Vaer Report Details
Age: 87 years old
Gender: Female
State: Outside US
- Patient Died?
- No
- Vaccine information
-
Name: COVID19 (COVID19 (MODERNA))
Type: Coronavirus 2019 vaccine
Manufacturer: MODERNA
Lot: 030g21a
- Date report was received
- 2022-03-04
- Date form completed
- Date Vaccinated
- 2021-12-24
- Date of Onset
- 38
- Number of days (onset date – vaccination date)
- 38
- Adverse Event Description
-
acute coronary heart syndrome and positivity for sars cov 2 in trivaccinate; acute coronary heart syndrome and positivity for sars cov 2 in trivaccinate; this case was received (reference number: it-minisal02-841031) 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 covid-19 (acute coronary heart syndrome and positivity for sars cov 2 in trivaccinate) and acute coronary syndrome (acute coronary heart syndrome and positivity for sars cov 2 in trivaccinate) in an 87-year-old female patient who received mrna-1273 (spikevax) (batch no. 030g21a) for covid-19 vaccination. no medical history information was reported. on 24-dec-2021, the patient received dose of mrna-1273 (spikevax) (intramuscular) .25 milliliter. on 31-jan-2022, the patient experienced covid-19 (acute coronary heart syndrome and positivity for sars cov 2 in trivaccinate) (seriousness criterion hospitalization) and acute coronary syndrome (acute coronary heart syndrome and positivity for sars cov 2 in trivaccinate) (seriousness criterion hospitalization). at the time of the report, covid-19 (acute coronary heart syndrome and positivity for sars cov 2 in trivaccinate) and acute coronary syndrome (acute coronary heart syndrome and positivity for sars cov 2 in trivaccinate) outcome was unknown. diagnostic results (normal ranges are provided in parenthesis if available): on 31-jan-2022, sars-cov-2 test: inconclusive (inconclusive) inconclusive. the action taken with mrna-1273 (spikevax) (intramuscular) was unknown. for mrna-1273 (spikevax) (intramuscular), the reporter did not provide any causality assessments. no concomitant medications were provided. no treatment medications were provided. additional information on drug was reported as abuse/misuse. company comment: this regulatory authority case concerns an 87-year-old female patient, with no medical history reported, who experienced the unexpected serious aesi of covid-19 and acute coronary syndrome. the events occurred approximately 1 month 8 days after receiving a dose of mrna-1273 vaccine and resulted in hospitalization. at the time of the report the outcome of the events was unknown. additional information on drug was reported as abuse/misuse. the benefit-risk relationship of mrna-1273 vaccine is not affected by this report.; sender's comments: this regulatory authority case concerns an 87-year-old female patient, with no medical history reported, who experienced the unexpected serious aesi of covid-19 and acute coronary syndrome. the events occurred approximately 1 month 8 days after receiving a dose of mrna-1273 vaccine and resulted in hospitalization. at the time of the report the outcome of the events was unknown. additional information on drug was reported as abuse/misuse. the benefit-risk relationship of mrna-1273 vaccine is not affected by this report
- Lab Data
-
test date: 20220131; test name: covid-19 pcr test; test result: inconclusive ; result unstructured data: inconclusive
- List of symptoms
-
covid-19 sars-cov-2 test acute coronary syndrome
- 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