VAERS ID: 922443

AGE: 32| SEX: F|STATE: GA (United States)

Description

Vaccine administered on 12/29, severe burning while injecting and for 5-10 seconds after injecting. 12/30 noticed lesion on upper arm in area of injection- erythematous, warm, pruritic, raised area, about 4x4cm. No change until 1/5. 1/5: 7.5x4cm lesion, increased pruritus, warm, erythematic, and 3-5 pin-head sized vesicles with clear exudate formed on the medial side of lesion. Pregnancy history- 4 pregnancies in past 12 months with no live births. 2 miscarriages and 1 ectopic. LMP 12/12/20, patient was pregnant at time of injection but unaware.

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Symptoms

Injection site erythema, Injection site swelling, Immediate post-injection reaction, Injection site pruritus, Injection site warmth, Injection site vesicles, Burning sensation, Exposure during pregnancy

Vaccines

VAX DATE: 12-29-2020| ONSET DATE: 12-30-2020| DAYS TO ONSET: 1
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 0 COVID19 MODERNA 02bl20 IM LA

RECVDATE:01-06-2021
RPT_DATE:
CAGE_YR:32
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:
V_ADMINBY:PVT
OTHER_MEDS:Prenatal Vitamins, CoQ10, Florastor probiotic, Vancomyacin, zyrtec
CUR_ILL:C. Diff
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:01-06-2021
BIRTH_DEFECT:U
OFC_VISIT:Y
ER_ED_VISIT:U
ALLERGIES:Shellfish
V_FUNDBY:

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