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VAERS Report 2157272

Case Report Section

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