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VAERS Report 2136747

Case Report Section

Détails du rapport Vaer

Âge: 71 ans

Genre: Male

Région : Outside US

Patient décédé?
Non
Renseignements sur les vaccins

Nom: COVID19 (COVID19 (MODERNA))

Type : Coronavirus 2019 vaccine

Fabricant: MODERNA

Lot: ef841ac5-d48d-4


Date de réception du rapport
2022-02-24
Date à laquelle le formulaire est complèté
Date de vaccination
2021-12-21
Date d’apparition
1
Nombre de jours (date d’apparition – date de vaccination)
1
Description de l’événement indésirable

paralysis of the 6th optic nerve; fever: 37.5 to 38 degrees celcius; fatigue; this case was received via regulatory authority (reference number: nl-lrb-00778110) on 18-feb-2022 and was forwarded to moderna on 18-feb-2022. this regulatory authority case was reported by a consumer and describes the occurrence of vith nerve paralysis (paralysis of the 6th optic nerve) in a 71-year-old male patient who received mrna-1273 (spikevax) (batch no. ef841ac5-d48d-4d1d-9686-d35d43bd0a8) for covid-19 vaccination. the occurrence of additional non-serious events is detailed below. the patient's past medical history included suspected covid-19 on 03-mar-2020. previously administered products included for product used for unknown indication: biontech/pfizer vaccin (comirnaty) covid-19 vaccin pfizer injvlst 0,3mlcovid-19 vaccin pfizer injvlst on 26-apr-2021, biontech/pfizer vaccin (comirnaty) covid-19 vaccin pfizer injvlst 0,3mlcovid-19 vaccin pfizer injvlst on 26-apr-2021, biontech/pfizer vaccin (comirnaty) covid-19 vaccin pfizer injvlst 0,3mlcovid-19 vaccin pfizer injvlst on 26-apr-2021, biontech/pfizer vaccin (comirnaty) covid-19 vaccin pfizer injvlst 0,3mlcovid-19 vaccin pfizer injvlst on 31-may-2021, biontech/pfizer vaccin (comirnaty) covid-19 vaccin pfizer injvlst 0 and3mlcovid-19 vaccin pfizer injvlst on 31-may-2021. past adverse reactions to the above products included fatigue with biontech/pfizer vaccin (comirnaty) covid-19 vaccin pfizer injvlst 0,3mlcovid-19 vaccin pfizer injvlst, biontech/pfizer vaccin (comirnaty) covid-19 vaccin pfizer injvlst 0 and3mlcovid-19 vaccin pfizer injvlst; fever with biontech/pfizer vaccin (comirnaty) covid-19 vaccin pfizer injvlst 0 and3mlcovid-19 vaccin pfizer injvlst; and somnolence with biontech/pfizer vaccin (comirnaty) covid-19 vaccin pfizer injvlst 0,3mlcovid-19 vaccin pfizer injvlst, biontech/pfizer vaccin (comirnaty) covid-19 vaccin pfizer injvlst 0 and3mlcovid-19 vaccin pfizer injvlst. on 21-dec-2021, the patient received dose of mrna-1273 (spikevax) (unknown route) 1 dosage form. on 22-dec-2021, the patient experienced body temperature increased (fever: 37.5 to 38 degrees celcius) and fatigue (fatigue). on 01-jan-2022, the patient experienced vith nerve paralysis (paralysis of the 6th optic nerve) (seriousness criterion disability). at the time of the report, body temperature increased (fever: 37.5 to 38 degrees celcius) and fatigue (fatigue) had resolved and vith nerve paralysis (paralysis of the 6th optic nerve) had not resolved. diagnostic results (normal ranges are provided in parenthesis if available): on 22-dec-2021, body temperature increased: fever: 37.5 to 38 degrees celcius (high) fever: 37.5 to 38 degrees celcius. no concomitant medication provided. no treatment medication reported. company comment this regulatory authority case concerns a 71-year-old male patient, with no reported medical history, who experienced the unexpected serious event (disability) of vith nerve paralysis, which occurred approximately 11 days after receiving a dose of mrna-1273 vaccine, considered the 3rd dose for covid19 vaccination. primary vaccination against covid-19 was completed with biontech/pfizer vaccine (interchange of vaccine products). at the time of report, event had not resolved. the benefit-risk relationship of mrna-1273 vaccine is not affected by this report.; sender's comments: this regulatory authority case concerns a 71-year-old male patient, with no reported medical history, who experienced the unexpected serious event (disability) of vith nerve paralysis, which occurred approximately 11 days after receiving a dose of mrna-1273 vaccine, considered the 3rd dose for covid19 vaccination. primary vaccination against covid-19 was completed with biontech/pfizer vaccine (interchange of vaccine products). at the time of report, event had not resolved. the benefit-risk relationship of mrna-1273 vaccine is not affected by this report

Données de laboratoire
test date: 20211222; test name: body temperature increased; result unstructured data: fever: 37.5 to 38 degrees celcius
Liste des symptômes
fatigue body temperature increased vith nerve paralysis
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