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This is VAERS ID 1404384

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1404384
VAERS Form:2
Age:22.0
Sex:Male
Location:Foreign
Vaccinated:2021-06-03
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA LOT3002332 / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Rash, Vaccination site erythema

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:
Preexisting Conditions: Medical History/Concurrent Conditions: Vesicoureteral reflux
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': GBMODERNATX, INC.MOD20212

Write-up: Rash; sore red rash painful to touch about 2 inches below the injection site; This regulatory authority case was reported by a consumer and describes the occurrence of RASH (Rash) and VACCINATION SITE ERYTHEMA (sore red rash painful to touch about 2 inches below the injection site) in a 22-year-old male patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) (batch no. LOT3002332) for COVID-19 vaccination. The patient''s past medical history included Vesicoureteral reflux. On 03-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 RASH (Rash) (seriousness criterion medically significant). 04-Jun-2021, the patient experienced VACCINATION SITE ERYTHEMA (sore red rash painful to touch about 2 inches below the injection site) (seriousness criterion medically significant). At the time of the report, RASH (Rash) had not resolved and VACCINATION SITE ERYTHEMA (sore red rash painful to touch about 2 inches below the injection site) outcome was unknown. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Unknown) was unknown. No concomitant medications was provided by the reporter. No treatment information was provided. Patient relevant medical history includes Long COVID investigations still going on. Patient stated that he had not tested positive for COVID-19 since having the vaccine. 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.; 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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