Sex: U
Vaccine: COVID19
Symptoms: Physical examination, Pyrexia, Respiratory rate, SARS-CoV-2 test, Vital signs measurement
Clinical narrative: Blood pressure high; Dizzy; Myalgia/myalgias; Fever/high fever over 103; Fatigue; Vomiting; Increase forgetfulness; Confusion; very sick; no energy; Head hurt/head hurt 24/7 and the COVID VAXX has made it worse; Back hurt/back hurt 24/7 and the COVID VAXX has made it worse; This spontaneous case was reported by a non-health professional and describes the occurrence of BACK PAIN (Back hurt/back hurt 24/7 and the COVID VAXX has made it worse), MEMORY IMPAIRMENT (Increase forgetfulness), CONFUSIONAL STATE (Confusion), HYPERTENSION (Blood pressure high) and ILLNESS (very sick) in a  patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 prophylaxis. The occurrence of additional non-serious events is detailed below.     The patient's past medical history included Encephalopathy on 16-Sep-2019, Drug overdose on 16-Sep-2019, Drug overdose on 15-Sep-2019 and MRI brain abnormal on 21-Sep-2019. Concurrent medical conditions included Bipolar disorder since 21-Sep-2019. Concomitant products included QUETIAPINE FUMARATE (SEROQUEL), CLONIDINE HYDROCHLORIDE (CATAPRES [CLONIDINE HYDROCHLORIDE]), SALBUTAMOL SULFATE (VENTOLIN HFA) and NALOXONE HYDROCHLORIDE (NARCAN) for an unknown indication.   On 18-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 15-Sep-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 15-Sep-2021,  after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced MEMORY IMPAIRMENT (Increase forgetfulness), CONFUSIONAL STATE (Confusion), MYALGIA (Myalgia/myalgias), PYREXIA (Fever/high fever over 103), FATIGUE (Fatigue) and VOMITING (Vomiting). In September 2021, the patient experienced BACK PAIN (Back hurt/back hurt 24/7 and the COVID VAXX has made it worse), ILLNESS (very sick), ASTHENIA (no energy) and HEADACHE (Head hurt/head hurt 24/7 and the COVID VAXX has made it worse). On 20-Sep-2021, the patient experienced HYPERTENSION (Blood pressure high) and DIZZINESS (Dizzy). At the time of the report, BACK PAIN (Back hurt/back hurt 24/7 and the COVID VAXX has made it worse), MEMORY IMPAIRMENT (Increase forgetfulness), CONFUSIONAL STATE (Confusion), HYPERTENSION (Blood pressure high), ILLNESS (very sick), ASTHENIA (no energy), DIZZINESS (Dizzy), MYALGIA (Myalgia/myalgias), PYREXIA (Fever/high fever over 103), FATIGUE (Fatigue), VOMITING (Vomiting) and HEADACHE (Head hurt/head hurt 24/7 and the COVID VAXX has made it worse) outcome was unknown.      DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 15-Sep-2021, Body temperature: 103 High fever. On 20-Sep-2021, Blood pressure measurement: 151/98 mmHg and 154/91 mmHg. On 20-Sep-2021, Heart rate: regular with normal S1, S2 sounds and 103 beats per minute. On 20-Sep-2021, Ophthalmological examination: No eye discharge was noted. On 20-Sep-2021, Oxygen saturation: 98 %. On 20-Sep-2021, Physical examination: Alert and oriented to person/place/time had a steady gait and was interactive. No shortness of breath and cough were noted. No shortness of breath and cough were noted. Upon auscultation chest was clean with a normal respiratory effort. No wheezes/rales or rhonchi were noted. Abdomen was soft and non-tender, it was not distended. There was no rebound or guarding. Mood and affect were assessed as normal. Skin was warm and dry and moved all extremities with full range of motion. Back exam showed no midline tenderness of the thoracic/lumbar/sacral spinal region.. On 20-Sep-2021, Respiratory rate: 20 breaths per minute. On 20-Sep-2021, Vital signs measurement: remained with in normal limits (stable). On an unknown date, SARS-CoV-2 test: (Negative) Negative.         On 20-Sep-2021, the patient presented to an urgent care. Upon arrival to the urgent care, the patient ambulated into the intake room was alert, oriented and in no apparent distress. At that time of arrival to the urgent care the patient was afebrile. The patient denied shortness of breath, loss of consciousness, abdominal pain, focal weaknesses, focal numbness, nausea, vomiting and vision/speech disturbances.   Precautious were given to the patient; however, no treatment information was provided by the reporter. At the end of the visit, the patient felt comfortable with discharge and was instructed to follow up with primary care as needed. The urgent care facility sent the patient home with blood pressure high and dizzy.   This case was linked to MOD-2022-599515 (Patient Link).