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VAERS Report 2157230

Case Report Section

Vaer Report Details

Age: 77 years old

Gender: Male

State: Outside US

Patient Died?
No
Vaccine information

Name: COVID19 (COVID19 (MODERNA))

Type: Coronavirus 2019 vaccine

Manufacturer: MODERNA

Lot: 216037


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2022-02-02
Date of Onset
2
Number of days (onset date – vaccination date)
2
Adverse Event Description

impossibility to stand in balance and walk; impossibility to stand in balance and walk; impossibility to stand in balance and walk; this regulatory authority case was reported by a consumer and describes the occurrence of gait disturbance (impossibility to stand in balance and walk), balance disorder (impossibility to stand in balance and walk) and dysstasia (impossibility to stand in balance and walk) in a 77-year-old male patient who received mrna-1273 (spikevax) (batch no. 216037) for covid-19 vaccination. 1st dose comirnaty on 22 april 2021 at 12.13 pm left shoulder lot ex0893 expired on 31 july 2021. 2nd dose comirnaty on 14 may 2021 at 11.41 left shoulder lot fa4597 expired on 31 august 2021. concomitant products included nebivolol hydrochloride (lobivon) from 22-dec-2021 to an unknown date, doxazosin mesilate (cardura) from 09-oct-2013 to an unknown date, furosemide (furosemide flx) from 13-apr-2014 to an unknown date, calcitriol (rocaltrol) from 26-oct-2017 to an unknown date and folic acid (folinal) from 22-dec-2021 to an unknown date for renal failure, ezetimibe from 25-oct-2016 to an unknown date, ursodeoxycholic acid (deursil) from 22-dec-2021 to an unknown date, lactobacillus acidophilus (acido) from 29-dec-2009 to an unknown date, valproate sodium (depakin) from 22-dec-2021 to an unknown date and calcitriol (rocaltrol) from 22-dec-2021 to an unknown date for an unknown indication. on 02-feb-2022, the patient received dose of mrna-1273 (spikevax) (intramuscular) .25 milliliter. on 04-feb-2022, the patient experienced gait disturbance (impossibility to stand in balance and walk) (seriousness criterion hospitalization), balance disorder (impossibility to stand in balance and walk) (seriousness criterion hospitalization) and dysstasia (impossibility to stand in balance and walk) (seriousness criterion hospitalization). at the time of the report, gait disturbance (impossibility to stand in balance and walk), balance disorder (impossibility to stand in balance and walk) and dysstasia (impossibility to stand in balance and walk) had not resolved. the action taken with mrna-1273 (spikevax) (intramuscular) was unknown. no treatment information was provided. sender's comment: 1st dose comirnaty 22/04/2021 at 12.13 pm left shoulder lot: ex0893 expires 31/07/2021. 2nd dose comirnaty 14/05/2021 at 11.41 left shoulder lot: fa4597 expired 31/08/2021. access in p.s on 04/02/2022 and admission in neurology. this is a regulatory authority case concerning a 77-year-old, male patient with no relevant medical history, who experienced the unexpected events of gait disturbance, balance disorder, dysstasia. the events occurred 2 days after the unspecified dose of mrna-1273 covid 19 vaccine. no treatment information was provided. the events were reported as not resolved. the benefit-risk relationship of mrna-1273 covid 19 vaccine, is not affected by this report.; reporter's comments: metabolic picture of important ir (close to dialysis).; sender's comments: this is a regulatory authority case concerning a 77-year-old, male patient with no relevant medical history, who experienced the unexpected events of gait disturbance, balance disorder, dysstasia. the events occurred 2 days after the unspecified dose of mrna-1273 covid 19 vaccine. no treatment information was provided. the events were reported as not resolved. the benefit-risk relationship of mrna-1273 covid 19 vaccine, is not affected by this report

Lab Data
na
List of symptoms
gait disturbance balance disorder dysstasia
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