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From the 9/17/2021 release of VAERS data:

This is VAERS ID 905937



Case Details

VAERS ID: 905937 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Missouri  
Vaccinated:2020-12-21
Onset:2020-12-21
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 001J20A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Breath sounds abnormal, Cough, Headache, Rash, Rhinorrhoea, Stridor, Throat irritation
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Hypersensitivity (narrow), Respiratory failure (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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: AMLODIPINE 5 MG DAILY ALBUTEROL INHALER 2 PUFFS Q6H PRN SOA CARVEDILOL CR 80 MG DAILY DILTIAZEM SR 240 MG BID HCTZ 12.5 MG DAILY LEVOTHYROXINE 175 MCG DAILY MON - FRIDAY LEVOTHYROXINE 200 MCG DAILY SAT/SUN NTG 0.4 MG SL PRN CHEST PAIN PRAVA
Current Illness:
Preexisting Conditions:
Allergies: ASPIRIN - BODY RASH CODEINE - ANAPHYLAXIS CEPHALEXIN - RASH WITH BLISTER MEPERIDINE - RASH WITH BLISTERS ALL ANTIBIOTICS EXCEPT MACROLIDES AND QUINOLONES - RASH WITH BLISTERS MINT LAVENDER OREGANO BEE BALM CATNIP HYSSOP LEMON BALM MOVI-PREP SULFA - ANAPHYLAXIS
Diagnostic Lab Data:
CDC Split Type:

Write-up: PT WITH KNOWN H/O SEVERE ALLERGIC REACTION - APPROXIMATELY 15 MINUTES AFTER INJECTION, BEGAN TO COUGH AND EXPERIENCE ITCHY THROAT. SHE REPORTED THAT THIS IS WHAT HAS HAPPENED WITH OTHER ALLERGIC REACTIONS. SHE REQUESTED ORAL DIPHENHYDRAMINE HOWEVER SYMPTOMS WORSENED QUICKLY - DETERMINATION WAS MADE TO ADMINISTER EPINEPHRINE. SHE WAS GIVEN A DOSE OF 0.3 MG EPINEPHINE IM AT 1402. PT QUICKLY BEGAN TO FEEL BETTER. SHE WAS GIVEN ORAL BENADRYL 100 MG (PER HER REQUEST - SHE SAYS THIS IS HOW MUCH SHE TAKES EVERY TIME SHE HAS AN ALLERGIC REACTION). DOSE GIVEN AT 1410. SHE DID HAVE COMPLETE RESOLUTION OF HER SYMPTOMS. SHE WAS KEPT IN THE CLINIC FOR OBSERVATION. AT 1430, PT AGAIN BEGAN EXPERIENCING SYMPTOMS AGAIN, SHE WAS COUGHING AND HAD ITCHY THROAT. SHE WAS IMMEDIATELY TAKEN TO THE ED. SHE HAD COUGH, RUNNY NOSE, RASH ON FORARMS ONLY - NOT PRESENT ON CHEST OR BACK OR FACE. AN IV WAS PLACED BY ULTRASOUND IN HER LEFT AC. AT 1438, EPI 0.3 MG IM GIVEN 1440 - FAMOTIDINE 20 MG IV GIVEN 1441 - METHYLPREDNISOLONE 125 MG IV GIVEN 1442 - FAMOTIDINE 20 MG IV GIVEN 1443 - DIPHENHYDRAMINE 50 MG IV 1444 - VITALS - 136/94, HR - 92, OXYGEN SAT - 96% ON RA 1445 - PT C/O HEADACHE, STILL COUGHING, RASH PERSISTS 1450 - IPRATROPIUM / ALBUTEROL + RACEMIC EPI GIVEN 1453 - STILL CONTINUOUS DRY COUGH, RASH BETTER 1455 - BREATHING TREATMENT COMPLETE - COUGH MUCH BETTER 1457 - HEIGHT - 63" WEIGHT - 87.7 KG, 97.4 TEMP, HR - 77, OXYGEN SAT 96% 1504 - PT REPORTS FEELING MUCH BETTER, NO COUGH, NO RASH, LUNGS CTA BIL, NSR - HR - 75, 127/89, 96% ON RA 1610 - PT DOING WELL - PLANNING TO BE DISCHARGED - WITH RX FOR EPI PEN AND PREDNISONE 50 MG DAILY X 3 1616 - SYMPTOMS RETURNED, CONTINUOUS COUGH RETURNED, RASH PRESENT ON ARM, OXYGEN SAT 93%, 146/102, HR - 91, RUNNY NOSE 1619 - IPRATROPIUM / ALBUTEROL + RACEMIC EPI GIVEN - LUNGS DIMINISHED IN BASES WTIH STRIDOR HIGHER UP NEW IV PLACED IN LEFT HAND 1620 - 151/91, OXYGEN SAT 99% ON RA, HR - 86


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