National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

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

This is VAERS ID 905986



Case Details

VAERS ID: 905986 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Texas  
Vaccinated:2020-12-15
Onset:2020-12-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2020-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA EK 5730 / 1 LA / IM

Administered by: Military       Purchased by: ?
Symptoms: Induration, Mass, Pruritus, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: to many to list
Current Illness: none
Preexisting Conditions: b/p, diabetic, on a daily baby asa, chol meds, multi vitamins
Allergies: entex, pcn, adhesive tape sensitivity
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe swelling, hard lump, hot to touch, severe itching


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=905986


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166