VAERS ID: 1757817

AGE: 13| SEX: F|STATE: FR (Unknown)

Description

Seizures; Pain at the vaccination site; Malaise; This case was received via regulatory authority (Reference number: 2021TJP098245) on 25-Sep-2021 and was forwarded to Moderna on 30-Sep-2021. This case, initially reported to the regulatory authority by a physician, was received via the regulatory authority (Ref, v21128843). On an unknown date, the patient received the 1st dose of this vaccine. On 22-Sep-2021, the patient received the 2nd dose of this vaccine. The patient slept until early afternoon because of pain at the vaccination site and malaise. Around 15:25, the patient woke up and went to the toilet. The patient experienced seizure (clonic convulsion, upward eye deviation, and cyanosis of lip) for several minutes in the toilet, and an ambulance was called, and the patient was transported to the reporting hospital. It was 38.0 degrees Celsius when the ambulance crew contacted the patient. On arrival in the hospital, the patient's level of consciousness was clear, but quadriplegia persisted. There were no obvious abnormalities in blood tests or head CT. The patient was hospitalized for follow-up. On an unknown date, the general condition rapidly improved after hospitalization. On 24-Sep-2021, recovery of the symptoms was confirmed. The patient was discharged from the hospital. The outcome of pain at the vaccination site, malaise, and seizures was reported as recovered. Follow-up investigation will be made. Company Comment: The events developed after the administration of COVID-19 vaccine mRNA (mRNA 1273) and there is temporal relationship.; Reporter's Comments: The events developed after the administration of COVID-19 vaccine mRNA (mRNA 1273) and there is temporal relationship.; Sender's Comments: This case concerns a 13 year-old female patient with no medical history reported, who experienced the unexpected serious events of a seizure, vaccination site pain and malaise leading to hospitalization. The events occurred on the same day after receiving the second dose of mRNA-1273 vaccne. The rechallenge was not applicable since no information for the first dose is available, and no additional dosing will be given. The reporter assessed the events as related to the product. The benefit-risk relationship of the product is not affected by this report. Event seriousness assessed as per Regulatory Authority reporting,

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Symptoms

Malaise, Vaccination site pain, Seizure

Vaccines

VAX DATE: 09-22-2021| ONSET DATE: 09-22-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 1 COVID19 MODERNA 3005289 OT

RECVDATE:10-04-2021
RPT_DATE:
CAGE_YR:
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:Y
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:
V_ADMINBY:
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:JPMODERNATX, INC.MOD20213
FORM_VERS:
TODAYS_DATE:10-04-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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