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This is VAERS ID 1776059

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/15/2021

VAERS ID: 1776059
VAERS Form:2
Age:55.0
Sex:Female
Location:Georgia
Vaccinated:2021-09-12
Onset:2021-09-12
Submitted:0000-00-00
Entered:2021-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939901 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Injection site swelling, Incorrect route of product administration

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Site: Swelling at Injection Site-Mild, Additional Details: Patient complains of knot/lump of skin at injection site that has lasted for 28 days. The knot/lump of skin locates below the deltoid muscle, about 3-4 inches above the elbow. Patient doesn''t complain of any itching or tenderness. Inappropriate administration technique is suspected. The vaccine may be given too low on arm.

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