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VAERS Report 2157072

Case Report Section

Détails du rapport Vaer

Âge: 41 ans

Genre: Male

Région : Outside US

Patient décédé?
Non
Renseignements sur les vaccins

Nom: COVID19 (COVID19 (MODERNA))

Type : Coronavirus 2019 vaccine

Fabricant: MODERNA

Lot: unknown


Date de réception du rapport
2022-03-04
Date à laquelle le formulaire est complèté
Date de vaccination
2022-01-09
Date d’apparition
17
Nombre de jours (date d’apparition – date de vaccination)
17
Description de l’événement indésirable

pulmonary embolism; this case was received (reference number: gr-greof-202200751) on 25-feb-2022 and was forwarded to moderna on 25-feb-2022. this regulatory authority case was reported by a physician and describes the occurrence of pulmonary embolism (pulmonary embolism) in a 41-year-old male patient who received mrna-1273 (spikevax) for covid-19 vaccination. the patient's past medical history included smoker (10 p/y). concomitant products included levothyroxine sodium (thyrohormone) for an unknown indication. on 09-jan-2022, the patient received third dose of mrna-1273 (spikevax) (unknown route) 1 dosage form. on 26-jan-2022, the patient experienced pulmonary embolism (pulmonary embolism) (seriousness criteria hospitalization, medically significant and life threatening). at the time of the report, pulmonary embolism (pulmonary embolism) was resolving. for mrna-1273 (spikevax) (unknown), the reporter did not provide any causality assessments. additional information on concomitant product was reported as thyrohormone levothyroxine sodium. treatment details was not reported by the reporter. company comment: this regulatory case concerns a 41-year-old, male patient with no relevant medical history, who experienced the unexpected, serious (seriousness criteria life-threatening, hospitalization and medically significant), aesi of pulmonary embolism 17 days after the third dose of mrna-1273. at the time of report, outcome of the event was resolving. the benefit-risk relationship of mrna-1273 vaccine is not affected by this report. the case was assessed as serious as per regulatory authority report.; sender's comments: this regulatory case concerns a 41-year-old, male patient with no relevant medical history, who experienced the unexpected, serious (seriousness criteria life-threatening, hospitalization and medically significant), aesi of pulmonary embolism 17 days after the third dose of mrna-1273. at the time of report, outcome of the event was resolving. the benefit-risk relationship of mrna-1273 vaccine is not affected by this report. the case was assessed as serious as per regulatory authority report

Données de laboratoire
na
Liste des symptômes
pulmonary embolism
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?
Oui
Séjour à l’hôpital
Non
Nombre de jours à l’hôpital
Non spécifié
Invalidité permanente?
Non
Allergies:
na
Maladie actuelle
na