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VAERS Report 2136759

Case Report Section

Détails du rapport Vaer

Âge: 52 ans

Genre: Male

Région : Outside US

Patient décédé?
Non
Renseignements sur les vaccins

Nom: COVID19 (COVID19 (MODERNA))

Type : Coronavirus 2019 vaccine

Fabricant: MODERNA

Lot: xku2xzast5dknnn


Date de réception du rapport
2022-02-24
Date à laquelle le formulaire est complèté
Date de vaccination
2022-01-04
Date d’apparition
14
Nombre de jours (date d’apparition – date de vaccination)
14
Description de l’événement indésirable

longembolieen; headache; don't feel good; fatigue; stuffiness led to stabbing pain.; this case was received via regulatory authority (reference number: nl-lrb-00780910) on 17-feb-2022 and was forwarded to moderna on 17-feb-2022. this regulatory authority case was reported by a consumer and describes the occurrence of pulmonary embolism (longembolieen) in a 52-year-old male patient who received mrna-1273 (spikevax) (batch no. xku2xzast5dknnnpgnrj42#0) for covid-19 vaccination. the occurrence of additional non-serious events is detailed below. the patient's past medical history included covid-19 on 11-dec-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 10-jun-2021, biontech/pfizer vaccin (comirnaty) covid-19 vaccin pfizer injvlst 0 and3mlcovid-19 vaccin pfizer injvlst on 19-aug-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. concomitant products included apixaban and oxycodone hydrochloride (oxycodon) for an unknown indication. on 04-jan-2022, the patient received dose of mrna-1273 (spikevax) (unknown route) 1 dosage form. on 18-jan-2022, the patient experienced dyspnoea (stuffiness led to stabbing pain.) and pulmonary embolism (longembolieen) (seriousness criteria hospitalization, medically significant and life threatening). on an unknown date, the patient experienced malaise (don't feel good), fatigue (fatigue) and headache (headache). at the time of the report, dyspnoea (stuffiness led to stabbing pain.) and pulmonary embolism (longembolieen) was resolving and malaise (don't feel good), fatigue (fatigue) and headache (headache) had not resolved. diagnostic results (normal ranges are provided in parenthesis if available): on 11-dec-2020, sars-cov-2 test positive: positive (positive) positive. on 08-jan-2022, sars-cov-2 test false positive: positive (positive) positive. on an unknown date, computerised tomogram: results not reported unknown. on an unknown date, electrocardiogram: results not reported unknown. on an unknown date, ultrasound scan: results not reported unknown. no treatment details were reported. this is a regulatory case concerning a 52-year-old male patient with a medical history of covid-19, who experienced the unexpected serious event of pulmonary embolism and non serious events of dyspnea, malaise, fatigue and headache. a concomitant product in this case pfizer covid-19 vaccine. the event pulmonary embolism (aesi) occurred approximately 2 weeks after the received dose of mrna � 1273 vaccine. pulmonary embolism was reported as life threatening and caused hospitalization and at the time of report the event had not resolved. the reporter's assessment was not provided. the benefit-risk relationship of the vaccine is not affected by this report.; sender's comments: this is a regulatory case concerning a 52-year-old male patient with a medical history of covid-19, who experienced the unexpected serious event of pulmonary embolism and non serious events of dyspnea, malaise, fatigue and headache. a concomitant product in this case pfizer covid-19 vaccine. the event pulmonary embolism (aesi) occurred approximately 2 weeks after the received dose of mrna � 1273 vaccine. pulmonary embolism was reported as life threatening and caused hospitalization and at the time of report the event had not resolved. the reporter's assessment was not provided. the benefit-risk relationship of the vaccine is not affected by this report

Données de laboratoire
test name: ct scan; result unstructured data: unknown; test name: ecg; result unstructured data: unknown; test date: 20220108; test name: corona, bevestigd met test; test result: positive ; result unstructured data: positive; test date: 20201211; test name: corona, bevestigd met test; test result: positive ; result unstructured data: positive; test name: ultrasound; result unstructured data: unknown
Liste des symptômes
malaise fatigue headache dyspnoea pulmonary embolism electrocardiogram computerised tomogram sars-cov-2 test positive ultrasound scan sars-cov-2 test false positive
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