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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1430203



Case Details

VAERS ID: 1430203 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002C21A / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Paraesthesia, Rash, Rash erythematous, Rash papular
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tizanidine 4mg Tablets, Citalopram 40mg tablets, Alprazolam 1mg tablets, Acyclovir 400mg tablets, Acetaminophen/ Codeine #4 tablets, Meloxicam 15mg tablets
Current Illness: chronic pain, anxiety/depression, h/o shingles infections
Preexisting Conditions: chronic pain, anxiety/depression, h/o shingles infections
Allergies: none reported
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient came to pharmacy on 6/27/21 to ask about a rash that appeared late night on 6/26/21. She received her 2nd Moderna COVID vaccine on 6/26/21, around 11am. Patient stated she noticed a tingling sensation on her upper back, at the base of her neck on the evening of 6/26/21. When she awoke on 6/27/21, there was a slight red, raised rash on both arms and legs. When she reported to the pharmacy around 11am on 6/27/21, rash on limbs was not really red anymore but still slightly raised. The rash on her upper back was still present and red, about the size of a half dollar coin. Patient stated that the tingling sensation was still present and went down a few inches form the visible red place, She reported no itching or pain and taking no medications to alleviate symptoms. I informed her to continue watching and seek medical attention if things got worse.


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