Adverse Event Reporting

VAERS ID 1836821
Gender Female
Age 58
StateCode WI
Pharmaceutical Company MODERNA
Lot Number 939904
Number of vaccinations
Vaccinated 2021-10-26
Onset 2021-10-27
  • Fatigue
  • Pyrexia
  • Chest discomfort
  • Injection site pain
  • Injection site swelling
  • Cough
  • Anosmia
  • Rhinorrhoea
  • Ageusia

Current Illness


Preexisting Conditions


Other Medications

Yes- Claritin

Previous Vaccinations



Laboratory Data


Per Client, received second dose of Moderna COVID 19 vaccine in the left arm on 10/26/2021.
Next day on 10/27/2021, left arm at site swollen and painful.
Later in day on 10/27/2021, symptoms of fever, runny nose, slight loss of taste and smell, fatigue, intermittent cough and slight chest discomfort, for now over a week since vaccine on 10/26/2021.
Client dose have underlying medical conditions and taking prescription medications.
Client reported taking over the counter Tylenol for pain and fever.
PHN provided COVID 19 vaccine education with Client.
PHN recommend that Client follow up with PCP, go into Urgent Care, ER or call 911 for medical emergency.
Per Client, will be follow up with PCP and COVID 19 test