Vaer Report Details
Age: 86 years old
Gender: Male
State: Outside US
- Patient Died?
- No
- Vaccine information
-
Name: COVID19 (COVID19 (MODERNA))
Type: Coronavirus 2019 vaccine
Manufacturer: MODERNA
Lot: 016g21a
- Date report was received
- 2022-03-04
- Date form completed
- Date Vaccinated
- 2021-12-10
- Date of Onset
- 13
- Number of days (onset date – vaccination date)
- 13
- Adverse Event Description
-
enterocarditis and right eye swelling; enterocarditis and right eye swelling; this case was received (reference number: it-minisal02-841779) on 28-feb-2022 and was forwarded to moderna on 28-feb-2022. this regulatory authority case was reported by a consumer and describes the occurrence of eye oedema (enterocarditis and right eye swelling) and endocarditis (enterocarditis and right eye swelling) in an 86-year-old male patient who received mrna-1273 (spikevax) (batch no. 016g21a) for covid-19 vaccination. no medical history information was reported. on 10-dec-2021, the patient received dose of mrna-1273 (spikevax) (intramuscular) .5 milliliter. on 23-dec-2021, the patient experienced eye oedema (enterocarditis and right eye swelling) (seriousness criterion hospitalization) and endocarditis (enterocarditis and right eye swelling) (seriousness criterion hospitalization). at the time of the report, eye oedema (enterocarditis and right eye swelling) and endocarditis (enterocarditis and right eye swelling) had not resolved. the action taken with mrna-1273 (spikevax) (intramuscular) was unknown. no concomitant medications were reported. no treatment details were reported. company comment this is a regulatory case concerning a 86-year-old male patient with no medical history reported, who experienced the serious, due to hospitalization, unexpected events of eye oedema and endocarditis (verbatim: enterocarditis and right eye swelling), which occurred approximately 13 days after a dose of mrna-1273. no further information regarding the clinical course and treatment of the events were provided. the benefit-risk relationship of mrna-1273 vaccine is not affected by this report.; sender's comments: this is a regulatory case concerning a 86-year-old male patient with no medical history reported, who experienced the serious, due to hospitalization, unexpected events of eye oedema and endocarditis (verbatim: enterocarditis and right eye swelling), which occurred approximately 13 days after a dose of mrna-1273. no further information regarding the clinical course and treatment of the events were provided. the benefit-risk relationship of mrna-1273 vaccine is not affected by this report
- Lab Data
-
na
- List of symptoms
-
endocarditis eye oedema
- 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