VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 10/01/2021
** VAERS DATABASE Last updated: October 1, 2021**
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Manufacturers

Total Manufacturer
187,133MODERNA
33,878JANSSEN
2,321PFIZER\BIONTECH
1,091GLAXOSMITHKLINE BIOLOGICALS
983UNKNOWN MANUFACTURER
363MERCK & CO. INC.
229SEQIRUS, INC.
45DYNAVAX TECHNOLOGIES CORPORATION
41NOVARTIS VACCINES AND DIAGNOSTICS
29SANOFI PASTEUR
18EMERGENT BIOSOLUTIONS
8PAXVAX
7TEVA PHARMACEUTICALS
4PFIZER\WYETH
3BERNA BIOTECH, LTD.
2SMITHKLINE BEECHAM
2INTERCELL AG
2PROTEIN SCIENCES CORPORATION
1CSL LIMITED

Incidents per State

State Total
77,548
AK1,869
AL5,581
AR3,688
AS47
AZ14,288
CA61,984
CO11,665
CT8,149
DC1,663
DE1,807
FL37,749
FM5
GA15,058
GU120
HI2,453
IA4,625
ID2,692
IL20,334
IN24,007
KS4,615
KY7,696
LA4,887
MA14,654
MD12,514
ME3,129
MH11
MI18,739
MN12,528
MO9,710
MP29
MS2,790
MT2,375
NC16,368
ND1,356
NE2,880
NH3,100
NJ17,634
NM3,916
NV4,239
NY34,355
OH19,081
OK6,195
OR8,636
PA23,083
PR2,370
QM2
RI2,088
SC6,411
SD1,212
TN9,131
TX35,174
UT4,273
VA14,937
VI64
VT1,676
WA14,909
WI11,259
WV2,388
WY861
XB5
XL1
XV2

ID: 1592349
Sex: F
Age: 47
State:

Vax Date: 06/08/2021
Onset Date: 06/14/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Dysphagia, Epiglottitis

Symptoms: Tingling in feet and lower legs, numbness/tingling in left hand, weakness/trembling in thighs/legs, persistent headaches, appearance of very small blood spots under the skin, elevation of heart rate, unusually dry mouth and eyes upon waking, difficulty sleeping, significant fatigue. These symptoms began about a week after the vaccination and persisted for approximately 6 weeks before seeing notable improvement. As of today (10 weeks post vaccination) I am still experiencing tingling in my legs several days a week, however my headaches and fatigue have subsided. I was evaluated by my PCP with a range of blood tests (all normal), and a neurologist who diagnosed my condition as vaccine induced neuropathy.

Other Meds: Vitamin D, multivitamin

Current Illness: None

ID: 1592350
Sex: M
Age: 54
State: HI

Vax Date: 04/19/2021
Onset Date: 08/15/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: Facial paralysis, (Bells Palsy) Onset: 8/15 gradual paralysis to full paralysis by 8/17.

Other Meds: Focus Factor, vitamin D3

Current Illness: None

ID: 1592351
Sex: F
Age: 56
State: WA

Vax Date: 01/15/2021
Onset Date: 03/08/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Walnuts

Symptom List: Chest discomfort, Dysphagia, Pain in extremity, Visual impairment

Symptoms: On March 9, developed significant palpitations. These recurred every day and on March 15 I went to ED. No MI detected but Holter monitor for next 2 days shower 600 PACs per day. Started Flecainide, which helped. Breast MRI in April showed large pericardial effusion behind left atrium. Took medication until July 1st. Palpitations resolved.

Other Meds: Metoprolol, sertraline, calcium, magnesium, vitamin d, fish oil

Current Illness: None

ID: 1592352
Sex: F
Age: 39
State: FL

Vax Date: 08/01/2021
Onset Date: 08/15/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data:

Allergies: Iodine, tetracycline, macrobid, bactrim, azythromyacin, NSAIDS, Toradol, Penicilin, Pepcid, Benadryl, Lactose Intolerant, latex, lidocaine

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Started with extremely sore throat the first week. Still have sore throat and hoarseness at times. A white circle was around the injection site. Left arm at injection will hurt on and off. Alot of fatigue and body aches. Rash on my right eyelid, unknown if it is shingles. Started antiviral but did not tolerate it.

