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VAERS Report 2157142

Case Report Section

Vaer Report Details

Age: 78 years old

Gender: Male

State: Outside US

Patient Died?
No
Vaccine information

Name: COVID19 (COVID19 (MODERNA))

Type: Coronavirus 2019 vaccine

Manufacturer: MODERNA

Lot: 216035


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2022-01-28
Date of Onset
0
Number of days (onset date – vaccination date)
0
Adverse Event Description

severe chest pain that spread down under his arm to stomach area; loss of appetite; severe chest pain that spread down under his arm to stomach area; severe chest pain that spread down under his arm to stomach area; weak with pain; discoloured face; this case was received via regulatory authority (reference number: ie-ra-2022-092203) 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 chest pain (severe chest pain that spread down under his arm to stomach area), decreased appetite (loss of appetite), axillary pain (severe chest pain that spread down under his arm to stomach area), abdominal pain upper (severe chest pain that spread down under his arm to stomach area), asthenia (weak with pain) and skin discolouration (discoloured face) in a 78-year-old male patient who received mrna-1273 (spikevax) (batch no. 216035) for covid-19 vaccination. previously administered products included for covid-19 immunization: comirnaty. past adverse reactions to the above products included no adverse event with comirnaty. on 28-jan-2022, the patient received third dose of mrna-1273 (spikevax) (unknown route) 1 dosage form. in january 2022, the patient experienced chest pain (severe chest pain that spread down under his arm to stomach area) (seriousness criteria hospitalization, medically significant and life threatening), decreased appetite (loss of appetite) (seriousness criteria hospitalization, medically significant and life threatening), axillary pain (severe chest pain that spread down under his arm to stomach area) (seriousness criteria hospitalization, medically significant and life threatening), abdominal pain upper (severe chest pain that spread down under his arm to stomach area) (seriousness criteria hospitalization, medically significant and life threatening), asthenia (weak with pain) (seriousness criteria hospitalization, medically significant and life threatening) and skin discolouration (discoloured face) (seriousness criteria hospitalization, medically significant and life threatening). at the time of the report, chest pain (severe chest pain that spread down under his arm to stomach area), decreased appetite (loss of appetite), axillary pain (severe chest pain that spread down under his arm to stomach area), abdominal pain upper (severe chest pain that spread down under his arm to stomach area), asthenia (weak with pain) and skin discolouration (discoloured face) had not resolved. diagnostic results (normal ranges are provided in parenthesis if available): on an unknown date, blood test: results not reported results not provided. concomitant medications were not provided by the reporter. dosage text was reported as booster dose. treatment information was not provided. company comment: this regulatory case concerns a 78-year-old, male patient with no relevant medical history, who experienced the unexpected, serious (hospitalized, disability, medically significant) events of chest pain with axillary pain and abdominal pain along with asthenia, decreased appetite and skin discolouration. the events occurred 48 hours after receiving the booster dose of mrna-1273 vaccine. it should also be noted that the patient previously received another brand of covid-19 vaccine, comirnaty, on an unspecified date (interchange of vaccine products). on an unknown date, blood tests were conducted but results were not provided in the case. clinical course and treatment details were also not disclosed. at the time of reporting, the patient has not recovered from the events. the benefit-risk relationship of mrna-1273 is not affected by this report. events' seriousness was assessed as per regulatory authority's report, however there was no information in the source document supporting that the events were life-threatening and resulted in a persistent or permanent incapacity. sender's comments: this regulatory case concerns a 78-year-old, male patient with no relevant medical history, who experienced the unexpected, serious (hospitalized, disability, medically significant) events of chest pain with axillary pain and abdominal pain along with asthenia, decreased appetite and skin discolouration. the events occurred 48 hours after receiving the booster dose of mrna-1273 vaccine. it should also be noted that the patient previously received another brand of covid-19 vaccine, comirnaty, on an unspecified date (interchange of vaccine products). on an unknown date, blood tests were conducted but results were not provided in the case. clinical course and treatment details were also not disclosed. at the time of reporting, the patient has not recovered from the events. the benefit-risk relationship of mrna-1273 is not affected by this report. events' seriousness was assessed as per regulatory authority's report, however there was no information in the source document supporting that the events were life-threatening and resulted in a persistent or permanent incapacity

Lab Data
test name: blood test; result unstructured data: results not provided
List of symptoms
chest pain decreased appetite asthenia skin discolouration abdominal pain upper axillary pain blood test
Patient Died?
No
Date Died
NA
Birth defect
false
Vaccine Administered By:
Unknown
Vaccine Purchased By:
Unknown
Patient visit ER?
No
Patient Hospitalized?
Yes
Stay in hospital
No
Days in hospital
Unspecified
Permanent disability?
No
Allergies:
na
Current Illness
na