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This is VAERS ID 1418404

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1418404
VAERS Form:2
Age:65.0
Sex:Male
Location:West Virginia
Vaccinated:2021-06-17
Onset:2021-06-20
Submitted:0000-00-00
Entered:2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026D21A / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Eye swelling, Rash, Rash macular, Rash pruritic

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: pt stated had taken steroid pills within the last weeks, but he could not tell me the name and he did not get the medications filled at our pharmacy
Current Illness: Poison Ivy
Preexisting Conditions: IMZ intake form said he had issues with his "heart"
Allergies: NKDA
Diagnostic Lab Data: none to date
CDC 'Split Type':

Write-up: Pt presented to pharmacy about 7:00pm on 6/22/21 stating he had gotten a rash on both arms and a place around his left eye about 3 days after his second Moderna Covid shot that he received on 6/17/2021. Both arms had sparse, red spots on them. On the side of his left eye he had it was a little red and looked a little swollen. He stated they itched some and his "itch" pills at home did not help (he could not tell me the name of them). He did state that about 3 weeks ago he had taken some steroid pills for poison ivy. He did not fill them at this pharmacy and could not tell me the name of them. He said the spots and the swelling on his eye were worse in the mornings. Told pt I would contact his primary care doctor tomorrow and he said he would as well.

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