Adverse Event Reporting

VAERS ID 924690
Gender Female
Age 38
StateCode NC
Pharmaceutical Company MODERNA
Lot Number 039K20A
Number of vaccinations 1
Vaccinated 2021-01-05
Onset 2021-01-05
Condition Permanent Disability
  • Chills
  • Pain
  • Impaired work ability
  • Body temperature increased
  • Injection site reaction
  • Contusion
  • Joint range of motion decreased
  • Musculoskeletal disorder
  • Inflammation

Current Illness


Preexisting Conditions

Pericardial effusion (fluid around heart) mostly resolved after surgery few months ago Year around allergies

Other Medications

Benadryl, vitamin d, vitamin b12

Previous Vaccinations



Laboratory Data

Dr visit at immediate care


Three to four hours after vaccine had bruising, major loss of range of motion, severe sharp pain, elevated temp and chills due to reaction of injection site Treatment given 24 hrs later- strong antibiotics, anti inflammatory, exercise, and three days out of work Due to loss of function of left arm due to inflammation