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This is VAERS ID 1376021

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1376021
VAERS Form:2
Age:33.0
Sex:Female
Location:Florida
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 003C21A / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Pruritus, Throat tightness

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: No additional medication taken
Current Illness: No illness
Preexisting Conditions: No chronic or long-standing conditions
Allergies: Peanuts
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Fifteen minutes after injection of Moderna COVID vaccine, patient came back to pharmacy. She was complaining of severe itching and some throat tightness. Patient was given diphenhydramine 50 mg as one time dose. Patient BP was monitored, and monitored signs for breathing problems. Patient stated "felt better" after 30 minutes of receiving diphenhydramine. Blood pressure returned to normal (130/85 mm/hg). Patient has family member pick her up and went home.

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