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VAERS Report 2115892

Case Report Section

Détails du rapport Vaer

Âge: 57 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
2021-06-04
Date d’apparition
161
Nombre de jours (date d’apparition – date de vaccination)
161
Description de l’événement indésirable

this case was received(reference number: at-basgages-2022-004861) 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 (vaccination failure) and covid-19 (sars-cov-2 infection) in a 57-year-old female patient who received mrna-1273 (spikevax) (batch nos. 3002545 and 3003602) for covid-19 vaccination.no medical history information was reported.on 04-jun-2021, the patient received first dose of mrna-1273 (spikevax) (intramuscular) 1 dosage form. on 15-jul-2021, received second dose of mrna-1273 (spikevax) (intramuscular) dosage was changed to 1 dosage form. on 12-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 12-nov-2021, sars-cov-2 test: positive (positive) positive. for mrna-1273 (spikevax) (intramuscular), the reporter did not provide any causality assessments. concomitant product use was not provided by the reporter. no treatment information was provided. company comment: this is a regulatory authority case concerning a 57-year-old female patient, with no medical history reported, who experienced the unexpected, serious (medically significant), and aesi of covid-19. the event occurred approximately 4 months after the second dose of mrna-1273 vaccine. vaccination failure was also reported, however, doses were given 41 days apart (inappropriate schedule of vaccine administered). covid-19 pcr test positive. the benefit-risk relationship of mrna-1273 vaccine is not affected by this report; sender's comments: this is a regulatory authority case concerning a 57-year-old female patient, with no medical history reported, who experienced the unexpected, serious (medically significant), and aesi of covid-19. the event occurred approximately 4 months after the second dose of mrna-1273 vaccine. vaccination failure was also reported, however, doses were given 41 days apart (inappropriate schedule of vaccine administered). covid-19 pcr test positive. the benefit-risk relationship of mrna-1273 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