| Days after vaccination:||1
|Vaccination / Manufacturer
||Lot / Dose
||Site / Route|
|COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA
||011J20A / 1
||RA / IM
Administered by: Public Purchased by: ?
Symptoms: Injection site erythema,
Injection site swelling,
Injection site warmth,
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Permanent Disability? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Other Medications: Levothyroxin 25mcg, Vit D 10,000 iu, Zyrtec 10 mg.
Preexisting Conditions: Hashimoto?s
Allergies: Erythromycin, penicillin, sulfa
Diagnostic Lab Data:
CDC Split Type:
Write-up: Pt(I) report swelling, redness, and warmth at the injection site was first noticed in the morning at 6:30 am on 12/24/2020 currently 2.5 inches by 1 5/8 inches. Pt has history of hives. Hive type rash noted on inside of right arm. Hive do not itch.