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VAERS Report 2095545

Case Report Section

Vaer Report Details

Age: 30 years old

Gender: Female

State: Pennsylvania

Patient Died?
No
Vaccine information

Name: COVID19 (COVID19 (MODERNA))

Type: Coronavirus 2019 vaccine

Manufacturer: MODERNA

Lot: 078j21a


Date report was received
2022-02-08
Date form completed
Date Vaccinated
2022-01-03
Date of Onset
12
Number of days (onset date – vaccination date)
12
Adverse Event Description

chronic spontaneous urticaria, widespread of hives and red scratch marks all over random parts of body, comes and goes usually lasting 15-60 mins then disappearing only to appear on a different part of my body. the hives are extremely itchy so i?ve had to take all sorts of over the counter allergy medicine but no signs of the hives going away anytime soon

Lab Data
na
List of symptoms
pruritus erythema urticaria chronic spontaneous urticaria
Patient Died?
No
Date Died
NA
Birth defect
false
Vaccine Administered By:
Unknown
Vaccine Purchased By:
Unknown
Patient visit ER?
No
Patient Hospitalized?
No
Stay in hospital
No
Days in hospital
Unspecified
Permanent disability?
No
Allergies:
na
Current Illness
na