VAERS ID: 1819757

AGE: 17| SEX: M|STATE: FR (Unknown)

Description

Myopericarditis; Pyrexia; This case was received via Regulatory Authority (Reference number: JP-TAKEDA-2021TJP109779) on 19-Oct-2021 and was forwarded to Moderna on 22-Oct-2021. This case, initially reported to the Regulatory Agency (RA) by a physician, was received via the RA (Ref, v21129527). On an unknown date, the patient received the 1st dose of the vaccine. On 09-Oct-2021, the patient received the 2nd dose of the vaccine. From 10-Oct-2021 to 11-Oct-2021, the patient had pyrexia of 38s degrees Celsius. On 12-Oct-2021, at 03:00, the patient was aware of pain in the left chest for approximately 10 minutes. As chest discomfort sensation persisted thereafter, the patient visited a hospital. An electrocardiogram showed ST elevations in II, III, and aVF, and the result of blood sampling revealed an inflammatory response and elevated cardiac enzymes. Echocardiography showed enhanced pericardium brightness and accumulation of pericardial fluid. The patient was admitted to the hospital for suspected myopericarditis. On an unspecified date, as of the date, any virus that can cause myocarditis had not been detected. Cardiac contrast-enhanced MRI showed findings suggestive of myocarditis. The result of myocardial biopsy showed normal findings of myocardium. After being hospitalized, the patient had no chest pain, cardiac failure, or arrythmia, and the course of the disease was favorable without transformation to fulminant myocarditis. The symptoms had not resolved. The outcome of pyrexia and myopericarditis was reported as ongoing and unchanged. 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: Not reported. 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 17 year old male patient, with no relevant medical history reported, who experienced serious unexpected AESI of myocarditis after second dose of mRNA-1273. The event occurred 4 days after second dose of mRNA-1273. The re-challenge is not applicable. The benefit-risk relationship of Spikevax is not affected by this report.

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Symptoms

Pyrexia, Myocarditis, Echocardiogram, Blood test, Electrocardiogram, Body temperature, Biopsy heart, Magnetic resonance imaging heart

Vaccines

VAX DATE: 10-09-2021| ONSET DATE: 10-10-2021| DAYS TO ONSET: 1
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 1 COVID19 MODERNA 3005791 OT

RECVDATE:10-27-2021
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: Myocardial biopsy; Result Unstructured Data: Normal; Test Date: 20211012; Test Name: Blood sampling; Result Unstructured Data: Revealed an inflammatory response and elevated cardiac enzymes; Test Date: 20211010; Test Name: Body temperature; Result Unstructured Data: 38s Cel; Test Date: 20211011; Test Name: Body temperature; Result Unstructured Data: 38s Cel; Test Date: 20211012; Test Name: Echocardiography; Result Unstructured Data: Showed enhanced pericardium brightness and accumulation of pericardial fluid.; Test Date: 20211012; Test Name: Electrocardiogram; Result Unstructured Data: Showed ST elevations in II, III, and aVF; Test Name: Cardiac contrast-enhanced MRI; Result Unstructured Data: Showed findings suggestive of myocarditis
V_ADMINBY:
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:JPMODERNATX, INC.MOD20213
FORM_VERS:
TODAYS_DATE:10-26-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:Y
ALLERGIES:
V_FUNDBY:

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