Adverse Event Reporting

VAERS ID 913445
Gender Female
Age 24
Pharmaceutical Company MODERNA
Lot Number
Number of vaccinations 1
Vaccinated 2020-12-27
Onset 2020-12-27
Condition Hospitalized Life Threatening
  • Chest discomfort
  • Intensive care
  • Lip swelling
  • Pruritus
  • Urticaria
  • Anaphylactic reaction

Current Illness

Preexisting Conditions

Other Medications

Previous Vaccinations

Influenza vaccine = hives


Pt reports having hives to the influenza vaccine

Laboratory Data


Pt developed anaphylaxis, was given IM Benadryl, and was sent to the ED.
Pt spent 1 night in the hospital, went home, and has come back and is in the ICU.
Pt had hives, itching, chest tightness, swollen lips.