VAERS ID: 2013696

AGE: 12| SEX: F|STATE: FR (Unknown)

Description

Fever; Headache; Labored breathing; Unconsciousness; 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 LOSS OF CONSCIOUSNESS (Unconsciousness), PYREXIA (Fever), HEADACHE (Headache) and DYSPNOEA (Labored breathing) in a 12-year-old female patient who received mRNA-1273 (COVID-19 Vaccine Moderna) (batch no. 06F289) 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 06-Dec-2021, the patient experienced LOSS OF CONSCIOUSNESS (Unconsciousness) (seriousness criterion hospitalization) and DYSPNOEA (Labored breathing) (seriousness criterion hospitalization). On 06-Dec-2021 at 7:30 AM, the patient experienced PYREXIA (Fever) (seriousness criterion hospitalization) and HEADACHE (Headache) (seriousness criterion hospitalization). At the time of the report, LOSS OF CONSCIOUSNESS (Unconsciousness), PYREXIA (Fever) and HEADACHE (Headache) was resolving and DYSPNOEA (Labored 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. No treatment medications were reported. Company comment: This case concerns a 12-year-old female patient, with no medical history reported, who experienced the serious unexpected events of loss of consciousness, dyspnoea, headache and pyrexia after a dose of mRNA-1273. The events occurred 8 days after vaccination. Events outcome were recovering except for dyspnoea which was resolved. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.; Sender's Comments: This case concerns a 12-year-old female patient, with no medical history reported, who experienced the serious unexpected events of loss of consciousness, dyspnoea, headache and pyrexia after a dose of mRNA-1273. The events occurred 8 days after vaccination. Events outcome were recovering except for dyspnoea which was resolved. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.

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Symptoms

Pyrexia, Headache, Dyspnoea, Loss of consciousness

Vaccines

VAX DATE: 11-29-2021| ONSET DATE: 12-06-2021| DAYS TO ONSET: 7
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 0 COVID19 MODERNA 06F289 OT Unknown

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:N
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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