The first case was a 49-year-old male who presented with a history of chronic spontaneous urticaria for the past twenty-eight years. The patient's hives presented on the front and back of his body, including his feet and hips. His exacerbating factors include warm temperatures and sunlight, however, there are times that wheals appear spontaneously. Previously, the patient has tried and failed two different high dose first generation H1 antihistamines (Carbinoxamine and Cyproheptadine), as well as an H2 blocking antihistamine (Ranitidine). Subsequently, the patient was started on omalizumab (Xolair) 300 mg every four weeks, with success experienced after the third dose. The patient had been consistent with his omalizumab injections, and his symptoms were well controlled by pharmacotherapy for about 2 months. After the second dose of the Moderna COVID19 vaccine, the patient had a flare of urticaria identical to previous episodes. The outbreak occurred 16 hours after receiving the vaccination. The patient took cetirizine, and the wheals resolved within 6 hours. Since this flare up, the patient now continues to develop hives every 2 to 3 days, and his symptoms are no longer controlled with pharmacotherapy.