National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 9/3/2021 release of VAERS data:

This is VAERS ID 1437483



Case Details

VAERS ID: 1437483 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-06-30
Onset:2021-06-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 0011D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None in the system
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient got her 1st shot of COVID Moderna Vaccine at the pharmacy on 06/30 @ 11:40 AM. After 15 minutes of sitting in the waiting area, patient reports that she is feeling a general mild itchy feeling all over her body that comes and goes in phases. Patient did not report swelling, throat tightening, injection site pain, or injection site itching. Injection site redness or swelling was not observed. Pharmacist decided to administer one dose of diphenhydramine 25mg, gave one more capsule for patient to take home, and counseled on the sign and symptoms of anaphylaxis allergic reaction. Patient feels fine after another 15 minutes observation.


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1437483


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166