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This is VAERS ID 1329687

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1329687
VAERS Form:2
Age:41.0
Sex:Male
Location:Virginia
Vaccinated:2021-05-18
Onset:2021-05-18
Submitted:0000-00-00
Entered:2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 038C21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Injection site pruritus, Pruritus

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Site: Itching at Injection Site-Medium, Systemic: Allergic: Itch (specify: facial area, extremeties)-Medium, Additional Details: GAVE PT MODERNA COVID VACCINE. ABOUT 15 MINUTES LATER PT REPORTS FEELING ITCHY ON THE FACE. WAITED A FEW MORE MINUTES AND THE ITCH BEGAN TO SPREAD TO CHEST AND ARMS. GAVE PT BENDRYL AND ASKED TO STAY 15 MORE MINUTES. RESOLVED WITH BENADRYL.

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