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This is VAERS ID 1245426

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1245426
VAERS Form:2
Age:
Sex:Female
Location:Massachusetts
Vaccinated:2021-04-12
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 RA / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Anaphylactic reaction

Life Threatening? Yes
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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No medical history was reported.)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: Anaphylactic reaction; This spontaneous case was reported by a consumer and describes the occurrence of ANAPHYLACTIC REACTION (Anaphylactic reaction) in a 48-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 039K20A) for COVID-19 vaccination. The patient''s past medical history included No adverse event (No medical history was reported.). On 12-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 12-Apr-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced ANAPHYLACTIC REACTION (Anaphylactic reaction) (seriousness criteria medically significant and life threatening). At the time of the report, ANAPHYLACTIC REACTION (Anaphylactic reaction) outcome was unknown. Not Provided The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant product use was not provided. The patient received treatment with oral Benadryl 50mg (Diphenhydramine). She was given IV push 50mg of benadryl in the ambulance. Then in the hospital, she received Epi-pen (epinephrine) and other medications. Reportedly, the patient had an anaphylactic reaction 10 minutes after the dose was administered and was sent to the emergency room. They observed her there at about 11 AM and discharged her about 5-6 PM. They gave her IV push 50 mg Benadryl and 50 mg oral Benadryl and gave her Epi-pen and other meds in the hospital. Patient does not have a HCP. Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.


Changed on 5/7/2021

VAERS ID: 1245426 Before After
VAERS Form:2
Age:
Sex:Female
Location:Massachusetts
Vaccinated:2021-04-12
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 RA / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Anaphylactic reaction

Life Threatening? Yes
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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No medical history was reported.)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: Anaphylactic reaction; This spontaneous case was reported by a consumer and describes the occurrence of ANAPHYLACTIC REACTION (Anaphylactic reaction) in a 48-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 039K20A) for COVID-19 vaccination. The patient''s past medical history included No adverse event (No medical history was reported.). On 12-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 12-Apr-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced ANAPHYLACTIC REACTION (Anaphylactic reaction) (seriousness criteria medically significant and life threatening). At the time of the report, ANAPHYLACTIC REACTION (Anaphylactic reaction) outcome was unknown. Not Provided The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant product use was not provided. The patient received treatment with oral Benadryl 50mg (Diphenhydramine). She was given IV push 50mg of benadryl in the ambulance. Then in the hospital, she received Epi-pen (epinephrine) and other medications. Reportedly, the patient had an anaphylactic reaction 10 minutes after the dose was administered and was sent to the emergency room. They observed her there at about 11 AM and discharged her about 5-6 PM. They gave her IV push 50 mg Benadryl and 50 mg oral Benadryl and gave her Epi-pen and other meds in the hospital. Patient does not have a HCP. Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.


Changed on 5/14/2021

VAERS ID: 1245426 Before After
VAERS Form:2
Age:
Sex:Female
Location:Massachusetts
Vaccinated:2021-04-12
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 RA / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Anaphylactic reaction

Life Threatening? Yes
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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: No adverse event (No medical history was reported.)
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20210

Write-up: Anaphylactic reaction; This spontaneous case was reported by a consumer and describes the occurrence of ANAPHYLACTIC REACTION (Anaphylactic reaction) in a 48-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 039K20A) for COVID-19 vaccination. The patient''s past medical history included No adverse event (No medical history was reported.). On 12-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 12-Apr-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced ANAPHYLACTIC REACTION (Anaphylactic reaction) (seriousness criteria medically significant and life threatening). At the time of the report, ANAPHYLACTIC REACTION (Anaphylactic reaction) outcome was unknown. Not Provided The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant product use was not provided. The patient received treatment with oral Benadryl 50mg (Diphenhydramine). She was given IV push 50mg of benadryl in the ambulance. Then in the hospital, she received Epi-pen (epinephrine) and other medications. Reportedly, the patient had an anaphylactic reaction 10 minutes after the dose was administered and was sent to the emergency room. They observed her there at about 11 AM and discharged her about 5-6 PM. They gave her IV push 50 mg Benadryl and 50 mg oral Benadryl and gave her Epi-pen and other meds in the hospital. Patient does not have a HCP. Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1245426&WAYBACKHISTORY=ON


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