Adverse Event Reporting

VAERS ID	1153980
Gender	Unknown
Age
StateCode	ND
Pharmaceutical Company	MODERNA
Lot Number
Number of vaccinations
Vaccinated
Onset
Condition	Permanent Disability

Symptoms

• Anaphylactic reaction

Current Illness

Preexisting Conditions

Medical History/Concurrent Conditions: No adverse event

Other Medications

Previous Vaccinations

Allergies

Laboratory Data

Write-up

anaphylaxis; A Spontaneous report was received from a nurse concerning unknown patient who received Modern's COVID-19 vaccine (mRNA-1273) and experienced Anaphylactic reaction.
The patient's medical history was unknown.
Concomitant medications are not reported.
On unknown date prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (lot/batch: unknown) for prophylaxis of COVID-19 infection.
On an unknown date the patient experienced Anaphylactic reactions.
The event is considered as medically significant.
No treatment was given.
No lab details are provided.
No Action taken with mRNA-1273 in response to the events was not reported.
At the time of this report, the outcome of the events were unknown.
; Reporter's Comments: Very limited information regarding this event has been provided at this time.
Further information has been requested.