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VAERS Report 2157231

Case Report Section

Détails du rapport Vaer

Âge: 66 ans

Genre: Male

Région : Outside US

Patient décédé?
Non
Renseignements sur les vaccins

Nom: COVID19 (COVID19 (MODERNA))

Type : Coronavirus 2019 vaccine

Fabricant: MODERNA

Lot: 000004a


Date de réception du rapport
2022-03-04
Date à laquelle le formulaire est complèté
Date de vaccination
2022-01-31
Date d’apparition
2
Nombre de jours (date d’apparition – date de vaccination)
2
Description de l’événement indésirable

bilateral pulmonary embolism; this case was received via agency (reference number: it-minisal02-841004) on 24-feb-2022 and was forwarded to moderna on 24-feb-2022. this regulatory authority case was reported by a physician and describes the occurrence of pulmonary embolism (bilateral pulmonary embolism) in a 66-year-old male patient who received mrna-1273 (spikevax) (batch no. 000004a) for covid-19 vaccination. no medical history information was reported. on 31-jan-2022, the patient received dose of mrna-1273 (spikevax) (intramuscular) .25 milliliter. on 02-feb-2022, after starting mrna-1273 (spikevax), the patient experienced pulmonary embolism (bilateral pulmonary embolism) (seriousness criterion hospitalization). at the time of the report, pulmonary embolism (bilateral pulmonary embolism) had not resolved. for mrna-1273 (spikevax) (intramuscular), the reporter did not provide any causality assessments. no concomitant medications were mentioned. no treatment details were reported. it was reported that patient had bilateral pulmonary embolism two weeks after 3-dose sars-cov2 vaccine with moderna vaccine. all diagnostic-instrumental tests were performed which excluded all other possible causes of embolism. company comment: this regulatory case concerns a 66-year-old male patient with no medical history reported, who experienced the unexpected serious (medically significant according to authority report), event of pulmonary embolism (adverse event of special interest), 2 days after the third dose of mrna-1273 vaccine. clinical details, treatment not reported. it was reported that all diagnostic tests were performed which excluded all other possible causes of embolism. outcome was reported as not resolved at the time of reporting. the benefit-risk relationship of mrna-1273 vaccine is not affected by this report.; reporter's comments: bilateral pulmonary embolism two weeks after 3-dose sars-cov2 vaccine with moderna vaccine. all diagnostic-instrumental tests were performed which exclude all other possible causes of embolism.; sender's comments: this regulatory case concerns a 66-year-old male patient with no medical history reported, who experienced the unexpected serious (medically significant according to authority report), event of pulmonary embolism (adverse event of special interest), 2 days after the third dose of mrna-1273 vaccine. clinical details, treatment not reported. it was reported that all diagnostic tests were performed which excluded all other possible causes of embolism. outcome was reported as not resolved at the time of reporting. the benefit-risk relationship of mrna-1273 vaccine is not affected by this report

Données de laboratoire
na
Liste des symptômes
pulmonary embolism
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