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VAERS Report 2115874

Case Report Section

Détails du rapport Vaer

Âge: 40 ans

Genre: Male

Région : Outside US

Patient décédé?
Non
Renseignements sur les vaccins

Nom: COVID19 (COVID19 (MODERNA))

Type : Coronavirus 2019 vaccine

Fabricant: MODERNA

Lot: 3002339


Date de réception du rapport
2022-02-16
Date à laquelle le formulaire est complèté
Date de vaccination
2021-05-20
Date d’apparition
177
Nombre de jours (date d’apparition – date de vaccination)
177
Description de l’événement indésirable

vaccination failure; sars-cov-2 infection; this case was received via regulatory authority (reference number: at-basgages-2022-004704) on 07-feb-2022 and was forwarded to moderna on 07-feb-2022. this regulatory authority case was reported by a physician and describes the occurrence of vaccination failure (vaccination failure) and covid-19 (sars-cov-2 infection) in a 40-year-old male patient who received mrna-1273 (spikevax) (batch nos. 3002916 and 3002339) for covid-19 vaccination. no medical history information was reported. on 20-may-2021, the patient received first dose of mrna-1273 (spikevax) (intramuscular) 1 dosage form. on 25-jun-2021, received second dose of mrna-1273 (spikevax) (intramuscular) dosage was changed to 1 dosage form. on 13-nov-2021, the patient experienced vaccination failure (vaccination failure) (seriousness criterion medically significant) and covid-19 (sars-cov-2 infection) (seriousness criterion medically significant). at the time of the report, vaccination failure (vaccination failure) and covid-19 (sars-cov-2 infection) outcome was unknown. diagnostic results (normal ranges are provided in parenthesis if available): on 13-nov-2021, sars-cov-2 test: positive (positive) positive. for mrna-1273 (spikevax) (intramuscular), the reporter did not provide any causality assessments. no concomitant medications were reported. no treatment medications were reported. company comment: this regulatory authority case concerns a 40-year-old male patient, with unknown medical history, who experienced the unexpected serious (seriousness criterion- other medically important condition) event of covid-19(aesi). the event occurred 5 months 24 days after the first dose of mrna-1273 vaccine and 4 months 19 days after the second dose of mrna-1273 vaccine, the 2nd dose administered 36 days after the 1st dose. covid-19 pcr test was positive. there is no available information regarding clinical course and treatment medication. the benefit-risk relationship of mrna-1273 vaccine is not affected by this report.; sender's comments: this regulatory authority case concerns a 40-year-old male patient, with unknown medical history, who experienced the unexpected serious (seriousness criterion- other medically important condition) event of covid-19(aesi). the event occurred 5 months 24 days after the first dose of mrna-1273 vaccine and 4 months 19 days after the second dose of mrna-1273 vaccine, the 2nd dose administered 36 days after the 1st dose. covid-19 pcr test was positive. there is no available information regarding clinical course and treatment medication. the benefit-risk relationship of mrna-1273 vaccine is not affected by this report

Données de laboratoire
test date: 20211113; 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