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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1696719

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Case Details

VAERS ID: 1696719 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-08-19
Onset:2021-08-23
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Injection site erythema, Injection site pruritus, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (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: Novolog, Tresiba, Metformin, Vit D, Vit B12, Losartan, Metoprolol, Omeprazole, Fish Oil, Coconut Oil. Vit E, Biotin, Keratin
Current Illness:
Preexisting Conditions: Type 1 Diabetic (have had pancreatitis) with Hypertension
Allergies: Lortab and Lantus
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 4 day after the injection I developed a rash/hives on both arms and the tops or hands. Approximately a week later my injection site became red and very itchy and I also developed a rash/hives on the backs of my legs at the knee bend. It has now been 25 days since the injection and I stillo have the rash/hives on the back of my legs but the ones on my arms are gone.


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