Page breadcrumb nav

VAERS Report 2157190

Case Report Section

Vaer Report Details

Age: 52 years old

Gender: Female

State: Outside US

Patient Died?
No
Vaccine information

Name: COVID19 (COVID19 (MODERNA))

Type: Coronavirus 2019 vaccine

Manufacturer: MODERNA

Lot: 030g21a


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2022-01-07
Date of Onset
1
Number of days (onset date – vaccination date)
1
Adverse Event Description

sense of nausea and vomiting, fainting (3 times), severe headache, fever 38, fatigue, gastrointestinal upset; sense of nausea and vomiting, fainting (3 times), severe headache, fever 38, fatigue, gastrointestinal upset; sense of nausea and vomiting, fainting (3 times), severe headache, fever 38, fatigue, gastrointestinal upset; sense of nausea and vomiting, fainting (3 times), severe headache, fever 38, fatigue, gastrointestinal upset; sense of nausea and vomiting, fainting (3 times), severe headache, fever 38, fatigue, gastrointestinal upset; sense of nausea and vomiting, fainting (3 times), severe headache, fever 38, fatigue, gastrointestinal upset; this case was initially received via regulatory authority(reference number: it-ra02-830576) on 28-jan-2022. the most recent information was received 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 fatigue (sense of nausea and vomiting, fainting (3 times), severe headache, fever 38, fatigue, gastrointestinal upset), loss of consciousness (sense of nausea and vomiting, fainting (3 times), severe headache, fever 38, fatigue, gastrointestinal upset), vomiting (sense of nausea and vomiting, fainting (3 times), severe headache, fever 38, fatigue, gastrointestinal upset), nausea (sense of nausea and vomiting, fainting (3 times), severe headache, fever 38, fatigue, gastrointestinal upset), headache (sense of nausea and vomiting, fainting (3 times), severe headache, fever 38, fatigue, gastrointestinal upset) and pyrexia (sense of nausea and vomiting, fainting (3 times), severe headache, fever 38, fatigue, gastrointestinal upset) in a 52-year-old female patient who received mrna-1273 (spikevax) (batch no. 030g21a) for covid-19 vaccination. the patient's past medical history included epistaxis and headache. concurrent medical conditions included seasonal allergy and allergy. concomitant products included alprazolam (xanax) for an unknown indication. on 07-jan-2022, the patient received dose of mrna-1273 (spikevax) (intramuscular) .25 milliliter. on 08-jan-2022, the patient experienced fatigue (sense of nausea and vomiting, fainting (3 times), severe headache, fever 38, fatigue, gastrointestinal upset) (seriousness criterion medically significant), loss of consciousness (sense of nausea and vomiting, fainting (3 times), severe headache, fever 38, fatigue, gastrointestinal upset) (seriousness criterion medically significant), vomiting (sense of nausea and vomiting, fainting (3 times), severe headache, fever 38, fatigue, gastrointestinal upset) (seriousness criterion medically significant), nausea (sense of nausea and vomiting, fainting (3 times), severe headache, fever 38, fatigue, gastrointestinal upset) (seriousness criterion medically significant), headache (sense of nausea and vomiting, fainting (3 times), severe headache, fever 38, fatigue, gastrointestinal upset) (seriousness criterion medically significant) and pyrexia (sense of nausea and vomiting, fainting (3 times), severe headache, fever 38, fatigue, gastrointestinal upset) (seriousness criterion medically significant). at the time of the report, fatigue (sense of nausea and vomiting, fainting (3 times), severe headache, fever 38, fatigue, gastrointestinal upset), loss of consciousness (sense of nausea and vomiting, fainting (3 times), severe headache, fever 38, fatigue, gastrointestinal upset), vomiting (sense of nausea and vomiting, fainting (3 times), severe headache, fever 38, fatigue, gastrointestinal upset), nausea (sense of nausea and vomiting, fainting (3 times), severe headache, fever 38, fatigue, gastrointestinal upset), headache (sense of nausea and vomiting, fainting (3 times), severe headache, fever 38, fatigue, gastrointestinal upset) and pyrexia (sense of nausea and vomiting, fainting (3 times), severe headache, fever 38, fatigue, gastrointestinal upset) was resolving. the action taken with mrna-1273 (spikevax) (intramuscular) was unknown. no treatment medication was provided. senders comment: severity criterion added: serious other clinically relevant condition, following evaluation of the presence of "loss of consciousness" in the ime list, an event reported together with others and which the reporter indicates as having a great impact on the quality of life. company comment: this regulatory authority case concerns a 52-year-old female with a medical history of headaches who experienced the serious (medically significant) unexpected events of fatigue, loss of consciousness, vomiting, nausea, headache and pyrexia 1 day after an unknown dose of mrna-1273. testing and treatment are not reported. the outcome is resolving. the history of headache is a confounder as the patient had these before the reported event. the risk-benefit relationship of mrna-1273 vaccine is not affected by this report. most recent follow-up information incorporated above includes: on 28-feb-2022: significant follow up added. seriousness upgraded for all events and case. senders comment added. reporter's comments: severity criterion added: serious other clinically relevant condition, following evaluation of the presence of "loss of consciousness" in the ime list, an event reported together with others and which the reporter indicates as having a great impact on the quality of life.; sender's comments: this regulatory authority case concerns a 52-year-old female with a medical history of headaches who experienced the serious (medically significant) unexpected events of fatigue, loss of consciousness, vomiting, nausea, headache and pyrexia 1 day after an unknown dose of mrna-1273. testing and treatment are not reported. the outcome is resolving. the history of headache is a confounder as the patient had these before the reported event. the risk-benefit relationship of mrna-1273 vaccine is not affected by this report

Lab Data
na
List of symptoms
fatigue vomiting nausea headache pyrexia loss of consciousness
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
na