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This is VAERS ID 1386145

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1386145
VAERS Form:2
Age:66.0
Sex:Female
Location:Washington
Vaccinated:2021-06-04
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 047C21A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Pruritus, Face injury, Eye pruritus

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: Stomach pain and diarrhea, seasonal allergies
Preexisting Conditions:
Allergies: Codeine, Levothyroxine sodium, Penicillin G, Sulfamethoxaole, trimethoprim
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt experiencing intense itching on eye and on body. Pt said symptoms began after vaccination (June 4, 2021-4 days), has been taking Benadryl nightly since but has had no relief. No reaction was noted during 30 minute period after vaccine and pt stated that itching began at home that night. Pt unsure if eye itching is associated with hitting face on rope by accident, but entire body itching continues. Pt told to go to clinic and advised to make appointment with PCP. Pt refused referral for prompt care due to cost of care.

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