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This is VAERS ID 1408789

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1408789
VAERS Form:2
Age:35.0
Sex:Female
Location:Foreign
Vaccinated:2021-05-28
Onset:2021-06-01
Submitted:0000-00-00
Entered:2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Lip swelling, Urticaria, 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:
Preexisting Conditions: Medical History/Concurrent Conditions: Lactation decreased
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Test Result: Negative; Result Unstructured Data: No - Negative COVID-19 test.
CDC 'Split Type': GBMODERNATX, INC.MOD20212

Write-up: Hives; Lip swelling; This regulatory authority case was reported by a consumer and describes the occurrence of URTICARIA (Hives) and LIP SWELLING (Lip swelling) in a 35-year-old female patient who received mRNA-1273 (Moderna CoviD-19 Vaccine) for COVID-19 vaccination. The patient''s past medical history included Lactation decreased. On 28-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 LIP SWELLING (Lip swelling) (seriousness criterion medically significant). On 03-Jun-2021, the patient experienced URTICARIA (Hives) (seriousness criterion medically significant). At the time of the report, URTICARIA (Hives) and LIP SWELLING (Lip swelling) was resolving. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, SARS-CoV-2 test: negative (Negative) No - Negative COVID-19 test. The action taken with mRNA-1273 (Moderna CoviD-19 Vaccine) (Unknown) was unknown. The concomitant medications were not provided. No treatment medications were reported. 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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