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VAERS Report 2156935

Case Report Section

Vaer Report Details

Age: 44 years old

Gender: Female

State: Outside US

Patient Died?
No
Vaccine information

Name: COVID19 (COVID19 (MODERNA))

Type: Coronavirus 2019 vaccine

Manufacturer: MODERNA

Lot: unknown


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2022-02-26
Date of Onset
0
Number of days (onset date – vaccination date)
0
Adverse Event Description

general body pain; throbbing headache; skin pain; feverish; fatigue; fuzzy head; this case was received reference number: gb-mhra-adr 26657155) on 28-feb-2022 and was forwarded to moderna on 28-feb-2022. this regulatory authority case was reported by a consumer and describes the occurrence of pain (general body pain), headache (throbbing headache), pain of skin (skin pain), pyrexia (feverish), fatigue (fatigue) and feeling abnormal (fuzzy head) in a 44-year-old female patient who received mrna-1273 (moderna covid-19 vaccine) for an unknown indication. concurrent medical conditions included wegeners granulomatosis and immunodeficiency (has an illness or condition, not listed above, which reduces the immune response (e.g. immunodef...). on 26-feb-2022, the patient received third dose of mrna-1273 (moderna covid-19 vaccine) (unknown route) 1 dosage form. on 26-feb-2022, the patient experienced pain (general body pain) (seriousness criterion medically significant), headache (throbbing headache) (seriousness criterion medically significant), pain of skin (skin pain) (seriousness criterion medically significant), pyrexia (feverish) (seriousness criterion medically significant), fatigue (fatigue) (seriousness criterion medically significant) and feeling abnormal (fuzzy head) (seriousness criterion medically significant). at the time of the report, pain (general body pain), headache (throbbing headache), pain of skin (skin pain), fatigue (fatigue) and feeling abnormal (fuzzy head) had not resolved and pyrexia (feverish) was resolving. diagnostic results (normal ranges are provided in parenthesis if available): on an unknown date, sars-cov-2 test: negative (negative) no - negative covid-19 test. the action taken with mrna-1273 (moderna covid-19 vaccine) (unknown) was unknown. no concomitant medications were provided. patient did not tested positive for covid-19 after taking the vaccine. she did not had symptoms associated with covid-19. she was not pregnant. she was not enrolled in clinical trial. it was reported that, her report was not related to possible inflammation of the heart (myocarditis or pericarditis). no treatment medications were provided. company comment: this is a regulatory authority case concerning a 44-year-old female patient with medical history of granulomatosis with polyangiitis and immunodeficiency, who experienced the unexpected and serious (medically significant) events of fatigue, pain, headache, pain of skin, pyrexia, and feeling abnormal that occurred the same day after a dose of mrna-1273 vaccine (given as a third dose) was administered. medical history of granulomatosis with polyangiitis and immunodeficiency remain as confounders. 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 44-year-old female patient with medical history of granulomatosis with polyangiitis and immunodeficiency, who experienced the unexpected and serious (medically significant) events of fatigue, pain, headache, pain of skin, pyrexia, and feeling abnormal that occurred the same day after a dose of mrna-1273 vaccine (given as a third dose) was administered. medical history of granulomatosis with polyangiitis and immunodeficiency remain as confounders. the benefit-risk relationship of mrna-1273 vaccine is not affected by this report

Lab Data
test name: covid-19 virus test; test result: negative ; result unstructured data: no - negative covid-19 test
List of symptoms
fatigue feeling abnormal headache pain pyrexia sars-cov-2 test pain of skin
Patient Died?
No
Date Died
NA
Birth defect
false
Vaccine Administered By:
Unknown
Vaccine Purchased By:
Unknown
Patient visit ER?
No
Patient Hospitalized?
No
Stay in hospital
No
Days in hospital
Unspecified
Permanent disability?
No
Allergies:
na
Current Illness
immunodeficiency (has an illness or condition, not listed above, which reduces the immune response (e.g. immunodef...); wegeners granulomatosis