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This is VAERS ID 1332505

History of Changes from the VAERS Wayback Machine

First Appeared on 5/21/2021

VAERS ID: 1332505
VAERS Form:2
Age:19.0
Sex:Female
Location:New York
Vaccinated:2021-04-06
Onset:2021-05-04
Submitted:0000-00-00
Entered:2021-05-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 006BZ1A / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Hypersensitivity

Life Threatening? Yes
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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: EPIPEN; CELEXA [CELECOXIB]; SINGULAIR; NEXPLANON; OMEPRAZOLE; FLUTICASONE; ALBUTEROL [SALBUTAMOL]
Current Illness: Allergy to animal (Report mentions allergy to Cat dancer); Allergy to metals (No details); Allergy to vaccine; Asthma; Drug allergy (Risperdal); Drug allergy (Neomycin); Drug allergy (Depakote); Drug allergy (Ativan); Environmental allergy (No details); Latex allergy (No details)
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20211

Write-up: Allergic Reaction following her second Moderna covid 19 vaccine; This case was received via VAERS (Reference number: 496918) on 05-May-2021 and was forwarded to Moderna on 05-May-2021. This spontaneous case was reported by a health care professional (subsequently medically confirmed) and describes the occurrence of HYPERSENSITIVITY (Allergic Reaction following her second Moderna Covid 19 vaccine) in a 19-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 0210Z1A and 006BZ1A) for COVID-19 vaccination. Concurrent medical conditions included Asthma, Allergy to animal (Report mentions allergy to Cat dancer), Allergy to metals (No details), Latex allergy (No details), Drug allergy (Neomycin), Drug allergy (Ativan), Environmental allergy (No details), Drug allergy (Risperdal), Drug allergy (Depakote) and Allergy to vaccine. Concomitant products included EPINEPHRINE (EPIPEN), CELECOXIB (CELEXA [CELECOXIB]), MONTELUKAST SODIUM (SINGULAIR), ETONOGESTREL (NEXPLANON), OMEPRAZOLE, FLUTICASONE and ALBUTEROL [SALBUTAMOL] for an unknown indication. On 06-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 04-May-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 04-May-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced HYPERSENSITIVITY (Allergic Reaction following her second Moderna covid 19 vaccine) (seriousness criterion life threatening). At the time of the report, HYPERSENSITIVITY (Allergic Reaction following her second Moderna covid 19 vaccine) had resolved. Patient presented to the emergency room by EMS for allergic reaction following her second Moderna covid 19 vaccine. She received her shot and began to feel her tongue swelling and she developed body wide itching. Patient received an injection of her Epi-pen at the facility and transferred to the emergency room. She was observed on a cardiac monitor for several hours and discharged home. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Treatment for the events included administration of the patient''s prescribed Epi-pen. This was administered at the vaccine facility. The patient was subsequently transferred to the emergency room. The patient was on a cardiac monitoring in the emergency room for several hours and was ultimately discharged home. It was noted per source that COVID vaccination will now be listed as an allergy for the patient. 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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