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VAERS Report 2157215

Case Report Section

Vaer Report Details

Age: 21 years old

Gender: Female

State: Outside US

Patient Died?
No
Vaccine information

Name: COVID19 (COVID19 (MODERNA))

Type: Coronavirus 2019 vaccine

Manufacturer: MODERNA

Lot: unknown


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2021-06-16
Date of Onset
182
Number of days (onset date – vaccination date)
182
Adverse Event Description

pericardite; this case was received via regulatory authority(reference number: it-ra02-840728) on 24-feb-2022 and was forwarded to moderna on 24-feb-2022. this regulatory authority case was reported by a consumer and describes the occurrence of pericarditis (pericardite) in a 21-year-old female patient who received mrna-1273 (spikevax) for covid-19 vaccination. the patient's past medical history included epilepsy (epilepsy). on 16-jun-2021, the patient received dose of mrna-1273 (spikevax) (unknown route) 1 dosage form. on 15-dec-2021, the patient experienced pericarditis (pericardite) (seriousness criterion medically significant). at the time of the report, pericarditis (pericardite) had not resolved. the action taken with mrna-1273 (spikevax) (unknown) was unknown. patient's medical history included chromosome 7 long arm partial trisomy epilepsy the event was severe. no concomitant medication information was reported no treatment medication information was reported company comment: this regulatory case concerns a 21-year-old, female patient with no relevant medical history reported, who experienced serious (medically significant) unexpected aesi event of pericarditis, 6 months after receiving a dose of mrna-1273 vaccine. at the time of the report, event had not resolved. the benefit-risk relationship of mrna-1273 is not affected by this report. event seriousness assessed as per regulatory authority reporting. most recent follow-up information incorporated above includes: on 25-feb-2022: significant follow-up contains, dose start date added. reporter's comments: chromosome 7 long arm partial trisomy epilepsy 08/02/2022 severity modified on the basis of the ime list from non-serious to 'severe-other clinically relevant condition; sender's comments: this regulatory case concerns a 21-year-old, female patient with no relevant medical history reported, who experienced serious (medically significant) unexpected aesi event of pericarditis, 6 months after receiving a dose of mrna-1273 vaccine. at the time of the report, event had not resolved. the benefit-risk relationship of mrna-1273 is not affected by this report. event seriousness assessed as per regulatory authority reporting

Lab Data
na
List of symptoms
pericarditis
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