Adverse Event Reporting
| VAERS ID | 1001676 |
|---|---|
| Gender | Female |
| Age | 77 |
| StateCode | FL |
| Pharmaceutical Company | MODERNA |
| Lot Number | 023L20A |
| Number of vaccinations | 1 |
| Vaccinated | 2021-01-23 |
| Onset | 2021-01-23 |
| Condition | Permanent Disability |
Symptoms
- Injection site rash
- Injection site vesicles
Current Illness
never smoked and does not drink
Preexisting Conditions
glaucoma
Other Medications
timolol eye drops; calcium and multiple vitamin
Previous Vaccinations
Allergies
none
Laboratory Data
EXAMINED BY PHYSICIAN ASST, 28-Jan-2021, severe reaction to vaccine, there was no test conducted outside of review and analysis by the physician asst who reported results
Write-up
Upon receiving the Moderna vaccine (1st dose) a significant rash occurred in the area of the injection site.
Additionally, a large blister covered the significant rash