Page breadcrumb nav

VAERS Report 2115871

Case Report Section

Détails du rapport Vaer

Âge: 29 ans

Genre: Female

Région : Outside US

Patient décédé?
Non
Renseignements sur les vaccins

Nom: COVID19 (COVID19 (MODERNA))

Type : Coronavirus 2019 vaccine

Fabricant: MODERNA

Lot: 3002545


Date de réception du rapport
2022-02-16
Date à laquelle le formulaire est complèté
Date de vaccination
2021-05-28
Date d’apparition
162
Nombre de jours (date d’apparition – date de vaccination)
162
Description de l’événement indésirable

sars-cov-2 infection; vaccination failure; this case was received via regulatory authority (reference number: at-basgages-2022-004002) on 09-feb-2022 and was forwarded to moderna on 09-feb-2022. this regulatory authority case was reported by a physician and describes the occurrence of covid-19 (sars-cov-2 infection) and vaccination failure (vaccination failure) in a 29-year-old female patient who received mrna-1273 (spikevax) (batch nos. 3002545 and 214001) for covid-19 vaccination. no medical history information was reported. on 28-may-2021, the patient received first dose of mrna-1273 (spikevax) (intramuscular) 1 dosage form. on 09-jul-2021, received second dose of mrna-1273 (spikevax) (intramuscular) dosage was changed to 1 dosage form. on 06-nov-2021, the patient experienced covid-19 (sars-cov-2 infection) (seriousness criterion medically significant) and vaccination failure (vaccination failure) (seriousness criterion medically significant). at the time of the report, covid-19 (sars-cov-2 infection) and vaccination failure (vaccination failure) outcome was unknown. diagnostic results (normal ranges are provided in parenthesis if available): on 06-nov-2021, sars-cov-2 test: positive (positive) positive. for mrna-1273 (spikevax) (intramuscular), the reporter did not provide any causality assessments. company comment: this is a regulatory authority case concerning a 29-year-old female patient with no reported medical history, who experienced the serious unexpected event of covid-19 (aesi), almost 4 months after the administration of second dose of mrna-1273 vaccine. vaccination failure was also reported as an event. clinical course and treatment details were not provided. the benefit-risk relationship of mrna-1273 vaccine is not affected by this report. events seriousness (medically significant) captured as per regulatory authority assessment in source document. concomitant medication was not reported. treatment information was not provided.; sender's comments: company comment: this is a regulatory authority case concerning a 29-year-old female patient with no reported medical history, who experienced the serious unexpected event of covid-19 (aesi), almost 4 months after the administration of second dose of mrna-1273 vaccine. vaccination failure was also reported as an event. clinical course and treatment details were not provided. the benefit-risk relationship of mrna-1273 vaccine is not affected by this report. events seriousness (medically significant) captured as per regulatory authority assessment in source document

Données de laboratoire
test date: 20211106; test name: covid-19 pcr test; test result: positive ; result unstructured data: positive
Liste des symptômes
covid-19 sars-cov-2 test vaccination failure
Patient décédé?
Non
Date de décès
N/A
Anomalie congénitale
false
Vaccin administré par :
Unknown
Vaccin acheté par :
Inconnu
Visite d’un patient à l’urgence?
Non
Patient hospitalisé?
Non
Séjour à l’hôpital
Non
Nombre de jours à l’hôpital
Non spécifié
Invalidité permanente?
Non
Allergies:
na
Maladie actuelle
na