Other Meds: Ativan 0.5 Zyrtec Pro-air

Current Illness: N/A

ID: 1592353
Sex: F
Age: 37
State: TN

Vax Date: 08/09/2021
Onset Date: 08/11/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Na

Symptom List: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Severe chest pains, heart populations. Edema in lungs. Blood pressure issues. Pleurisy

Other Meds: Trazadone. Venafaxine. Trazadone. Klonopin.

Current Illness:

ID: 1592354
Sex: M
Age:
State:

Vax Date: 08/18/2021
Onset Date: 08/19/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Chills, Confusional state, Eye inflammation, Headache, Laboratory test

Symptoms: Severe side effects compared to Moderna 2nd Shot including high fever, teeth rattling chills, joint and muscle pain, sob, severe fatigue and malaise. These sxs were for the Moderna Booster Shot(3rd Shot) Sx resolved after 36 hrs.

Other Meds: Prednisone 20mg/day, Metoprolol, Tamsulosin , Lisinopril, Atorvastatin,

Current Illness: None

ID: 1592356
Sex: F
Age: 28
State: NY

Vax Date: 08/15/2021
Onset Date: 08/16/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: PENICILLIN.

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: First dose: Chest pain 5 days. SOB. Second dose: Chest pain 3 days. Migraine 5 days. SOB 1 day. Tx? None.

Other Meds: None

Current Illness: None.

ID: 1592357
Sex: M
Age: 38
State: NJ

Vax Date: 05/01/2021
Onset Date: 08/16/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none known

Symptom List: Pharyngeal swelling

Symptoms: Client was vaccinated with Moderna vaccine for Covid on or about April 1 and May 1, 2021. Developed Covid symptoms (mild) on 8/16. Tested PCR + on 8/19. Reported as a breakthrough Covid case in a fully vaccinated person.

Other Meds: none known

Current Illness: none known

ID: 1592358
Sex: F
Age: 33
State: OH

Vax Date: 08/20/2021
Onset Date: 08/20/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: perphenazine

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient received the first dose of Pfizer covid-19 vaccine at approximately 11:30am on 8/20/21. She left the store, did some shopping, got home and around 2:00pm while she was at home her throat started to feel like it was closing. She called 911, an ambulance came to her, gave her epinephrine injection, took her to the hospital. She received a prescription for an epipen.

Other Meds:

Current Illness:

ID: 1592359
Sex: F
Age: 84
State:

Vax Date: 01/19/2021
Onset Date: 08/20/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: LISINOPRIL, CARBAMAZEPINE, AMLIDIPINE, CLONIDINE, HYDRALAZINE, MORPHINE, SITAGLIPTIN

Symptom List: Diarrhoea, Nasal congestion

Symptoms: BREAK THRU COVID CASE

Other Meds: APIXABAN, CARVEDILOL, CITALOPRAM, DILTIAZEPAM, SYNTHROID, PANTOPRAZOLE, METFORMIN,

Current Illness:

ID: 1592360
Sex: F
Age: 31
State: CA

Vax Date: 01/05/2021
Onset Date: 08/20/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Allergy to hydrocodone- hives, shortness of breath

Symptom List: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: Pain at injection site since evening of injection, continued pain at injection site with any exercise or touching site since date of injection to present. Severe headache for 4 days after injection. Chest discomfort for 1 week after injection.

Other Meds: None

Current Illness: None

ID: 1592361
Sex: F
Age: 52
State: MA

Vax Date: 08/19/2021
Onset Date: 08/20/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies: No

Symptom List: Rash, Urticaria

Symptoms: First dose. Flu symptoms, Chest pains, racing heart, shortness of breath. All symptoms went away after two days except shortness of breath. It went away one week later. Flu like symptoms after second dose but not as sick. Symptoms went away but shortness of breath is back. Lungs feel tender and sore. When I breath in O2 feels cut off. Like pneumonia.

