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VAERS Report 2157205

Case Report Section

Vaer Report Details

Age: 12 years old

Gender: Female

State: Outside US

Patient Died?
No
Vaccine information

Name: COVID19 (COVID19 (MODERNA))

Type: Coronavirus 2019 vaccine

Manufacturer: MODERNA

Lot: 000033a


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2022-01-18
Date of Onset
0
Number of days (onset date – vaccination date)
0
Adverse Event Description

in the evening symptoms appeared: fever 39.5, sore throat, lack of appetite, headache, pain in left injection site. symptoms for two days; in the evening symptoms appeared: fever 39.5, sore throat, lack of appetite, headache, pain in left injection site. symptoms for two days; in the evening symptoms appeared: fever 39.5, sore throat, lack of appetite, headache, pain in left injection site. symptoms for two days; in the evening symptoms appeared: fever 39.5, sore throat, lack of appetite, headache, pain in left injection site. symptoms for two days; in the evening symptoms appeared: fever 39.5, sore throat, lack of appetite, headache, pain in left injection site. symptoms for two days; this case was received via the ra (reference number: it-minisal02-840355) on 23-feb-2022 and was forwarded to moderna on 23-feb-2022. this regulatory authority case was reported by a pharmacist and describes the occurrence of hyperpyrexia (in the evening symptoms appeared: fever 39.5, sore throat, lack of appetite, headache, pain in left injection site. symptoms for two days), administration site pain (in the evening symptoms appeared: fever 39.5, sore throat, lack of appetite, headache, pain in left injection site. symptoms for two days), headache (in the evening symptoms appeared: fever 39.5, sore throat, lack of appetite, headache, pain in left injection site. symptoms for two days), oropharyngeal pain (in the evening symptoms appeared: fever 39.5, sore throat, lack of appetite, headache, pain in left injection site. symptoms for two days) and decreased appetite (in the evening symptoms appeared: fever 39.5, sore throat, lack of appetite, headache, pain in left injection site. symptoms for two days) in a 12-year-old female patient who received mrna-1273 (spikevax) (batch no. 000033a) for covid-19 vaccination. no medical history information was reported. on 18-jan-2022, the patient received dose of mrna-1273 (spikevax) (intramuscular) .5 milliliter. on 18-jan-2022, the patient experienced hyperpyrexia (in the evening symptoms appeared: fever 39.5, sore throat, lack of appetite, headache, pain in left injection site. symptoms for two days) (seriousness criterion medically significant), administration site pain (in the evening symptoms appeared: fever 39.5, sore throat, lack of appetite, headache, pain in left injection site. symptoms for two days) (seriousness criterion medically significant), headache (in the evening symptoms appeared: fever 39.5, sore throat, lack of appetite, headache, pain in left injection site. symptoms for two days) (seriousness criterion medically significant), oropharyngeal pain (in the evening symptoms appeared: fever 39.5, sore throat, lack of appetite, headache, pain in left injection site. symptoms for two days) (seriousness criterion medically significant) and decreased appetite (in the evening symptoms appeared: fever 39.5, sore throat, lack of appetite, headache, pain in left injection site. symptoms for two days) (seriousness criterion medically significant). at the time of the report, hyperpyrexia (in the evening symptoms appeared: fever 39.5, sore throat, lack of appetite, headache, pain in left injection site. symptoms for two days), administration site pain (in the evening symptoms appeared: fever 39.5, sore throat, lack of appetite, headache, pain in left injection site. symptoms for two days), headache (in the evening symptoms appeared: fever 39.5, sore throat, lack of appetite, headache, pain in left injection site. symptoms for two days), oropharyngeal pain (in the evening symptoms appeared: fever 39.5, sore throat, lack of appetite, headache, pain in left injection site. symptoms for two days) and decreased appetite (in the evening symptoms appeared: fever 39.5, sore throat, lack of appetite, headache, pain in left injection site. symptoms for two days) was resolving. for mrna-1273 (spikevax) (intramuscular), the reporter did not provide any causality assessments. no concomitant drug details were reported. 1st batch dose 094f21a administered on 21-dec-2021 no adrs no treatment details were reported. company comment: this regulatory case concerns a 12-year-old, female patient with no medical history reported, who experienced the unexpected, serious (medically significant) events of hyperpyrexia, administration site pain, headache, oropharyngeal pain and decreased appetite. the events occurred on the same day after administration of an unspecified dose of the moderna mrna-1273 vaccine. treatment information was not provided. however, the events were resolving at the time of the report. the benefit-risk relationship of the moderna mrna-1273 vaccine is not affected by this report.; sender's comments: this regulatory case concerns a 12-year-old, female patient with no medical history reported, who experienced the unexpected, serious (medically significant) events of hyperpyrexia, administration site pain, headache, oropharyngeal pain and decreased appetite. the events occurred on the same day after administration of an unspecified dose of the moderna mrna-1273 vaccine. treatment information was not provided. however, the events were resolving at the time of the report. the benefit-risk relationship of the moderna mrna-1273 vaccine is not affected by this report

Lab Data
na
List of symptoms
headache decreased appetite oropharyngeal pain hyperpyrexia administration site pain
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