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From the 7/23/2021 release of VAERS data:

This is VAERS ID 1331030



Case Details

VAERS ID: 1331030 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: New York  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Injection site pruritus, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), 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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client C/O itchiness at injection site and left index finger. Full body assessment done, ice pack provided, 3 sets of vital signs done. At 2:56 pm client took Benadryl 25 mg, p.o. At 3:20pm client denied any itchiness, no acute distress, leave vaccination site at with daughter and mother. Provided client with education to be alert to any respiratory issues and seek 911 if in respiratory distress.


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