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VAERS Report 2157137

Case Report Section

Vaer Report Details

Age: 38 years old

Gender: Male

State: Outside US

Patient Died?
No
Vaccine information

Name: COVID19 (COVID19 (MODERNA))

Type: Coronavirus 2019 vaccine

Manufacturer: MODERNA

Lot: unknown


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2022-01-27
Date of Onset
0
Number of days (onset date – vaccination date)
0
Adverse Event Description

affecting my home and work life; neuralgia from the top of my head on left side to the bottom of my face since day of booster; sporadic sharp pains in left leg; exhaustion; affecting my home and work life; consistently bad pain in fest side of neck / consistent pain; this case was received via agency (reference number: ie-hpra-2022-092136) on 25-feb-2022 and was forwarded to moderna on 25-feb-2022. this regulatory authority case was reported by a consumer and describes the occurrence of loss of personal independence in daily activities (affecting my home and work life), trigeminal neuralgia (neuralgia from the top of my head on left side to the bottom of my face since day of booster), pain in extremity (sporadic sharp pains in left leg), fatigue (exhaustion), impaired work ability (affecting my home and work life) and neck pain (consistently bad pain in fest side of neck / consistent pain) in a 38-year-old male patient who received mrna-1273 (spikevax) for covid-19 immunisation. no medical history information was reported. on 27-jan-2022, the patient received third dose of mrna-1273 (spikevax) (unknown route) .25 milliliter. on 27-jan-2022, the patient experienced loss of personal independence in daily activities (affecting my home and work life) (seriousness criterion disability), trigeminal neuralgia (neuralgia from the top of my head on left side to the bottom of my face since day of booster) (seriousness criterion disability), pain in extremity (sporadic sharp pains in left leg) (seriousness criterion disability), fatigue (exhaustion) (seriousness criterion disability), impaired work ability (affecting my home and work life) (seriousness criterion disability) and neck pain (consistently bad pain in fest side of neck / consistent pain) (seriousness criterion disability). at the time of the report, loss of personal independence in daily activities (affecting my home and work life), trigeminal neuralgia (neuralgia from the top of my head on left side to the bottom of my face since day of booster), pain in extremity (sporadic sharp pains in left leg), fatigue (exhaustion), impaired work ability (affecting my home and work life) and neck pain (consistently bad pain in fest side of neck / consistent pain) outcome was unknown. no concomitant drug details were reported. no treatment information was provided. dosage text: booster dose company comment. this regulatory case concerns a 38 � year � old, male patient with no medical history reported, who experienced the unexpected, serious events of trigeminal neuralgia, pain in extremity, neck pain, fatigue. the events, which were reported as disabling, occurred the same day after the administration of a booster dose of mrna � 1273 vaccine; reported as third dose of the patient's covid-19 vaccination schedule. the report stated that the patient experienced neuralgia from the top of his head (on the left side) to the bottom of his face and neck, and unilateral leg pain, which affected his daily activities and his work. no further details were provided for medical review. the benefit-risk relationship of mrna-1273 vaccine is not affected by this report.; sender's comments: this regulatory case concerns a 38 � year � old, male patient with no medical history reported, who experienced the unexpected, serious events of trigeminal neuralgia, pain in extremity, neck pain, fatigue. the events, which were reported as disabling, occurred the same day after the administration of a booster dose of mrna � 1273 vaccine; reported as third dose of the patient's covid-19 vaccination schedule. the report stated that the patient experienced neuralgia from the top of his head (on the left side) to the bottom of his face and neck, and unilateral leg pain, which affected his daily activities and his work. no further details were provided for medical review. the benefit-risk relationship of mrna-1273 vaccine is not affected by this report

Lab Data
na
List of symptoms
fatigue pain in extremity neck pain impaired work ability loss of personal independence in daily activities trigeminal neuralgia
Patient Died?
No
Date Died
NA
Birth defect
false
Vaccine Administered By:
Unknown
Vaccine Purchased By:
Unknown
Patient visit ER?
No
Patient Hospitalized?
No
Stay in hospital
No
Days in hospital
Unspecified
Permanent disability?
Yes
Allergies:
na
Current Illness
na