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VAERS ID: 1864533

AGE: 42| SEX: F|State: TN

Description

Site: Pain at Injection Site-Severe, Site: Swelling at Injection Site-Medium, Systemic: Joint Pain-Severe, Systemic: Numbness (specify: facial area, extremities)-Severe, Systemic: Tingling (specify: facial area, extemities)-Severe, Error: Shoulder Joint Injury (prolonged pain, tingling, etc.)-, Additional Details: according to patient, vaccine was administered by standing pharmacist. Vaccine was given too far forward and to the front of shoulder as opposed to in the deltoid

Symptoms

Arthralgia, Paraesthesia, Hypoaesthesia, Product administered at inappropriate site, Injection site pain, Injection site swelling, Limb injury

Vaccines

VAX DATE: 04 November 2021 | ONSET DATE: 04 November 2021 | DAYS TO ONSET: 0
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • MODERNA
  • COVID19 (COVID19 (MODERNA))

        RECVDATE:
        12 November 2021
        CAGE_YR:
        42
        CAGE_MO:
        RPT_DATE:
        DIED:
        DATEDIED:
        L_THREAT:
        ER_VISIT:
        HOSPITAL:
        HOSPDAYS:
        X_STAY:
        DISABLE:
        RECOVD:
        N
        LAB_DATA:
        V_ADMINBY:
        PHM
        OTHER_MEDS:
        CUR_ILL:
        HISTORY:
        PRIOR_VAX:
        SPLTTYPE:
        FORM_VERS:
        2
        TODAYS_DATE:
        12 November 2021
        BIRTH_DEFECT:
        OFC_VISIT:
        ER_ED_VISIT:
        Y
        ALLERGIES:
        V_FUNDBY:
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