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VAERS Report 2157287

Case Report Section

Détails du rapport Vaer

Âge: 74 ans

Genre: Male

Région : Outside US

Patient décédé?
Non
Renseignements sur les vaccins

Nom: COVID19 (COVID19 (MODERNA))

Type : Coronavirus 2019 vaccine

Fabricant: MODERNA

Lot: 3005884


Date de réception du rapport
2022-03-04
Date à laquelle le formulaire est complèté
Date de vaccination
2022-01-04
Date d’apparition
1
Nombre de jours (date d’apparition – date de vaccination)
1
Description de l’événement indésirable

on 04/01/22 i carried out 3rd dose with a modrna spikewax vaccine on my left arm; since 5 i had an explosion of ophthalmic shingles in my left eye and crusts left side of the head.; on 04/01/22 i carried out 3rd dose with a modrna spikewax vaccine on my left arm; since 5 i had an explosion of ophthalmic shingles in my left eye and crusts left side of the head.; this case was received via agency (reference number: it-minisal02-842207) 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 ophthalmic herpes zoster (on 04/01/22 i carried out 3rd dose with a modrna spikewax vaccine on my left arm; since 5 i had an explosion of ophthalmic shingles in my left eye and crusts left side of the head.) and scab (on 04/01/22 i carried out 3rd dose with a modrna spikewax vaccine on my left arm; since 5 i had an explosion of ophthalmic shingles in my left eye and crusts left side of the head.) in a 74-year-old male patient who received mrna-1273 (spikevax) (batch no. 3005884) for covid-19 vaccination. no medical history information was reported. on 04-jan-2022, the patient received dose of mrna-1273 (spikevax) (intramuscular) .25 milligram. on 05-jan-2022, the patient experienced ophthalmic herpes zoster (on 04/01/22 i carried out 3rd dose with a modrna spikewax vaccine on my left arm; since 5 i had an explosion of ophthalmic shingles in my left eye and crusts left side of the head.) (seriousness criterion disability) and scab (on 04/01/22 i carried out 3rd dose with a modrna spikewax vaccine on my left arm; since 5 i had an explosion of ophthalmic shingles in my left eye and crusts left side of the head.) (seriousness criterion disability). at the time of the report, ophthalmic herpes zoster (on 04/01/22 i carried out 3rd dose with a modrna spikewax vaccine on my left arm; since 5 i had an explosion of ophthalmic shingles in my left eye and crusts left side of the head.) and scab (on 04/01/22 i carried out 3rd dose with a modrna spikewax vaccine on my left arm; since 5 i had an explosion of ophthalmic shingles in my left eye and crusts left side of the head.) had not resolved. the action taken with mrna-1273 (spikevax) (intramuscular) was unknown. no concomitant medications were reported. treatment information was not provided. first dose was given on 01-may-2021 with lot abw9941 and second dose on 24-july-2021 with lot abx8335. company comment: this is a regulatory authority case concerning a 74-year-old, male patient with no reported medical history, who experienced the unexpected serious (disability according to regulatory authority) events of ophthalmic herpes zoster left eye and scab left side of the head. the events occurred approximately 1 day after the unknown dose number of mrna-1273 vaccine administration. no reported treatment information. the outcome of the events were not resolved from the time of last observation. the patient's age remain confounder. the benefit-risk relationship of mrna-1273 vaccine is not affected by this report.; sender's comments: this is a regulatory authority case concerning a 74-year-old, male patient with no reported medical history, who experienced the unexpected serious (disability according to regulatory authority) events of ophthalmic herpes zoster left eye and scab left side of the head. the events occurred approximately 1 day after the unknown dose number of mrna-1273 vaccine administration. no reported treatment information. the outcome of the events were not resolved from the time of last observation. the patient's age remain confounder. the benefit-risk relationship of mrna-1273 vaccine is not affected by this report

Données de laboratoire
na
Liste des symptômes
scab ophthalmic herpes zoster
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?
Non
Séjour à l’hôpital
Non
Nombre de jours à l’hôpital
Non spécifié
Invalidité permanente?
Oui
Allergies:
na
Maladie actuelle
na