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VAERS Report 2136749

Case Report Section

Détails du rapport Vaer

Âge: 58 ans

Genre: Male

Région : Outside US

Patient décédé?
Non
Renseignements sur les vaccins

Nom: COVID19 (COVID19 (MODERNA))

Type : Coronavirus 2019 vaccine

Fabricant: MODERNA

Lot: unknown


Date de réception du rapport
2022-02-24
Date à laquelle le formulaire est complèté
Date de vaccination
2022-01-08
Date d’apparition
3
Nombre de jours (date d’apparition – date de vaccination)
3
Description de l’événement indésirable

pulmonary embolisms; this case was received via regulatory authority (reference number: nl-lrb-00779037) on 15-feb-2022 and was forwarded to moderna on 15-feb-2022. this regulatory authority case was reported by an other health care professional and describes the occurrence of pulmonary embolism (pulmonary embolisms) in a 58-year-old male patient who received mrna-1273 (spikevax) for covid-19 vaccination. 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 07-jun-2021, biontech/pfizer vaccin (comirnaty) covid-19 vaccin pfizer injvlst 0 and3mlcovid-19 vaccin pfizer injvlst on 12-jul-2021. past adverse reactions to the above products included no adverse reaction 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 08-jan-2022, the patient received dose of mrna-1273 (spikevax) (unknown route) 1 dosage form. on 11-jan-2022, the patient experienced pulmonary embolism (pulmonary embolisms) (seriousness criterion hospitalization). at the time of the report, pulmonary embolism (pulmonary embolisms) was resolving. for mrna-1273 (spikevax) (unknown), the reporter did not provide any causality assessments. concomitant medication were not reported treatment medication were not reported company comment: this is a regulatory authority case concerning a 58-year-old male patient, with no medical history reported, who experienced the unexpected, serious (hospitalization), and aesi of pulmonary embolism. the event occurred 3 days after a dose of mrna-1273 vaccine. patient completed primary vaccination against covid-19 with pfizer vaccine (interchange of vaccine products). the benefit-risk relationship of mrna-1273 vaccine is not affected by this report. most recent follow-up information incorporated above includes: on 15-feb-2022: translation document received on 18-feb-2022 included translated event verbatim.; sender's comments: this is a regulatory authority case concerning a 58-year-old male patient, with no medical history reported, who experienced the unexpected, serious (hospitalization), and aesi of pulmonary embolism. the event occurred 3 days after a dose of mrna-1273 vaccine. patient completed primary vaccination against covid-19 with pfizer vaccine (interchange of vaccine products). the benefit-risk relationship of mrna-1273 vaccine is not affected by this report

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