National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/19/2021 release of VAERS data:

This is VAERS ID 907811

Government Disclaimer on use of this data



Case Details

VAERS ID: 907811 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: Iowa  
Vaccinated:2020-12-23
Onset:2020-12-23
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Pruritus, Rash macular
SMQs:, Anaphylactic reaction (broad), 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? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertaline 50mg
Current Illness: none
Preexisting Conditions: none
Allergies: morphine
Diagnostic Lab Data:
CDC Split Type:

Write-up: Itchy blotchy spots, left arm, left ear, back


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=907811


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