VAERS ID: 1294837

AGE: 59| SEX: F|STATE: MA (United States)

Description

In and out of consciousness; feeling faint, fainted briefly/Passed out multiple times; Couldn't stand up; Flu-like symptoms; Fever with a temperature of 103 degress; This spontaneous case was reported by a consumer and describes the occurrence of LOSS OF CONSCIOUSNESS (In and out of consciousness) and SYNCOPE (feeling faint, fainted briefly/Passed out multiple times) in a 59-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 010N120A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No reported medical history. Concomitant products included AMITRIPTYLINE for an unknown indication. On 24-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 24-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 24-Mar-2021, the patient experienced LOSS OF CONSCIOUSNESS (In and out of consciousness) (seriousness criteria hospitalization and medically significant), SYNCOPE (feeling faint, fainted briefly/Passed out multiple times) (seriousness criteria hospitalization and medically significant), DYSSTASIA (Couldn't stand up) and INFLUENZA LIKE ILLNESS (Flu-like symptoms). 24-Mar-2021, the patient experienced PYREXIA (Fever with a temperature of 103 degress). At the time of the report, LOSS OF CONSCIOUSNESS (In and out of consciousness), SYNCOPE (feeling faint, fainted briefly/Passed out multiple times), DYSSTASIA (Couldn't stand up), INFLUENZA LIKE ILLNESS (Flu-like symptoms) and PYREXIA (Fever with a temperature of 103 degress) had not resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 24-Mar-2021, Body temperature: 103 High. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Patient received treatment medication included Tylenol, to alleviate the symptoms. Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.

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Symptoms

Pyrexia, Syncope, Influenza like illness, Loss of consciousness, Body temperature, Dysstasia

Vaccines

VAX DATE: 02-24-2021| ONSET DATE: 03-24-2021| DAYS TO ONSET: 28
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 1 COVID19 MODERNA 010N120A OT LA

RECVDATE:05-07-2021
RPT_DATE:
CAGE_YR:59
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:Y
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:Test Date: 20210324; Test Name: Body temperature
V_ADMINBY:
OTHER_MEDS:AMITRIPTYLINE
CUR_ILL:
HISTORY:Comments: No reported medical history
PRIOR_VAX:
SPLTTYPE:USMODERNATX, INC.MOD20211
FORM_VERS:
TODAYS_DATE:05-07-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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