National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/19/2021 release of VAERS data:

This is VAERS ID 1693559

Government Disclaimer on use of this data



Case Details

VAERS ID: 1693559 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: New York  
Vaccinated:2021-09-09
Onset:2021-09-10
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939893 / 2 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Dyskinesia, Feeling cold, Rash, Rash pruritic, Seizure like phenomena, Skin discolouration
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Convulsions (narrow), Dyskinesia (narrow), Noninfectious encephalopathy/delirium (broad), Hypotonic-hyporesponsive episode (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: fluoxetine 20 tablet, myrbetriq er 50 mg tab, ibuprofen 600 mg tab, estradiol 0.01% cream, rosuvastatin 5 mg tab, levothyroxine 100 mcg tab, ezetimibe 10 mg tab, fluoxetine 10 tab
Current Illness: n/a
Preexisting Conditions: osteoporosis, high cholesterol, hypothyroidism, heart disease
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient called pharmacy 09/12/2021 in the afternoon stating that she wanted to report an adverse event. She stated that on Friday night she experienced chills so cold it felt like she was in a freezer. She also stated that she felt she had seizure-like contractions, arms were jerking, and has pink plaque on both arms and they are itchy. She did not go to the hospital. She had been taking benadryl and using a heating pad to soothe herself. She said that she will reach out to her doctor tomorrow.


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1693559


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