Adverse Event Reporting

VAERS ID 1565047
Gender Female
Age 83
StateCode MI
Pharmaceutical Company MODERNA
Lot Number 080A21A
Number of vaccinations 1
Vaccinated 2021-02-09
Onset 2021-03-10
Condition Recovered
Symptoms
  • Rash macular
  • Vaccination site erythema
  • Lipohypertrophy

Current Illness

Preexisting Conditions

Other Medications

Previous Vaccinations

Allergies

Laboratory Data

Write-up

Pink blotch spreading on her arm; Lump around injection site; Red blotch around injection site; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of RASH MACULAR (Pink blotch spreading on her arm), LIPOHYPERTROPHY (Lump around injection site) and VACCINATION SITE ERYTHEMA (Red blotch around injection site) in an 83-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos.
038K20A and 080A21A) for COVID-19 vaccination.
No Medical History information was reported.
On 09-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form.
On 09-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form.
On 10-Mar-2021, the patient experienced LIPOHYPERTROPHY (Lump around injection site) and VACCINATION SITE ERYTHEMA (Red blotch around injection site).
On 11-Mar-2021, the patient experienced RASH MACULAR (Pink blotch spreading on her arm).
On 11-Mar-2021, LIPOHYPERTROPHY (Lump around injection site) had resolved.
At the time of the report, RASH MACULAR (Pink blotch spreading on her arm) and VACCINATION SITE ERYTHEMA (Red blotch around injection site) outcome was unknown.
Treatment included Tylenol on 10-Mar-2021.
concomitant medications not provided.