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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1374487



Case Details

VAERS ID: 1374487 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 017C21A / N/A RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Seroquel 500mg hs, Miralax 17 grams am, lactulose 30ml am, senna 8.6/ dss50mg 2 tabs am, miconazole topical cream bid groin folds, sodium bicarb 1300mg bid, ammonium lactate lotion bid, sevelamer 800mg tid with meals, sodium zirconium 10 gr
Current Illness: Stage 5 renal disease Schizoaffective disorder
Preexisting Conditions: Stage 5 renal disease Schizoaffective disorder edema
Allergies: NSAIDS Penicillin Haldol
Diagnostic Lab Data: Assessed by medical provider 6/2/21
CDC Split Type:

Write-up: Patient was up at 2355 laying on floor wailing about abdominal pain. Rash present on all 4 limbs. Rash continued on 6/2 extends from wrist to elbow separate pink circular weals larger and more numerous on right side. 6/3 rash decreasing on legs and forearms improving.


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