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VAERS Report 2115881

Case Report Section

Détails du rapport Vaer

Âge: 52 ans

Genre: Male

Région : Outside US

Patient décédé?
Non
Renseignements sur les vaccins

Nom: COVID19 (COVID19 (MODERNA))

Type : Coronavirus 2019 vaccine

Fabricant: MODERNA

Lot: 3001939


Date de réception du rapport
2022-02-16
Date à laquelle le formulaire est complèté
Date de vaccination
2021-05-10
Date d’apparition
186
Nombre de jours (date d’apparition – date de vaccination)
186
Description de l’événement indésirable

sars-cov-2 infection; vaccination failure; 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 52-year-old male patient who received mrna-1273 (spikevax) (batch nos. 3002920 and 3001939) for covid-19 vaccination. no medical history information was reported. on 10-may-2021, the patient received first dose of mrna-1273 (spikevax) (intramuscular) 1 dosage form. on 24-jun-2021, received second dose of mrna-1273 (spikevax) (intramuscular) dosage was changed to 1 dosage form. on 12-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 12-nov-2021, sars-cov-2 test: positive (positive) positive. for mrna-1273 (spikevax) (intramuscular), the reporter did not provide any causality assessments. no concomitant medication information was reported no treatment medication information was reported this is a regulatory authority case concerning a 52-year-old, male patient with no reported medical history, who experienced the unexpected serious events of covid-19 and vaccination failure. the events occurred approximately 5 months after the second dose of mrna-1273 covid 19 vaccine. patient tested positive for covid-19 pcr test. treatment information was not provided. the events outcome were reported as unknown. the benefit-risk relationship of mrna-1273 covid 19 vaccine, is not affected by this report.; sender's comments: this is a regulatory authority case concerning a 52-year-old, male patient with no reported medical history, who experienced the unexpected serious events of covid-19 and vaccination failure. the events occurred approximately 5 months after the second dose of mrna-1273 covid 19 vaccine. patient tested positive for covid-19 pcr test. treatment information was not provided. the events outcome were reported as unknown. the benefit-risk relationship of mrna-1273 covid 19 vaccine, is not affected by this report

Données de laboratoire
test date: 20211112; 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