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VAERS Report 2157287

Case Report Section

Vaer Report Details

Age: 74 years old

Gender: Male

State: Outside US

Patient Died?
No
Vaccine information

Name: COVID19 (COVID19 (MODERNA))

Type: Coronavirus 2019 vaccine

Manufacturer: MODERNA

Lot: 3005884


Date report was received
2022-03-04
Date form completed
Date Vaccinated
2022-01-04
Date of Onset
1
Number of days (onset date – vaccination date)
1
Adverse Event Description

on 04/01/22 i carried out 3rd dose with a modrna spikewax vaccine on my left arm; since 5 i had an explosion of ophthalmic shingles in my left eye and crusts left side of the head.; on 04/01/22 i carried out 3rd dose with a modrna spikewax vaccine on my left arm; since 5 i had an explosion of ophthalmic shingles in my left eye and crusts left side of the head.; this case was received via agency (reference number: it-minisal02-842207) on 28-feb-2022 and was forwarded to moderna on 28-feb-2022. this regulatory authority case was reported by a consumer and describes the occurrence of ophthalmic herpes zoster (on 04/01/22 i carried out 3rd dose with a modrna spikewax vaccine on my left arm; since 5 i had an explosion of ophthalmic shingles in my left eye and crusts left side of the head.) and scab (on 04/01/22 i carried out 3rd dose with a modrna spikewax vaccine on my left arm; since 5 i had an explosion of ophthalmic shingles in my left eye and crusts left side of the head.) in a 74-year-old male patient who received mrna-1273 (spikevax) (batch no. 3005884) for covid-19 vaccination. no medical history information was reported. on 04-jan-2022, the patient received dose of mrna-1273 (spikevax) (intramuscular) .25 milligram. on 05-jan-2022, the patient experienced ophthalmic herpes zoster (on 04/01/22 i carried out 3rd dose with a modrna spikewax vaccine on my left arm; since 5 i had an explosion of ophthalmic shingles in my left eye and crusts left side of the head.) (seriousness criterion disability) and scab (on 04/01/22 i carried out 3rd dose with a modrna spikewax vaccine on my left arm; since 5 i had an explosion of ophthalmic shingles in my left eye and crusts left side of the head.) (seriousness criterion disability). at the time of the report, ophthalmic herpes zoster (on 04/01/22 i carried out 3rd dose with a modrna spikewax vaccine on my left arm; since 5 i had an explosion of ophthalmic shingles in my left eye and crusts left side of the head.) and scab (on 04/01/22 i carried out 3rd dose with a modrna spikewax vaccine on my left arm; since 5 i had an explosion of ophthalmic shingles in my left eye and crusts left side of the head.) had not resolved. the action taken with mrna-1273 (spikevax) (intramuscular) was unknown. no concomitant medications were reported. treatment information was not provided. first dose was given on 01-may-2021 with lot abw9941 and second dose on 24-july-2021 with lot abx8335. company comment: this is a regulatory authority case concerning a 74-year-old, male patient with no reported medical history, who experienced the unexpected serious (disability according to regulatory authority) events of ophthalmic herpes zoster left eye and scab left side of the head. the events occurred approximately 1 day after the unknown dose number of mrna-1273 vaccine administration. no reported treatment information. the outcome of the events were not resolved from the time of last observation. the patient's age remain confounder. the benefit-risk relationship of mrna-1273 vaccine is not affected by this report.; sender's comments: this is a regulatory authority case concerning a 74-year-old, male patient with no reported medical history, who experienced the unexpected serious (disability according to regulatory authority) events of ophthalmic herpes zoster left eye and scab left side of the head. the events occurred approximately 1 day after the unknown dose number of mrna-1273 vaccine administration. no reported treatment information. the outcome of the events were not resolved from the time of last observation. the patient's age remain confounder. the benefit-risk relationship of mrna-1273 vaccine is not affected by this report

Lab Data
na
List of symptoms
scab ophthalmic herpes zoster
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