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This is VAERS ID 1376020

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1376020
VAERS Form:2
Age:55.0
Sex:Female
Location:California
Vaccinated:2021-06-04
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026B21A / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Anxiety, Pruritus

Life Threatening? No
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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: allergic rhinitis benign essential hypertension body mass index 30+ - obesity nonulcer dyspepsia systemic vasculitis
Preexisting Conditions:
Allergies: Amoxicillin and Lisinopril
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Itchiness started about 5 minutes after receiving the vaccine, patient was anxious. Diphenhydramine Hcl 25mg tablet given to patient, monitored for an additional 15 mins after medication was taken. Patient felt better, itchiness resolved, no other symptoms reported. Patient left the clinic at 4:23pm.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1376020&WAYBACKHISTORY=ON


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