Other Meds: NAC, multi vitamin, probiotic, vitamin D. Quentiapine

Current Illness: Back pain a month prior

ID: 1592362
Sex: F
Age: 57
State:

Vax Date: 03/10/2021
Onset Date: 08/18/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: BREAK THRU COVID CASE

Other Meds:

Current Illness:

ID: 1592524
Sex: M
Age: 36
State: IN

Vax Date: 08/20/2021
Onset Date: 08/20/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Dyspnoea, Fatigue, Feeling abnormal, Head discomfort, Headache

Symptoms: patient stood after giving vaccine and fainted. he never lost consciousness or complained of pain. he was able to sit up without feeling dizzy and moved to chair to rest further.

Other Meds:

Current Illness:

ID: 1592525
Sex: F
Age: 35
State: IN

Vax Date: 08/18/2021
Onset Date: 08/18/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: 2 hours after injection nausea and dizziness with slight vertigo. 14 hours after injection shooting pains from the injection site up the shoulder and through the jaw bone. 22 hours after injection fever of 102 with chills and muscle aches. All passed after the 36 hour mark. Now at the 48 hour marker the site is swelling larger with mild bruising and continuing to get larger.

Other Meds: None

Current Illness: None

ID: 1592526
Sex: F
Age: 15
State: CA

Vax Date: 08/14/2021
Onset Date: 08/17/2021
Rec V Date: 08/20/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Pt admitted to medical facility 8-17-21 with fever, HTN, local shot site reaction, chest pain, and vomiting; elevated liver enymes, troponins, and D-dimer. Dx: covid vax related myocarditis in obese, anxious teen with liver disease. Treated with steroids, IVIG, clonidine, zofran, and benadryl. Four normal EKGs, Echo with ejection fraction 64%, BP stablized, patient improved, discharged home 8-20-21.

Other Meds: none

Current Illness: Overweight (~100 Kg); Fatty Liver Disease; Anxiety

ID: 1592527
Sex: F
Age: 62
State: KY

Vax Date: 05/18/2021
Onset Date: 08/18/2021
Rec V Date: 08/20/2021
Hospital: Y

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies:

Symptom List: SARS-CoV-2 antibody test, SARS-CoV-2 test negative

Symptoms: Currently hospitalized

Other Meds: metformin, losartan, hctz, methotrexate

Current Illness:

ID: 1592528
Sex: M
Age: 55
State: TX

Vax Date: 08/17/2021
Onset Date: 08/17/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: HIBV
Manufacturer: MERCK & CO. INC.
Vax Name: HIB (PEDVAXHIB)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies: N/A

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Fever 3 days/Diarrhea 3 days/Headache 4 days- still taking Tylenol for it and now Friday at 715pm and still with headache/ rash both arm pits starting going away at day 3. /Tired 4 days / 2 days Brain was foggy/ Body joint pains 2 days almost 3

Other Meds: Duloxetine, Meloxicam,Cycobenzaprine,Atenolol,Mirtazapine,Losartan, Prazosin,Tramadol,Fluticasone Proplonate, Cetirizine, Niacin 250mg, Visibility-T, Omega 3

Current Illness: N/A

ID: 1592529
Sex: F
Age: 17
State: TN

Vax Date: 08/17/2021
Onset Date: 08/18/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: PNC13
Manufacturer: PFIZER\WYETH
Vax Name: PNEUMO (PREVNAR13)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: typical vaccine reactions within 24 hours (low grade fever, achiness, cough) that evolved into shortness of breath and chest pain. Seen in the ER 36 hours later and treated with ativan with some decrease in associated anxiety but persistent dyspnea and inability to exertion. Seen again in my office 48 hours later with very limited air movement on exam with pain with inspiration. Treated with albuterol with immediate relief and better air exchange. Sent home with albuterol and monitoring

Other Meds:

Current Illness:

ID: 1592530
Sex: F
Age: 55
State: CA

Vax Date: 08/17/2021
Onset Date: 08/17/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: RV1
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: ROTAVIRUS (ROTARIX)
Lot:
Dose Series: 1
Vax Route: PO
Vax Site: MO

Lab Data:

Allergies:

Symptom List: Blood pressure increased, Chest discomfort, Heart rate increased

Symptoms: Patient completed Moderna series and received Janssen

Other Meds:

Current Illness:

