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This is VAERS ID 1404341

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1404341
VAERS Form:2
Age:31.0
Sex:Female
Location:Foreign
Vaccinated:2021-05-31
Onset:2021-06-01
Submitted:0000-00-00
Entered:2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3002332 / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Urticaria, SARS-CoV-2 test

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:
Preexisting Conditions: Medical History/Concurrent Conditions: Lactation decreased
Allergies:
Diagnostic Lab Data: Test Date: 20210530; Test Name: COVID-19 virus test; Test Result: Negative ; Result Unstructured Data: Negative
CDC 'Split Type': GBMODERNATX, INC.MOD20212

Write-up: Hives; This regulatory authority case was reported by a consumer and describes the occurrence of URTICARIA (Hives) in a 31-year-old female patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) (batch no. 3002332) for COVID-19 vaccination. The patient''s past medical history included Lactation decreased. On 31-May-2021, the patient received first dose of mRNA-1273 (Moderna CoviD-19 Vaccine) (unknown route) 1 dosage form. On 01-Jun-2021, the patient experienced URTICARIA (Hives) (seriousness criterion medically significant). On 02-Jun-2021, URTICARIA (Hives) had resolved. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 30-May-2021, SARS-CoV-2 test: negative (Negative) Negative. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Unknown) was unknown. Concomitant medication and treatment information were not reported. Patient has not had symptoms associated with COVID-19 Patient was not enrolled in clinical trial and not currently breastfeeding Patient has not tested positive for COVID-19 since having the vaccine. Company comment:Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.; Sender''s Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.

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