VAERS ID: 2013692

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

Description

Difficulty of breathing; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 23-Dec-2021 and was forwarded to Moderna on 23-Dec-2021. This regulatory authority case was reported by an other health care professional and describes the occurrence of DYSPNOEA (Difficulty of breathing) in a 13-year-old male patient who received mRNA-1273 (COVID-19 Vaccine Moderna) (batch no. 086521A) for an unknown indication. No Medical History information was reported. On 29-Nov-2021, the patient received dose of mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 29-Nov-2021 at 8:00 PM, the patient experienced DYSPNOEA (Difficulty of breathing) (seriousness criterion hospitalization prolonged). At the time of the report, DYSPNOEA (Difficulty of breathing) had resolved. The action taken with mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular) was unknown. For mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medications were reported. Treatment information was not provided. COMPANY COMMENT: This is a regulatory case concerning a 13-year-old male patient with no clinical history who experienced the unexpected event of DYSPNOEA The event occurred 1 days after a dose of mRNA-1273. The rechallenge was not applicable since only information about a dose was disclosed The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.; Sender's Comments: COMPANY COMMENT: This is a regulatory case concerning a 13-year-old male patient with no clinical history who experienced the unexpected event of DYSPNOEA The event occurred 1 days after a dose of mRNA-1273. The rechallenge was not applicable since only information about a dose was disclosed The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.

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Symptoms

Dyspnoea

Vaccines

VAX DATE: 11-29-2021| ONSET DATE: 11-29-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 0 COVID19 MODERNA 086521A OT

RECVDATE:01-07-2022
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:PHMODERNATX, INC.MOD20214
FORM_VERS:
TODAYS_DATE:01-05-2022
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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