VAERS ID: 1881370

AGE: 85| SEX: F|STATE: IN (United States)

Description

11-11-2021 Day 2 arm pit itching and large hive on arm and chest area. Arm is swollen beside injection site not where injection was given. Took Benadryl. Day 3 hives larger and I am nauseated. 11-13,14,15,-2021 I was nauseated, had very bad gushing watery diarrhea and was unable to do anything except rest. Was very weak and my legs could barely hold me up. On 11-16-2021 I felt much better and took no Benadryl. Hives gone and feel fine 11-18-2021.

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Symptoms

Urticaria, Pruritus, Nausea, Asthenia, Diarrhoea, Muscular weakness, Peripheral swelling

Vaccines

VAX DATE: 11-10-2021| ONSET DATE: 11-11-2021| DAYS TO ONSET: 1
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 0 COVID19 MODERNA 032F21A IM LA

RECVDATE:11-18-2021
RPT_DATE:
CAGE_YR:85
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:
V_ADMINBY:
OTHER_MEDS:Clopidogril;Topiramate;Gabapentin;B12;Simvastatin;Alprazolam;Colestipol;Tylenol;D3;Colace; Probiotic.
CUR_ILL:No
HISTORY:No
PRIOR_VAX:Influenza
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:11-18-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:Tickid;Codeine;Demerol;Flexeril;Morohine;Phenobarbital;Sulfa;Lovenox;Seconal, Tape;Citroen; Preservatives in Flu Vaccine and Tetanus Vaccine; Talwin; Penicillins.
V_FUNDBY:

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