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 906315



Case Details

VAERS ID: 906315 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2020-12-22
Onset:2020-12-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011J20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Ear swelling, Erythema, Lip swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (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: patient pre medicated self with Benadryl per instructions of her PCP
Current Illness: n/a
Preexisting Conditions: crohns
Allergies: Butalbital-aspirin-caffeine Iodinated Diagnostic Agents Meperidine Infliximab Montelukast Montelukast Sodium Penicillin G Azathioprine Adhesives/tape Codeine Latex Morphine Nsaids Penicillins Tetracycline
Diagnostic Lab Data: steroids administered in the Emergency Department
CDC Split Type:

Write-up: At 35min post vaccine patient noted with redness to the chest, neck and going up to face and bilateral ears. Ears were swollen. Patient transferred to the Emergency Department where she was noticed to have swollen lips


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=906315


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