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This is VAERS ID 1437483

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1437483
VAERS Form:2
Age:63.0
Sex:Female
Location:South Carolina
Vaccinated:2021-06-30
Onset:2021-06-30
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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.

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