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VAERS Report 2157232

Case Report Section

Vaer Report Details

Age: 87 years old

Gender: Female

State: Outside US

Patient Died?
No
Vaccine information

Name: COVID19 (COVID19 (MODERNA))

Type: Coronavirus 2019 vaccine

Manufacturer: MODERNA

Lot: 030g21a


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2021-12-24
Date of Onset
38
Number of days (onset date – vaccination date)
38
Adverse Event Description

acute coronary heart syndrome and positivity for sars cov 2 in trivaccinate; acute coronary heart syndrome and positivity for sars cov 2 in trivaccinate; this case was received (reference number: it-minisal02-841031) on 24-feb-2022 and was forwarded to moderna on 24-feb-2022. this regulatory authority case was reported by a physician and describes the occurrence of covid-19 (acute coronary heart syndrome and positivity for sars cov 2 in trivaccinate) and acute coronary syndrome (acute coronary heart syndrome and positivity for sars cov 2 in trivaccinate) in an 87-year-old female patient who received mrna-1273 (spikevax) (batch no. 030g21a) for covid-19 vaccination. no medical history information was reported. on 24-dec-2021, the patient received dose of mrna-1273 (spikevax) (intramuscular) .25 milliliter. on 31-jan-2022, the patient experienced covid-19 (acute coronary heart syndrome and positivity for sars cov 2 in trivaccinate) (seriousness criterion hospitalization) and acute coronary syndrome (acute coronary heart syndrome and positivity for sars cov 2 in trivaccinate) (seriousness criterion hospitalization). at the time of the report, covid-19 (acute coronary heart syndrome and positivity for sars cov 2 in trivaccinate) and acute coronary syndrome (acute coronary heart syndrome and positivity for sars cov 2 in trivaccinate) outcome was unknown. diagnostic results (normal ranges are provided in parenthesis if available): on 31-jan-2022, sars-cov-2 test: inconclusive (inconclusive) inconclusive. the action taken with mrna-1273 (spikevax) (intramuscular) was unknown. for mrna-1273 (spikevax) (intramuscular), the reporter did not provide any causality assessments. no concomitant medications were provided. no treatment medications were provided. additional information on drug was reported as abuse/misuse. company comment: this regulatory authority case concerns an 87-year-old female patient, with no medical history reported, who experienced the unexpected serious aesi of covid-19 and acute coronary syndrome. the events occurred approximately 1 month 8 days after receiving a dose of mrna-1273 vaccine and resulted in hospitalization. at the time of the report the outcome of the events was unknown. additional information on drug was reported as abuse/misuse. the benefit-risk relationship of mrna-1273 vaccine is not affected by this report.; sender's comments: this regulatory authority case concerns an 87-year-old female patient, with no medical history reported, who experienced the unexpected serious aesi of covid-19 and acute coronary syndrome. the events occurred approximately 1 month 8 days after receiving a dose of mrna-1273 vaccine and resulted in hospitalization. at the time of the report the outcome of the events was unknown. additional information on drug was reported as abuse/misuse. the benefit-risk relationship of mrna-1273 vaccine is not affected by this report

Lab Data
test date: 20220131; test name: covid-19 pcr test; test result: inconclusive ; result unstructured data: inconclusive
List of symptoms
covid-19 sars-cov-2 test acute coronary syndrome
Patient Died?
No
Date Died
NA
Birth defect
false
Vaccine Administered By:
Unknown
Vaccine Purchased By:
Unknown
Patient visit ER?
No
Patient Hospitalized?
Yes
Stay in hospital
No
Days in hospital
Unspecified
Permanent disability?
No
Allergies:
na
Current Illness
na