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From the 11/26/2021 release of VAERS data:

Found 84,128 cases where Location is U.S., Territories, or Unknown and Vaccine is COVID19 and Manufacturer is MODERNA and Standard-MedDRA-Query broadly-matches 'Anaphylactic reaction'

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Case Details

This is page 13 out of 8,413

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VAERS ID: 909094 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2020-12-23
Onset:2020-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20A / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Cough, Dyspnoea, Fatigue, Headache, Injection site erythema, Injection site induration, Injection site swelling, Injection site warmth, Pain, Pyrexia, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tylenol, ibuprofen and albuteral inhaler
Current Illness:
Preexisting Conditions: Asthma
Allergies: Cipro, hydrocodone. Codeine
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: Site reaction. Red, swollen, hard and warm. Fever. Severe body aches, chills, shaking, cough, SOA, headache, fatigue.


VAERS ID: 909095 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Male  
Location: Colorado  
Vaccinated:2020-12-23
Onset:2020-12-25
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2020-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Foaming at mouth, Pain in extremity, Pallor, Pulse absent, Respiratory arrest, Somnolence, Unresponsive to stimuli
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (broad), Convulsions (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2020-12-25
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tamsulosin 0.4mg, Lactobacillus tablet, Nephro-vite tablet 0.8mg, Allopurinol 100mg, ferrous gluconate 324mg, melatonin 6mg, lisinopril 2.5mg, colace 100mg, metamucil powder, aspirin 81mg, amidoarone 200mg, hydrooxyzine 25mg, cholestyramine
Current Illness: End stage renal disease with dependence on renal dialysis, COPD, cirrhosis of the liver, hypokalemia, gout, heart failure, hyperlipidemia, atrial fibrillation.
Preexisting Conditions: Refused dialysis frequently resulting in episodes of hypokalemia and hospitalization, resident dependent on supplemental oxygen. The resident refused to go to dialysis on 12/23/2020 and said he was feeling fine.
Allergies: alprazolam, Lorazepam
Diagnostic Lab Data: None
CDC Split Type:

Write-up: on 12/24/2020 the resident was sleepy and stayed in bed most of the shift. He stated he was doing okay but requested pain medication for his legs at 250PM. At 255AM on 12/25/2020 the resident was observed in bed lying still, pale, eyes half open and foam coming from mouth and unresponsive. He was not breathing and with no pulse


VAERS ID: 909099 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Ohio  
Vaccinated:2020-12-23
Onset:2020-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Pruritus, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: influenza (same reaction)
Other Medications: none
Current Illness: none
Preexisting Conditions: Asthma
Allergies: seafood: anaphylaxis Penicillin: anaphylaxis flu vaccination X 3 previous years: rash/ itching (patient did not report this prior to COVID 19 Moderna vaccination)
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Client developed itchy rash to face, neck and chest approximately 15 minutes after injection. Client then reported that she had similar experience after her flu vaccination the past 3 years. Client took 25mg of Benadryl and was monitored for an additional 30 minutes at clinic site until rash was resolving. Client denied any issues/ complications with swallowing or breathing. Rash and itching was resolving prior to client leaving vaccination / monitoring site. Her significant other had brought her to the clinic and was available to drive her home. EMS was also on scene but did not need to provide assistance.


VAERS ID: 909107 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Female  
Location: Ohio  
Vaccinated:2020-12-24
Onset:2020-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 RA / -

Administered by: Public       Purchased by: ?
Symptoms: Chest discomfort, Chest pain, Electrocardiogram normal, Flushing, Palpitations
SMQs:, Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Diltiazem ER- 120mg once daily Bupropion XL 150mg once daily in AM Topiramate 25mg- twice daily Lamotrigine 200mg 2 tabs (400mg) once daily Vraylar 3mg- once daily hydroxyzine Pamoate 25mg 1-2 cap at bedtime multivitamin 1 tab daily Menopa
Current Illness: none
Preexisting Conditions: Anxiety Depression Bi-polar disorder History of PVCs Hyperlipidemia
Allergies: Client failed to list any allergies on vaccination screening questionnaire and when questioned by nurse prior to vaccination. When completing incident report client reports allergies to: Penicillin- unknown Latex- rash/ contact dermatitis Ultram- severe headache and nausea and vomiting Morphine- severe headache, nausea and nausea
Diagnostic Lab Data: EKG completed by EMS on site- Normal sinus rhythm noted along with possible infarct age undetermined
CDC Split Type:

Write-up: Client began feeling flushed approximately 10-15 minutes following vaccination with COVID-19 vaccine. Client stated her "chest had a heavy feeling" and she was experiencing heart palpitations (which she also reports are normal for her). She was concerned as the heart palpitations were occurring along with chest pain. EMS on scene at clinic site (precaution) and escorted client to area where EKG was completed. Normal sinus rhythm was noted along with possible infarct age undetermined ( as reported on strip)and client was asked if she would like to go to ER for additional evaluation which she refused. (Client signed refusal of medical treatment, transport and/ or evaluation form). Client was advised by EMS and health district staff to seek medical treatment or call 911 if symptoms persist or become worse. Client voiced understanding.


