), WHEEZING (wheezing), the last episode of COUGH (Cough), VOMITING (vomiting), NAUSEA (Nausea), PYREXIA (Fever) and CHILLS (Chills) had not resolved. Concomitant medication use information was not provided by reporter. Treatment medications included antibiotics for bronchitis started on 19-may-2021 and stopped on 26-may-2021. Treatment medication included Nasal drops, Antibiotics since 19-May taken 4x. Patient was still sick since the first vaccination, was never really healthy.Loads of antibiotics, cough syrup, pills, etc. There were also severe obstructive [rales] bilaterally,immunoglobulins, and sub-groups. Most recent FOLLOW-UP information incorporated above includes: On 07-Oct-2021: Follow up received on 07-oct-2021 vaccine information added and treatment medication added. On 07-Oct-2021: Translation document received on 12-Oct-2021.Patient''s Demographic updated. Pregnancy Status updated. Current condition added. Vaccine facility , Treatment medication and Events added. On 12-Oct-2021: Follow up received contains no new information.; Sender''s Comments: This case concerns a 17 year-old, female patient with relevant medical history of Anaphylaxis, Hypersensitivity reaction and Immunodeficiency, who experienced the serious unexpected events of pneumonia and angioedema. The event of pneumonia reported to have occurred at an unknown date prior to the Moderna COVID-19 vaccine. The event of angioedema occurred on the same day after the first dose of Moderna COVID-19 vaccine. The rechallenge was unknown. Product administered to patient of inappropriate age was considered as an additional event. The benefit-risk relationship of Moderna COVID-19 vaccine is not affected by this report. Events assessed as serious as per IME list.

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