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This is VAERS ID 1768612

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1768612
VAERS Form:2
Age:20.0
Sex:Male
Location:South Carolina
Vaccinated:2021-10-05
Onset:2021-10-05
Submitted:0000-00-00
Entered:2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 004F21A / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Pruritus, Rash, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Systemic: Allergic: Itch (specify: facial area, extremeties)-Medium, Systemic: Allergic: Rash Generalized-Medium, Additional Details: Patient came into the pharmacy on 10/6/21 about 1:25pm with hives. Patient developed hives on arms and legs. First symptoms started about 30 minutes after recieving vaccine. I instructed him to take benadryl and to go to his doctor or and urgent care to get treated

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