VAERS ID: 1796875

AGE: 14| SEX: M|STATE: FR (Unknown)

Description

Myocarditis; This case was received via regulatory authority (Reference number: JP-TAKEDA-2021TJP105707) on 11-Oct-2021 and was forwarded to Moderna on 18-Oct-2021. This case, initially reported to the regulatory authority by a (physician), was received via the regulatory authority (Ref, v21129868). On an unknown date, the patient received the 1st dose of this vaccine. On 02-Oct-2021, the patient received the 2nd dose of this vaccine. On 04-Oct-2021, chest pain and vomiting developed. On 05-Oct-2021, the patient visited the reporting hospital. The patient was diagnosed with myocarditis due to abnormally high troponin I level. The patient was transported to an advanced treatment hospital and was hospitalized. On 09-Oct-2021, the symptoms were resolving, and the patient was discharged from the hospital. The outcome of myocarditis was reported as resolving. Follow-up investigation will be made. Company Comment: The event developed after the administration of COVID-19 vaccine mRNA (mRNA 1273) and there is temporal relationship.; Reporter's Comments: The symptoms developed after the vaccination with this vaccine, and this event was considered to be causally related to this vaccine because there were no other causes other than the vaccine. The event developed after the administration of COVID-19 vaccine mRNA (mRNA 1273) and there is temporal relationship.; Sender's Comments: This case concerns a 14 year old male patient with no relevant medical history, who experienced the unexpected event of myocarditis. The event myocarditis occurred approximately 2 days after the second 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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Symptoms

Myocarditis, Troponin I

Vaccines

VAX DATE: 10-02-2021| ONSET DATE: 10-04-2021| DAYS TO ONSET: 2
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 1 COVID19 MODERNA 3002618 OT

RECVDATE:10-19-2021
RPT_DATE:
CAGE_YR:
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:Y
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:Test Date: 20211005; Test Name: Troponin I; Result Unstructured Data: abnormally high troponin I level.
V_ADMINBY:
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:JPMODERNATX, INC.MOD20213
FORM_VERS:
TODAYS_DATE:10-19-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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