VAERS ID: 1803202

AGE: 16| SEX: M|STATE: FR (Unknown)

Description

Myocarditis; Pyrexia; This case was received via regulatory authority(Reference number: 2021TJP106263) on 12-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, v21129161). On an unknown date, the patient received the 1st dose of this vaccine. On an unknown date, body temperature before the vaccination: 36.4 degrees Celsius. On 04-Oct-2021, at 17:00, the patient received the 2nd dose of this vaccine. Pyrexia developed. On 07-Oct-2021, at 06:00, chest discomfort developed. The patient visited the reporting hospital. Echocardiography was performed. Increased myocardial enzyme was noted. The patient was hospitalized with a diagnosis of myocarditis. Fluid replacement and anti-inflammatory analgesics were administered with rest. On 11-Oct-2021, the symptoms were resolving, and the patient was discharged from the hospital. The outcome of pyrexia and myocarditis was reported as resolving. 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: This case was considered as adverse reactions to this vaccine.; Sender's Comments: This is a regulatory case concerning a 16-year-old, male patient with no relevant history reported , who experienced the unexpected serious AESI event of myocarditis and pyrexia . The event myocarditis occurred approximately 4 days after the 2nd dose of mRNA-1273 Moderna vaccine, pyrexia occurred on the same day of 2nd dose. The rechallenge was not applicable (no more doses are expected) . Lab data: Increased myocardial enzyme was noted. The benefit-risk relationship of Spikevax is not affected by this report.

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Symptoms

Pyrexia, Myocarditis, Echocardiogram, Body temperature

Vaccines

VAX DATE: 10-04-2021| ONSET DATE: 10-04-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 1 COVID19 MODERNA 3005701 OT

RECVDATE:10-21-2021
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 Name: Body temperature; Result Unstructured Data: 36.4 degree Celsius; Test Date: 20211007; Test Name: Echocardiogram; Result Unstructured Data: Increased myocardial enzyme was noted
V_ADMINBY:
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:JPMODERNATX, INC.MOD20213
FORM_VERS:
TODAYS_DATE:10-20-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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