National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

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

This is VAERS ID 1440637



Case Details

VAERS ID: 1440637 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 009D21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye pruritus, Headache, Nausea, Throat irritation
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ortho cycline
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: Benedryl
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Pt received the vaccine 07/01/21 at 9:50. pt went home after the shot. she called the pharmacy at 11:20 stating that she was nauseous, headache, itchy eyes and scratchy throat. pe pt discussion in the past she had and allergy to benedryl (paridoxical rxn with benedryl causing anaphylaxis). due to this I instructed her to go to the ER and seek treatment.


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1440637


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