National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 908656

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 908656
VAERS Form:2
Age:26.0
Sex:Female
Location:Ohio
Vaccinated:2020-12-23
Onset:2020-12-23
Submitted:0000-00-00
Entered:2020-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K202A / 1 LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Lip swelling, Pruritus, Rash, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Returned to Vaccine Clinic approx. 60 minutes post vaccination with generalized itching, hive-like rash on chest, arms, and legs and "mild" lip swelling. VS normal and stable during clinic observation. O2 Sat at 100%. Evaluated by onsite physician. Received total of 5omg diphenhydramine during observation. D/C''d in 2 hrs with less itching and resolving rash. Accompanied and driven home by friend. Spoke with EH nurse on 12/24/2020 and stated additional 50 mg diphenhydramine at home 12/23/2020. Mild, fading rash today. PLAN: will be evaluated by Allergy Clinic and if cleared, will receive 2nd dose of vaccine in Allergy Clinic.


Changed on 5/7/2021

VAERS ID: 908656 Before After
VAERS Form:2
Age:26.0
Sex:Female
Location:Ohio
Vaccinated:2020-12-23
Onset:2020-12-23
Submitted:0000-00-00
Entered:2020-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K202A / 1 LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Lip swelling, Pruritus, Rash, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Returned to Vaccine Clinic approx. 60 minutes post vaccination with generalized itching, hive-like rash on chest, arms, and legs and "mild" lip swelling. VS normal and stable during clinic observation. O2 Sat at 100%. Evaluated by onsite physician. Received total of 5omg diphenhydramine during observation. D/C''d in 2 hrs with less itching and resolving rash. Accompanied and driven home by friend. Spoke with EH nurse on 12/24/2020 and stated additional 50 mg diphenhydramine at home 12/23/2020. Mild, fading rash today. PLAN: will be evaluated by Allergy Clinic and if cleared, will receive 2nd dose of vaccine in Allergy Clinic.


Changed on 5/14/2021

VAERS ID: 908656 Before After
VAERS Form:2
Age:26.0
Sex:Female
Location:Ohio
Vaccinated:2020-12-23
Onset:2020-12-23
Submitted:0000-00-00
Entered:2020-12-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K202A / 1 LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Lip swelling, Pruritus, Rash, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Returned to Vaccine Clinic approx. 60 minutes post vaccination with generalized itching, hive-like rash on chest, arms, and legs and "mild" lip swelling. VS normal and stable during clinic observation. O2 Sat at 100%. Evaluated by onsite physician. Received total of 5omg diphenhydramine during observation. D/C''d in 2 hrs with less itching and resolving rash. Accompanied and driven home by friend. Spoke with EH nurse on 12/24/2020 and stated additional 50 mg diphenhydramine at home 12/23/2020. Mild, fading rash today. PLAN: will be evaluated by Allergy Clinic and if cleared, will receive 2nd dose of vaccine in Allergy Clinic.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=908656&WAYBACKHISTORY=ON


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