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This is VAERS ID 1430389

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1430389
VAERS Form:2
Age:54.0
Sex:Male
Location:Texas
Vaccinated:2021-06-25
Onset:2021-06-26
Submitted:0000-00-00
Entered:2021-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011D21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Rash, Swelling face

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Smoker, Heart Disease
Preexisting Conditions: Heart Disease
Allergies: NKDA
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Wife called to report that patient developed a generalized rash throughout the body the night after receiving Moderna Covid shot. She provided him with Benadryl. Next morning his face was swollen and she decided to call the pharmacy. I advised her to provided Benadryl again and to take him to emergency room. Difficult breathing was not reported.

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