National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1026015

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 3/5/2021

VAERS ID: 1026015
VAERS Form:2
Age:
Sex:Female
Location:Oregon
Vaccinated:2021-01-24
Onset:2021-01-24
Submitted:0000-00-00
Entered:2021-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Anaphylactic reaction, Diarrhoea, Fatigue, Feeling abnormal, Feeling hot, Heart rate increased, Migraine, Myalgia, Nausea, Paraesthesia, Petechiae, Pruritus, Rash, Telangiectasia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anaphylactic reaction to drug (No other medical history provided)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: Had headache that was similar to migraine; Feeling foggy; Diarrhea; Episode of nausea; Extreme fatigue; Muscle ache; Rash inside armpit; Anaphylactic reaction; Tingling in arm; Itching; Rapid heartbeat; Started feeling hot; Petechia eye; Tiny broken vessel on both ankles; A spontaneous report was received from a consumer who was also a female patient over the age of 55 but under 60 years of age who received Moderna''s Covid-19 vaccine (mRNA-1273) and who experienced anaphylactic reaction, tingling in arm, itching, rapid heartbeat, started feeling hot, rash inside of armpit, petechia eye, tiny broken vessel on both ankles, headache similar to migraine, nausea, extreme fatigue, feeling foggy, muscle ache, and diarrhea. The patient''s medical history was significant for anaphylactic reaction to cephalosporin antibiotics. No other medical history was provided by the patient. Concomitant product use was not provided by the patient. On 24 Jan 2021, prior to the onset of symptoms, at the County Health Department, the patient received the first of two planned doses of mRNA-1273 intramuscularly into her upper left arm. Because of her past medical history, the patient was observed for 30 minutes at the facility for any adverse reaction. When the observation period ended the patient went to her car and sometime later began having a delayed reaction. She reported experiencing the following symptoms: "tingling in arm", "itching", "rapid heartbeat", "started feeling hot", "rash inside of armpit", "petechia eye", and "tiny broken vessel on both ankles". The patient went to an Urgent Care Clinic, where she was treated with an injection of diphenhydramine and an oral prednisone. She was given a prescription for diphenhydramine, and prednisone. The patient was informed that she had an anaphylactic reaction to the vaccine. On 25 Jan 2021, the patient stated she had a "headache similar to a migraine", "episode of nausea", "extreme fatigue", "feeling foggy", "muscle ache", and "diarrhea". She was being followed up by an allergist. Action taken with mRBA-1273 in response to the events was not provided. The outcome of the events, anaphylactic reaction, tingling in arm, itching, rapid heartbeat, started feeling hot, rash inside of armpit, petechia eye, and tiny broken vessel on both ankles, and headache similar to a migraine, episode of nausea, extreme fatigue, feeling foggy, muscle ache, and diarrhea, was considered unknown.; Reporter''s Comments: This case concerns a 55-60 year old female who had a serious unexpected anaphylactic reaction, with NS unexpected paranesthesia, pruritus, HR increased, feeling hot, rash, petechia, telangiectasia, migraine, feeling abnormal, diarrhea, and NS expected nausea, fatigue, myalgia. Event onset 1 day after first dose mRNA-1273. Based on the current available information and temporal association between the use of mRNA-1273 and the start date of the events, a causal relationship cannot be excluded.


