Received Aug 19, 2025
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| COVID19 | COVID19 (COVID19 (MODERNA)) | MODERNA | UNK | — | — |
proved to be deathly allergic to the COVID shot; This 69-year-old male subject was involved in an other study and received COVID-19 VACCINE MRNA (SPIKEVAX COVID-19 VACCINE NOS) for COVID-19 prophylaxis. The report describes a case of ALLERGY TO VACCINE (proved to be deathly allergic to the COVID shot). No Medical History information was reported. On an unknown date, the patient received dose of COVID-19 VACCINE MRNA (SPIKEVAX COVID-19 VACCINE NOS) (unknown route) 1 dosage form at an unspecified frequency. In 2022, the patient experienced ALLERGY TO VACCINE (proved to be deathly allergic to the COVID shot) (seriousness criterion medically significant). At the time of the report, ALLERGY TO VACCINE (proved to be deathly allergic to the COVID shot) outcome was unknown. The action taken with COVID-19 VACCINE MRNA (SPIKEVAX COVID-19 VACCINE NOS) (Unknown) was unknown. DCP-ID was reported as withheld id# with DCP name: 2025 Respiratory ATU Tracking Survey - CONSUMER. No concomitant medication was reported. It was unknown if the subject had allergies to medications, food and other products. Reporter stated that the subject provided a vague note that the subject proved to be allergic to the COVID shot when the subject took it. It was unknown if the event caused the subject to seek medical care. It was unknown if there were any other factors that could have led to the adverse event. It was unknown if the subject had experienced a similar event in the past. No treatment information was provided. This case was linked to US-MODERNATX, INC.-MOD-2025-788495 (E2B Linked Report). Reporter did not allow further contact; Reporter's Comments: Company comment: The benefit-risk relationship of product is not affected by this report.; Sender's Comments: US-MODERNATX, INC.-MOD-2025-788495:Same Report, Different patient