Vaer Report Details
Age: 52 years old
Gender: Male
State: Outside US
- Patient Died?
- No
- Vaccine information
-
Name: COVID19 (COVID19 (MODERNA))
Type: Coronavirus 2019 vaccine
Manufacturer: MODERNA
Lot: 214064
- Date report was received
- 2022-03-04
- Date form completed
- Date Vaccinated
- 2022-01-15
- Date of Onset
- 16
- Number of days (onset date – vaccination date)
- 16
- Adverse Event Description
-
oppression/weight on the heart shortness paresis slight right eye; oppression/weight on the heart shortness paresis slight right eye; oppression/weight on the heart shortness paresis slight right eye; this case was received via agency (reference number: it-minisal02-840189) on 23-feb-2022 and was forwarded to moderna on 23-feb-2022. this regulatory authority case was reported by a consumer and describes the occurrence of dyspnoea (oppression/weight on the heart shortness paresis slight right eye), ophthalmoplegia (oppression/weight on the heart shortness paresis slight right eye) and cardiac discomfort (oppression/weight on the heart shortness paresis slight right eye) in a 52-year-old male patient who received mrna-1273 (spikevax) (batch no. 214064) for covid-19 vaccination. concurrent conditions included autoimmune hypothyroidism. concomitant products included levothyroxine sodium (eutirox) for an unknown indication. on 15-jan-2022, the patient received dose of mrna-1273 (spikevax) (intramuscular) 1 dosage form. on 31-jan-2022, the patient experienced dyspnoea (oppression/weight on the heart shortness paresis slight right eye) (seriousness criterion hospitalization), ophthalmoplegia (oppression/weight on the heart shortness paresis slight right eye) (seriousness criterion hospitalization) and cardiac discomfort (oppression/weight on the heart shortness paresis slight right eye) (seriousness criterion hospitalization). at the time of the report, dyspnoea (oppression/weight on the heart shortness paresis slight right eye), ophthalmoplegia (oppression/weight on the heart shortness paresis slight right eye) and cardiac discomfort (oppression/weight on the heart shortness paresis slight right eye) had not resolved. the action taken with mrna-1273 (spikevax) (intramuscular) was unknown. no treatment details were reported. company comment : this regulatory authority case concerns a 52 -years-old, male patient with relevant medical history of autoimmune hypothyroidism reported, who experienced unexpected serious events of dyspnoea, ophthalmoplegia, cardiac discomfort (seriousness criterion hospitalization), which occurred 16 days after a dose of (dose number not specified) of mrna-1273 vaccine administration. medical history of autoimmune hypothyroidism remains as confounding. the benefit-risk relationship of mrna-1273 is not affected by this report. the events were assessed as serious as per regulatory authority�s report.; reporter's comments: autoimmune hypothyroidism.; sender's comments: this regulatory authority case concerns a 52 -years-old, male patient with relevant medical history of autoimmune hypothyroidism reported, who experienced unexpected serious events of dyspnoea, ophthalmoplegia, cardiac discomfort (seriousness criterion hospitalization), which occurred 16 days after a dose of (dose number not specified) of mrna-1273 vaccine administration. medical history of autoimmune hypothyroidism remains as confounding. the benefit-risk relationship of mrna-1273 is not affected by this report. the events were assessed as serious as per regulatory authority�s report
- Lab Data
-
na
- List of symptoms
-
dyspnoea ophthalmoplegia cardiac discomfort
- 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