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This is VAERS ID 1416215

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1416215
VAERS Form:2
Age:39.0
Sex:Female
Location:Foreign
Vaccinated:2021-06-02
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 3002917 / UNK - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Lymphadenopathy, Urticaria

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': ITMODERNATX, INC.MOD20212

Write-up: This regulatory authority case was reported by a consumer and describes the occurrence of URTICARIA and LYMPHADENOPATHY in a 39-year-old female patient who received mRNA-1273 (COVID 19 Vaccine Moderna) (batch no. 3002917) for COVID-19 vaccination. No Medical History information was reported. On 02-Jun-2021, the patient received dose of mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) .5 milliliter. On 04-Jun-2021, the patient experienced URTICARIA (seriousness criterion hospitalization). At the time of the report, URTICARIA and LYMPHADENOPATHY was resolving. The action taken with mRNA-1273 (COVID 19 Vaccine Moderna) (Intramuscular) was unknown. Concomitant medications were not provided. Treatment information was not provided. 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.; Reporter''s Comments: .; 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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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1416215&WAYBACKHISTORY=ON


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