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This is VAERS ID 1714680

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First Appeared on 9/24/2021

VAERS ID: 1714680
VAERS Form:2
Age:58.0
Sex:Female
Location:California
Vaccinated:2021-09-07
Onset:2021-09-07
Submitted:0000-00-00
Entered:2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 012E21A / 1 - / OT

Administered by: Unknown      Purchased by: ??
Symptoms: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: MULTIVITAMINS [VITAMINS NOS]; LISINOPRIL
Current Illness: Drug allergy; Sulfonamide allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USMODERNATX, INC.MOD20213

Write-up: Itchiness; Big red well; Swelling; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE PRURITUS (Itchiness), VACCINATION SITE ERYTHEMA (Big red well) and VACCINATION SITE SWELLING (Swelling) in a 58-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 012E21A) for COVID-19 vaccination. Concurrent medical conditions included Sulfonamide allergy and Drug allergy. Concomitant products included MULTIVITAMINS [VITAMINS NOS] and LISINOPRIL for an unknown indication. On 07-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 07-Sep-2021, the patient experienced VACCINATION SITE PRURITUS (Itchiness), VACCINATION SITE ERYTHEMA (Big red well) and VACCINATION SITE SWELLING (Swelling). The patient was treated with PARACETAMOL (TYLENOL) for Symptomatic treatment, at an unspecified dose and frequency. At the time of the report, VACCINATION SITE PRURITUS (Itchiness), VACCINATION SITE ERYTHEMA (Big red well) and VACCINATION SITE SWELLING (Swelling) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments.

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