Vaer Report Details
Age: 38 years old
Gender: Male
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
- 2022-01-27
- Date of Onset
- 0
- Number of days (onset date – vaccination date)
- 0
- Adverse Event Description
-
affecting my home and work life; neuralgia from the top of my head on left side to the bottom of my face since day of booster; sporadic sharp pains in left leg; exhaustion; affecting my home and work life; consistently bad pain in fest side of neck / consistent pain; this case was received via agency (reference number: ie-hpra-2022-092136) on 25-feb-2022 and was forwarded to moderna on 25-feb-2022. this regulatory authority case was reported by a consumer and describes the occurrence of loss of personal independence in daily activities (affecting my home and work life), trigeminal neuralgia (neuralgia from the top of my head on left side to the bottom of my face since day of booster), pain in extremity (sporadic sharp pains in left leg), fatigue (exhaustion), impaired work ability (affecting my home and work life) and neck pain (consistently bad pain in fest side of neck / consistent pain) in a 38-year-old male patient who received mrna-1273 (spikevax) for covid-19 immunisation. no medical history information was reported. on 27-jan-2022, the patient received third dose of mrna-1273 (spikevax) (unknown route) .25 milliliter. on 27-jan-2022, the patient experienced loss of personal independence in daily activities (affecting my home and work life) (seriousness criterion disability), trigeminal neuralgia (neuralgia from the top of my head on left side to the bottom of my face since day of booster) (seriousness criterion disability), pain in extremity (sporadic sharp pains in left leg) (seriousness criterion disability), fatigue (exhaustion) (seriousness criterion disability), impaired work ability (affecting my home and work life) (seriousness criterion disability) and neck pain (consistently bad pain in fest side of neck / consistent pain) (seriousness criterion disability). at the time of the report, loss of personal independence in daily activities (affecting my home and work life), trigeminal neuralgia (neuralgia from the top of my head on left side to the bottom of my face since day of booster), pain in extremity (sporadic sharp pains in left leg), fatigue (exhaustion), impaired work ability (affecting my home and work life) and neck pain (consistently bad pain in fest side of neck / consistent pain) outcome was unknown. no concomitant drug details were reported. no treatment information was provided. dosage text: booster dose company comment. this regulatory case concerns a 38 � year � old, male patient with no medical history reported, who experienced the unexpected, serious events of trigeminal neuralgia, pain in extremity, neck pain, fatigue. the events, which were reported as disabling, occurred the same day after the administration of a booster dose of mrna � 1273 vaccine; reported as third dose of the patient's covid-19 vaccination schedule. the report stated that the patient experienced neuralgia from the top of his head (on the left side) to the bottom of his face and neck, and unilateral leg pain, which affected his daily activities and his work. no further details were provided for medical review. the benefit-risk relationship of mrna-1273 vaccine is not affected by this report.; sender's comments: this regulatory case concerns a 38 � year � old, male patient with no medical history reported, who experienced the unexpected, serious events of trigeminal neuralgia, pain in extremity, neck pain, fatigue. the events, which were reported as disabling, occurred the same day after the administration of a booster dose of mrna � 1273 vaccine; reported as third dose of the patient's covid-19 vaccination schedule. the report stated that the patient experienced neuralgia from the top of his head (on the left side) to the bottom of his face and neck, and unilateral leg pain, which affected his daily activities and his work. no further details were provided for medical review. the benefit-risk relationship of mrna-1273 vaccine is not affected by this report
- Lab Data
-
na
- List of symptoms
-
fatigue pain in extremity neck pain impaired work ability loss of personal independence in daily activities trigeminal neuralgia
- 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?
- Yes
- Allergies:
-
na
- Current Illness
-
na