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This is VAERS ID 1350341

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1350341
VAERS Form:2
Age:23.0
Sex:Male
Location:Ohio
Vaccinated:2021-05-19
Onset:2021-05-22
Submitted:0000-00-00
Entered:2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009C21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Rash, Rash pruritic

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
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: None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient developed an itchy rash on the neck starting 3-4 days after receiving the Moderna vaccine. Advised patient to speak to doctor about the rash.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1350341&WAYBACKHISTORY=ON


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