Adverse Event Reporting

VAERS ID 925219
Gender Female
Age 66
StateCode OR
Pharmaceutical Company MODERNA
Lot Number 025J202A
Number of vaccinations 1
Vaccinated 2020-12-30
Onset 2020-12-31
Condition Permanent Disability
  • Hypoaesthesia
  • Rash
  • Urticaria
  • Back pain
  • Herpes zoster

Current Illness


Preexisting Conditions


Other Medications

Lysine, levothyroxine, B complex, Emergency C Estraidiol patch

Previous Vaccinations

Flu, , does not regularly get Flue vaccine as have had several episoede of flu illness last flu vaccine three years ago a half



Laboratory Data



Woke up Thursday am with hives on right lower abdomen and leg getting progressively worse throughout the day.
By that afternoon had back pain in right back and continuing hives.
Woke up Friday with numbness to right leg, hives, and back pain all on right side of body.
Had numbness to foot, face but especially thigh, back and across upper buttocks.
Saturday hives subsiding, numbness receding to face, upper thigh and foot only on right side of body.
Sunday, back pain some improved, no hives or hives minimal, numbness persists upper thigh face and foot on right side of body.
Monday, Tuesday and Wednesday the same.
Woke up Thursday with shingles rash to upper thigh back, numbness to foot face and upper thigh persist only on right side of body.