Report #2891549

Received Apr 2, 2026

Life-threateningHospitalizedER / ED visitOffice visitDisabled

A note on interpretation. VAERS reports are unverified and may be incomplete or coincidental. A report does not establish that a vaccine caused an event, and counts should not be used to calculate incidence or infer causation. Full disclaimer

Overview

Sex: Male
Age: 29 yrs
State: MA
Recovered: Not recovered
Vaccinated: Jan 26, 2021
Onset: Feb 20, 2021
Days to onset: 25
Hospital days: 3

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	2	012L20A	IM / AR

Symptoms (8)

Allergy test negativeAnaphylactic reactionAngioedemaAntinuclear antibodyAntinuclear antibody increasedAntiphospholipid antibodies positiveSystemic lupus erythematosusUrticaria

Symptom narrative

Idiopathic anaphylaxis, SLE. Multiple spontaneous events of urticaria, angioedema, anaphylaxis over the years of 2021-present

Current illness

N/A

Medical history

GERD, Depression/Anxiety, Hypogonadism, seasonal allergies

Other medications

Lexapro 20, Clomiphene 25mg, klonopin 0.5mg, testosterone cypionate 100mg weekly, zyrtec 10mg daily, omeprazole 40mg

Allergies

PCN, Cipro, cymbalta, sulfa, onion

Lab data

Traditional allergy testing (skin prick, patch testing, IgE etc) negative....... ANA started climbing 80-160-320-640. SSA>assay detection. Lupus antigoag + x2.