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This is VAERS ID 1397847

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1397847
VAERS Form:2
Age:30.0
Sex:Female
Location:Foreign
Vaccinated:2021-06-04
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3002332 / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Blister, Chills, Chromaturia, Headache, Lymphadenopathy, Pyrexia, Vomiting, Peripheral swelling, Vaccination site swelling, SARS-CoV-2 test

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: Asthmatic; Suspected COVID-19
Preexisting Conditions: Medical History/Concurrent Conditions: Allergy to animal; Lactation decreased; Comments: Previous known allergies to short haired animals. Asthmatic. No other medical history. Patient is not enrolled in clinical trial Patient is not pregnant,Patient is not currently breastfeeding
Allergies:
Diagnostic Lab Data: Test Date: 20200312; Test Name: COVID-19 virus test; Test Result: Inconclusive ; Result Unstructured Data: Positive COVID-19 test.
CDC 'Split Type': GBMODERNATX, INC.MOD20212

Write-up: blister on injection site and swollen arm - recovering 48hours later; chills; sleepless first night; Fever chills; Swollen glands; Fever; Headache; Swollen arm; Blister; Brown urine; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 07-Jun-2021 and was forwarded to Moderna on 07-Jun-2021. This regulatory authority case was reported by a consumer and describes the occurrence of PERIPHERAL SWELLING (Swollen arm) (serious criterion - medically significant), BLISTER (Blister) (serious criterion - medically significant), CHROMATURIA (Brown urine) (serious criterion - medically significant), VACCINATION SITE SWELLING (blister on injection site and swollen arm - recovering 48hours later) (serious criterion - medically significant), and PYREXIA (Fever) (serious criterion - medically significant), in a 30-year-old female patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) (batch no. 3002332) for COVID-19 vaccination. The occurrence of additional serious events is detailed below. Previous known allergies to short haired animals. Asthmatic. No other medical history. Patient is not enrolled in clinical trial Patient is not pregnant,Patient is not currently breastfeeding. The patient''s past medical history included Lactation decreased and Suspected COVID-19 since 06-Mar-2020. Concurrent medical conditions included Asthmatic. On 04-Jun-2021, the patient received first dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) 1 dosage form. On 04-Jun-2021, the patient experienced PERIPHERAL SWELLING (Swollen arm), (serious criterion - medically significant), BLISTER (Blister) (serious criterion - medically significant), CHROMATURIA (Brown urine) (serious criterion - medically significant), PYREXIA (Fever) (serious criterion - medically significant), HEADACHE (Headache) (serious criterion - medically significant), LYMPHADENOPATHY (Swollen glands) (serious criterion - medically significant), and PYREXIA (Fever chills) (serious criterion - medically significant). On an unknown date, the patient experienced VACCINATION SITE SWELLING (blister on injection site and swollen arm - recovering 48hours later) (serious criterion - medically significant), CHILLS (chills) (serious criterion - medically significant), and VOMITING (sleepless first night) (serious criterion - medically significant). On 05-Jun-2021, PYREXIA (Fever chills) had resolved. On 06-Jun-2021, HEADACHE (Headache) had resolved. At the time of the report, PERIPHERAL SWELLING (Swollen arm), BLISTER (Blister), VACCINATION SITE SWELLING (blister on injection site and swollen arm - recovering 48hours later), CHILLS (chills), LYMPHADENOPATHY (Swollen glands) and VOMITING (sleepless first night) was resolving, CHROMATURIA (Brown urine) had not resolved and PYREXIA (Fever) had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 12-Mar-2020, SARS-CoV-2 test: positive (Inconclusive) Positive COVID-19 test.. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Unknown) was unknown. Concomitant product were not provided/unknown. Treatment medication were not reported/unknown.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.

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