Adverse Event Reporting

VAERS ID 907878
Gender Female
Age 52
StateCode MO
Pharmaceutical Company MODERNA
Lot Number 025J202A
Number of vaccinations 1
Vaccinated 2020-12-23
Onset 2020-12-23
  • Headache
  • Dizziness
  • Chest discomfort
  • Dyspnoea
  • Limb discomfort
  • Dysphagia
  • Oxygen saturation normal
  • Emotional distress

Current Illness

Preexisting Conditions

Other Medications

Previous Vaccinations


Laboratory Data


Patient received COVID vaccine at approximately 9AM this morning.
Stayed 15 minutes after injection for monitoring, felt fine and returned to department.
Employee returned at approximately 11:45AM with possible symptoms of reaction.
Admitted to a headache that started approximately an hour after injection.
Symptoms now include heaviness of arm, chest, feeling emotional, light headed.
Vitals taken at 11:48 BP 150/86, P 79, R16 Pox 97.
Oral Benadryl 25mg administered PO 11:50AM.
EKG run.
Patients symptoms progressed to include difficulty breathing and swallowing.
Epi pen adult 0.
3mg administered IM Left thigh at 12:13PM.
Vitals checked at 12:13PM BP 188/90, pulse 97, pulse ox97.
Called for emergency response for transport to ER.
Pt remained stable until transport by EMS to ER.
Employee health informed of patient transport.
ER informed of patient transport.