Changed on 5/7/2021

VAERS ID: 1026015 Before After
VAERS Form:2
Age:
Sex:Female
Location:Oregon
Vaccinated:2021-01-24
Onset:2021-01-24
Submitted:0000-00-00
Entered:2021-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Anaphylactic reaction, Diarrhoea, Fatigue, Feeling abnormal, Feeling hot, Heart rate increased, Migraine, Myalgia, Nausea, Paraesthesia, Petechiae, Pruritus, Rash, Telangiectasia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anaphylactic reaction to drug (No other medical history provided)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: Had headache that was similar to migraine; Feeling foggy; Diarrhea; Episode of nausea; Extreme fatigue; Muscle ache; Rash inside armpit; Anaphylactic reaction; Tingling in arm; Itching; Rapid heartbeat; Started feeling hot; Petechia eye; Tiny broken vessel on both ankles; A spontaneous report was received from a consumer who was also a female patient over the age of 55 but under 60 years of age who received Moderna''s Covid-19 vaccine (mRNA-1273) and who experienced anaphylactic reaction, tingling in arm, itching, rapid heartbeat, started feeling hot, rash inside of armpit, petechia eye, tiny broken vessel on both ankles, headache similar to migraine, nausea, extreme fatigue, feeling foggy, muscle ache, and diarrhea. The patient''s medical history was significant for anaphylactic reaction to cephalosporin antibiotics. No other medical history was provided by the patient. Concomitant product use was not provided by the patient. On 24 Jan 2021, prior to the onset of symptoms, at the County Health Department, the patient received the first of two planned doses of mRNA-1273 intramuscularly into her upper left arm. Because of her past medical history, the patient was observed for 30 minutes at the facility for any adverse reaction. When the observation period ended the patient went to her car and sometime later began having a delayed reaction. She reported experiencing the following symptoms: "tingling in arm", "itching", "rapid heartbeat", "started feeling hot", "rash inside of armpit", "petechia eye", and "tiny broken vessel on both ankles". The patient went to an Urgent Care Clinic, where she was treated with an injection of diphenhydramine and an oral prednisone. She was given a prescription for diphenhydramine, and prednisone. The patient was informed that she had an anaphylactic reaction to the vaccine. On 25 Jan 2021, the patient stated she had a "headache similar to a migraine", "episode of nausea", "extreme fatigue", "feeling foggy", "muscle ache", and "diarrhea". She was being followed up by an allergist. Action taken with mRBA-1273 in response to the events was not provided. The outcome of the events, anaphylactic reaction, tingling in arm, itching, rapid heartbeat, started feeling hot, rash inside of armpit, petechia eye, and tiny broken vessel on both ankles, and headache similar to a migraine, episode of nausea, extreme fatigue, feeling foggy, muscle ache, and diarrhea, was considered unknown.; Reporter''s Comments: This case concerns a 55-60 year old female who had a serious unexpected anaphylactic reaction, with NS unexpected paranesthesia, pruritus, HR increased, feeling hot, rash, petechia, telangiectasia, migraine, feeling abnormal, diarrhea, and NS expected nausea, fatigue, myalgia. Event onset 1 day after first dose mRNA-1273. Based on the current available information and temporal association between the use of mRNA-1273 and the start date of the events, a causal relationship cannot be excluded.


Changed on 5/14/2021

VAERS ID: 1026015 Before After
VAERS Form:2
Age:
Sex:Female
Location:Oregon
Vaccinated:2021-01-24
Onset:2021-01-24
Submitted:0000-00-00
Entered:2021-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Anaphylactic reaction, Diarrhoea, Fatigue, Feeling abnormal, Feeling hot, Heart rate increased, Migraine, Myalgia, Nausea, Paraesthesia, Petechiae, Pruritus, Rash, Telangiectasia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Anaphylactic reaction to drug (No other medical history provided)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: Had headache that was similar to migraine; Feeling foggy; Diarrhea; Episode of nausea; Extreme fatigue; Muscle ache; Rash inside armpit; Anaphylactic reaction; Tingling in arm; Itching; Rapid heartbeat; Started feeling hot; Petechia eye; Tiny broken vessel on both ankles; A spontaneous report was received from a consumer who was also a female patient over the age of 55 but under 60 years of age who received Moderna''s Covid-19 vaccine (mRNA-1273) and who experienced anaphylactic reaction, tingling in arm, itching, rapid heartbeat, started feeling hot, rash inside of armpit, petechia eye, tiny broken vessel on both ankles, headache similar to migraine, nausea, extreme fatigue, feeling foggy, muscle ache, and diarrhea. The patient''s medical history was significant for anaphylactic reaction to cephalosporin antibiotics. No other medical history was provided by the patient. Concomitant product use was not provided by the patient. On 24 Jan 2021, prior to the onset of symptoms, at the County Health Department, the patient received the first of two planned doses of mRNA-1273 intramuscularly into her upper left arm. Because of her past medical history, the patient was observed for 30 minutes at the facility for any adverse reaction. When the observation period ended the patient went to her car and sometime later began having a delayed reaction. She reported experiencing the following symptoms: "tingling in arm", "itching", "rapid heartbeat", "started feeling hot", "rash inside of armpit", "petechia eye", and "tiny broken vessel on both ankles". The patient went to an Urgent Care Clinic, where she was treated with an injection of diphenhydramine and an oral prednisone. She was given a prescription for diphenhydramine, and prednisone. The patient was informed that she had an anaphylactic reaction to the vaccine. On 25 Jan 2021, the patient stated she had a "headache similar to a migraine", "episode of nausea", "extreme fatigue", "feeling foggy", "muscle ache", and "diarrhea". She was being followed up by an allergist. Action taken with mRBA-1273 in response to the events was not provided. The outcome of the events, anaphylactic reaction, tingling in arm, itching, rapid heartbeat, started feeling hot, rash inside of armpit, petechia eye, and tiny broken vessel on both ankles, and headache similar to a migraine, episode of nausea, extreme fatigue, feeling foggy, muscle ache, and diarrhea, was considered unknown.; Reporter''s Comments: This case concerns a 55-60 year old female who had a serious unexpected anaphylactic reaction, with NS unexpected paranesthesia, pruritus, HR increased, feeling hot, rash, petechia, telangiectasia, migraine, feeling abnormal, diarrhea, and NS expected nausea, fatigue, myalgia. Event onset 1 day after first dose mRNA-1273. Based on the current available information and temporal association between the use of mRNA-1273 and the start date of the events, a causal relationship cannot be excluded.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1026015&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166