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This is VAERS ID 1371629

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1371629
VAERS Form:2
Age:72.0
Sex:Female
Location:California
Vaccinated:2021-05-25
Onset:2021-06-01
Submitted:0000-00-00
Entered:2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 054C21A / 1 LA / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Injection site erythema

Life Threatening? No
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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Site: Redness at Injection Site-Medium, Systemic: it became red at the injection site a week after the vaccine-Medium, Additional Details: Pt said she was fine for 1 week then she npticed her arm where we did the injection is red around the injection site. she has some appointments and will take benadryl after so shes not sleepy she said. She said she didnt take anything for it. she sais she feels fine otherwise. no swelling or itching all over or difficulty breathing

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