VAERS ID: 909111 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Ohio  
Vaccinated:2020-12-23
Onset:2020-12-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2020-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20-2A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Asthma, Back pain, Blindness, Chest pain, Chills, Condition aggravated, Cough, Decreased appetite, Diarrhoea, Dizziness, Fatigue, Headache, Pain, Pyrexia, Spinal pain, Tachycardia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Asthma/bronchospasm (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: I do not have the information, but I had a reaction to the MMR vaccine when I was a child.
Other Medications: Zoloft, Protonix
Current Illness: No illnesses 30 days prior to vaccination or at the time of vaccination.
Preexisting Conditions: Asthma
Allergies: Latex, Dairy, Vicodin, Percocet, Sulfa
Diagnostic Lab Data: I had no laboratory test as of this date, still attempting recovery at home off of work.
CDC Split Type:

Write-up: The evening of the 24th, I felt lightheaded, sore, and extremely fatigued. Waking up on the 25th, I had diarrhea, vomiting, headache, coarse cough, asthma exacerbation, chest pain. Chest pain subsided but other symptoms remained. Around 11am, I developed cervical neck pain in the back of neck, and lower pack pain. I started to experience loss of vision upon standing, tachycardia, tactile fevers, chills, and loss of appetite with extreme fatigue.


VAERS ID: 909120 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Maine  
Vaccinated:2020-12-23
Onset:2020-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / SC

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Dyspnoea, Hypertension, Palpitations, Tachycardia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Hypertension (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Progesterone 200 mg.day estradiol 2 mg/day
Current Illness: none
Preexisting Conditions: mild asthma
Allergies: mushrooms keflex tramadol
Diagnostic Lab Data: none
CDC Split Type:

Write-up: dizziness shortness of breath tachycardia hypertension forceful heart contractions


VAERS ID: 909151 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Ohio  
Vaccinated:2020-12-23
Onset:2020-12-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2020-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram normal, Dizziness, Dyspnoea, Heart rate increased, Laboratory test normal, Loss of personal independence in daily activities, Tachycardia, X-ray normal
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Flu and hepatitis B at age 18, passed out 3 times that day
Other Medications: Effexor 150 mg daily Pepcid Zyrtec
Current Illness: No
Preexisting Conditions: Anxiety
Allergies: Amoxicillin Nickel
Diagnostic Lab Data: Labs, xrays, CT, all benign
CDC Split Type:

Write-up: 36 hours after vaccine, sudden onset tachycardia, shortness of breath, dizziness on the verge of passing out, called covid hotline, sent to ER due to resting heart rate of 130-150. Lasted approximately 9 hours, was going to be kept for observation in ED. Resting HR came down to 90 and sent home, following day unable to perform normal activities and unable to work for two days as of now


VAERS ID: 909169 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2020-12-24
Onset:2020-12-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dyspnoea, Fatigue, Feeling hot, Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin 5ml
Current Illness: None
Preexisting Conditions: None
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache several hours after injection with mild shortness of breath. I felt warm but did not seem to have an elevated temperature. Sore muscles and tired.


VAERS ID: 909189 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Iowa  
Vaccinated:2020-12-23
Onset:2020-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Body temperature increased, Chills, Erythema, Fatigue, Feeling cold, Headache, Injection site erythema, Pain, Pain in extremity, Skin warm
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Amitriptylline, levothyroxine, HCTZ, spironolactone, potassium, Zyrtec, birth control pill, Singulair, losartan, omeprazole. Monthly Emgality.
Current Illness: Had Covid symptoms 11/26, positive test result 11/29. Otherwise nothing.
Preexisting Conditions: Hypothyroidism, edema. Carpal tunnel, palpitations, migraines.
Allergies: All berries except blueberries. Walnuts, most everything outside pollen, grass, molds.
Diagnostic Lab Data: None. I am a nurse, I tried calling Employee Health but they are closed until Monday due to the holiday. I will call then.
CDC Split Type:

Write-up: Received shot at 12:30 PM. Started feeling really tired about 8:30 PM. Severe body aches and chills at 9:30 PM. Wearing layers under blankets and teeth chattering. Started getting a headache. Took Aleve 440 mg at 11:00 PM, did not help. Sleep at midnight, woke at 2:30 freezing and very achy. Woke again at 0630 same symptoms, woke again at 11:00 AM, severe aches, headache, but being so cold was subsiding. Highest temp I had during this was 99.7, so not bad. Felt tired and very achy all day Thursday arm is red and have other red areas now on that arm that are hot and painful, no more chilling. Just feeling tired Friday and still have the red spots on the arm by the injection site. Aches and headache subsided. I still had a post Covid cough and palpitations when I received the vaccine.


VAERS ID: 909195 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2020-12-23
Onset:2020-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 RA / IM

Administered by: School       Purchased by: ?
Symptoms: Throat irritation, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Shingrix
Other Medications: Lexapro, Zyrtec, vitamin D, milk of magnesia, Florastor
Current Illness: Bilateral adhesive capsulitis
Preexisting Conditions: Pre-diabetes, environmental allergies, anxiety
Allergies: Penicillin, multiple environmental and seasonal allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hives and scratchy throat


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