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VAERS Report 2157202

Case Report Section

Détails du rapport Vaer

Âge: 47 ans

Genre: Male

Région : Outside US

Patient décédé?
Non
Renseignements sur les vaccins

Nom: COVID19 (COVID19 (MODERNA))

Type : Coronavirus 2019 vaccine

Fabricant: MODERNA

Lot: 094f21a


Date de réception du rapport
2022-03-04
Date à laquelle le formulaire est complèté
Date de vaccination
2022-01-05
Date d’apparition
6
Nombre de jours (date d’apparition – date de vaccination)
6
Description de l’événement indésirable

saphenous thrombosis in the middle third of the leg.; this case was received (reference number: it-minisal02-840202) 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 thrombosis (saphenous thrombosis in the middle third of the leg.) in a 47-year-old male patient who received mrna-1273 (spikevax) (batch no. 094f21a) for covid-19 vaccination. no medical history information was reported. on 05-jan-2022, the patient received dose of mrna-1273 (spikevax) (intramuscular) .5 milliliter. on 11-jan-2022, after starting mrna-1273 (spikevax), the patient experienced thrombosis (saphenous thrombosis in the middle third of the leg.) (seriousness criterion hospitalization). at the time of the report, thrombosis (saphenous thrombosis in the middle third of the leg.) had resolved. it was reported that hypothyroidism treated with eutirox (5ml). no risk factors. no previous pathology. it was also reported that 07-feb-2022. insertion ecocolordoppler update warning information. company comment: this regulatory case concerns a 47-year-old male patient, with relevant medical history of hypothyroidism and bmi of 29.31 (overweight), experienced the unexpected serious aesi event, thrombosis, six days after a dose of mrna-1273. it was reported that the patient experienced saphenous thrombosis in the middle third of the leg and was hospitalized. at the time of reporting, the event had resolved. the patient's medical history of hypothyroidism and bmi of 29.31 (overweight) could be confounders to the event. the benefit-risk relationship of mrna-1273 is not affected by this report. event seriousness assessed as per regulatory authority reporting.; reporter's comments: hypothyroidism treated with eutirox (5ml) no risk factors. no previous pathology.; sender's comments: this regulatory case concerns a 47-year-old male patient, with relevant medical history of hypothyroidism and bmi of 29.31 (overweight), experienced the unexpected serious aesi event, thrombosis, six days after a dose of mrna-1273. it was reported that the patient experienced saphenous thrombosis in the middle third of the leg and was hospitalized. at the time of reporting, the event had resolved. the patient's medical history of hypothyroidism and bmi of 29.31 (overweight) could be confounders to the event. the benefit-risk relationship of mrna-1273 is not affected by this report. event seriousness assessed as per regulatory authority reporting

Données de laboratoire
na
Liste des symptômes
thrombosis
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