Adverse Event Reporting

VAERS ID 907081
Gender Female
Age 61
StateCode CA
Pharmaceutical Company MODERNA
Lot Number 011J20A
Number of vaccinations
Vaccinated 2020-12-22
Onset 2020-12-22
Condition Recovered
  • Rash
  • Pruritus

Current Illness


Preexisting Conditions

cutaneous lupus Rheumatoid arthritis

Other Medications

prebiotic Allegra multi vitamin

Previous Vaccinations

h/o reaction to allergy shot in the past, same feeling with on coming neck/face rash


penicillin shellfish

Laboratory Data



1600 Patient c/o itchiness to neck and face felt on coming rash 1625 notified me of reaction, advised to take Benadryl 50mg 1630 notified Pharmacist of reaction 1645 follow up with patient "doing okay" 1700 follow up call feeling the same not worse, leaving work for home, aware to go to ED if symptoms worsens