Adverse Event Reporting

VAERS ID 2559103
Gender Female
Age 75
StateCode FR
Pharmaceutical Company MODERNA
Lot Number AS7168B
Number of vaccinations 6
Vaccinated 2023-01-09
Onset
Condition
Symptoms
  • No adverse event
  • Vaccination error

Current Illness

Preexisting Conditions

Other Medications

Previous Vaccinations

Allergies

Laboratory Data

Write-up

Vaccine error; Patient did not report any adverse reaction; This spontaneous case was reported by an other health care professional and describes the occurrence of VACCINATION ERROR (Vaccine error) and NO ADVERSE EVENT (Patient did not report any adverse reaction) in a 75-year-old female patient who received mRNA-1273 BIVALENT .
222 (MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.
4/BA.
5)) (batch no.
AS7168B) for COVID-19 prophylaxis.
Previously administered products included for COVID-19 prophylaxis: MODERNA COVID-19 VACCINE on 04-Mar-2021, Moderna COVID-19 Vaccine on 01-Apr-2021, Moderna COVID-19 Vaccine on 05-Nov-2021 and Moderna COVID-19 Vaccine on 11-Jul-2022; for Product used for unknown indication: PFIZER BIONTECH COVID-19 VACCINE on 17-Sep-2022.
Past adverse reactions to the above products included No adverse event with MODERNA COVID-19 VACCINE, Moderna COVID-19 Vaccine, Moderna COVID-19 Vaccine, Moderna COVID-19 Vaccine and PFIZER BIONTECH COVID-19 VACCINE.
On 09-Jan-2023, the patient received sixth dose of mRNA-1273 BIVALENT .
222 (MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.
4/BA.
5)) (unknown route) .
5 milliliter.
On an unknown date, the patient experienced VACCINATION ERROR (Vaccine error) and NO ADVERSE EVENT (Patient did not report any adverse reaction).
At the time of the report, VACCINATION ERROR (Vaccine error) and NO ADVERSE EVENT (Patient did not report any adverse reaction) outcome was unknown.
For mRNA-1273 BIVALENT .
222 (MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.
4/BA.
5)) (Unknown), the reporter considered NO ADVERSE EVENT (Patient did not report any adverse reaction) to be not related.
No further causality assessment was provided for VACCINATION ERROR (Vaccine error).
Concomitant medications were not reported.
The nurse reported that there was a vaccine error.
The patient did not report any adverse reaction.
Treatment information was not provided.