National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts.org
Search Results

From the 1/14/2022 release of VAERS data:

This is VAERS ID 1931744

Government Disclaimer on use of this data



Case Details

VAERS ID: 1931744 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-11-15
Onset:2021-11-22
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-12-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 940067 / UNK - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Headache, Pyrexia, Seizure
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: PHMODERNATX, INC.MOD20214

Write-up: HEADACHE; SEIZURE; FEVER; This regulatory authority case was reported by a physician and describes the occurrence of PYREXIA (FEVER), SEIZURE (SEIZURE) and HEADACHE (HEADACHE) in a 13-year-old male patient who received mRNA-1273 (COVID-19 Vaccine Moderna) (batch no. 940067) for an unknown indication. No Medical History information was reported. On 15-Nov-2021, the patient received dose of mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular) 1 dosage form. On 22-Nov-2021 at 9:00 PM, the patient experienced PYREXIA (FEVER) (seriousness criterion death). On 23-Nov-2021, the patient experienced SEIZURE (SEIZURE) (seriousness criteria death and medically significant). On 24-Nov-2021 at 5:43 PM, the patient experienced HEADACHE (HEADACHE) (seriousness criterion death). The reported cause of death was Fever, Seizure and Headache. It is unknown if an autopsy was performed. For mRNA-1273 (COVID-19 Vaccine Moderna) (Intramuscular), the reporter did not provide any causality assessments. Concomitant product use was not provided by the reporter. No treatment information was provided.; Sender''s Comments: This case a 13-year-old male patient who received mRNA-1273 (COVID-19 Vaccine Moderna) with no relevant medical history who experienced the serious unexpected event of seizure 9 days after the second dose of the vaccine. Rechallenge is not applicable, since no further dosing is expected. The benefit-risk relationship is not affected by this report; Reported Cause(s) of Death: FEVER; SEIZURE; HEADACHE


New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=1931744


Copyright © 2022 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166