VAERS ID: 1884634

AGE: 69| SEX: F|STATE: NH (United States)

Description

This spontaneous case was reported by a consumer and describes the occurrence of BACK PAIN (My lower back is killing me), FEELING ABNORMAL (Not feeling great), PAIN (Achiness), URTICARIA (Hives on arm, trunk and rest of the body) and MYALGIA (Muscle pain) in a 69-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 004F21A, 017B21A and 010A21A) for COVID-19 vaccination. No Medical History information was reported.On 02-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form.On 31-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form.On 10-Nov-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced BACK PAIN (My lower back is killing me), FEELING ABNORMAL (Not feeling great), PAIN (Achiness), URTICARIA (Hives on arm, trunk and rest of the body) and MYALGIA (Muscle pain). The patient was treated with PARACETAMOL (TYLENOL [PARACETAMOL]) for Adverse event, at an unspecified dose and frequency and DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE]) for Adverse event, at an unspecified dose and frequency. At the time of the report, BACK PAIN (My lower back is killing me), FEELING ABNORMAL (Not feeling great), PAIN (Achiness), URTICARIA (Hives on arm, trunk and rest of the body) and MYALGIA (Muscle pain) had not resolved. No concomitant medication was reported.

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Symptoms

Urticaria, Myalgia, Pain, Back pain, Feeling abnormal

Vaccines

VAX DATE: 03-02-2021| ONSET DATE: | DAYS TO ONSET:
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 1 COVID19 MODERNA 010A21A OT LA

RECVDATE:11-19-2021
RPT_DATE:
CAGE_YR:69
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:
V_ADMINBY:
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:USMODERNATX, INC.MOD20213
FORM_VERS:
TODAYS_DATE:11-19-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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