ID: 1592531
Sex: F
Age: 53
State: TX

Vax Date: 06/24/2021
Onset Date: 06/24/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Dust, Seasonal Sinus Allergies, Clavulanic Acid, Neosporin

Symptom List: Injection site erythema, Injection site pruritus, Injection site swelling, Lymph node pain, Lymphadenopathy

Symptoms: I don't remember if I was at pharmacy at 4pm or 5pm exact. However, getting the shot, was easy. I was so shocked how easy it was. But the aftermath, became a different story. I had a few small items to purchase at the store. So, I got up and started walking from the pharmacy over to produce at a fast pace (for me). Within about 2 minutes, my heart was pounding fast. It scared me. I paused at flowers, took deep breathes, and started moving much slower. I felt a large, strong adrenaline rush in my body, but heart racing had slowed down. Since my heart slowed down, I thought, "Ok, I'll get my stuff." I did. However, each time I started moving a little faster, my heart would speed up, and that rush feeling would com. ...and that rush feeling would come back. That concerned me. Well, I methodically finished purchasing my few items walking slowly. I checked out and went back over to the pharmacy. The lady who gave me the injection saw me out of the corner of her eye. She was busy at one of the customer counters, so I walked over and sat down in the pharmacy chairs nearby. (I knew if something happened, she would see and help me). I sat for about 5 - 10 minutes. She stayed busy. I decided to drive slowly home. I got up, spoke with the lady (she said she was coming to check on me as soon as she finished with what she had in her hand). I told her I just wanted to let her know I was going home. She said ok. I left. I went home, arm looked fine. As long as I moved slowly, deliberately, I was ok. I went to bed early. By the next day, a red quarter sized circle appeared on my upper left arm. I expected that. Arm was a little sore (expected that). I went to work the next day. I tired very quickly, but I was able to do desk work. My co-workers thought I should have stayed home. But, I was not willing to get a demerit (point) for being absent for this. At that time I understood each person was a case by case basis. I wasn't willing to chance my case. Here is what I did NOT expect: the red circle on my upper left growing (bigger than an old silver dollar coin a few times) on my left upper arm that would come and go. My left arm being warm to the touch. Also, within a day or so after the shot, I felt a gel "pill" like circle IN my arm about an inch above my elbow. So, thinking the medicine needed help to move around, I started gently rubbing (massaging) my arm up and down. While the "gel" like substance disappeared, I started experiencing black and blue "bruising" in my left arm along with the redness. I would literally have red, black, and blue "come and go" spots on my arm. (I did NOT rub for long). This ended up causing a regression in my left arm among my tendons/ligaments that I thought was healed. (About a year or two ago, I had some tendon/ligament issues in that arm) I am not a happy camper. This went on for a few weeks. My co-workers told me I needed to get it checked out. (But I was still alive and able to function, so I guess that is what Moderna and the government would consider: success??!!) I (a person who believes in taking vaccines) was angry, frustrated, scared, and wished I had taken the JnJ or Pfizer vs Moderna. Then I decided NOT to take the second shot. This was ridiculous. I did go to my doctor, but for other issues. I did mention about getting my shot and what had happened. He glanced at my arm and said it appeared to be healing. I told him I may not be getting the second dose. I asked if we could see about how much antigen/antibiotic I had in my blood in a few weeks. We wanted to give this a little longer. Since then, my job is pressuring people to get the vaccine. I am very, very frustrated. I do have a Dr's appointment to see how I should proceed. A few times during these couple of months, when I would go back to do some general shopping, I would stop off at the Pharmacy to ask questions. I spoke with 3 different people in the pharmacy, explaining my experiences. 1 person mentioned that I should to the Vaers Safe Check-in and sign up (I did), 1 person mentioned they could never get through to Moderna to ask their questions (I'm thinking, but you are a pharmacy calling?!!!). Another person mentioned, they heard of another customer having the same effects I did. I left knowing I wasn't the only one. All would say, to seek medical attention if needed. Many times I was told, "That may be how YOUR body is reacting." I'm thinking, but there were TEST trials before the general public started taking it .... and some of my symptoms were NOT mentioned. As of August 19, 2021, I still have the shot injection mark on my upper left arm. I do not understand how this is still here. I get blood draws frequently, and my skin is penetrated to get the Remicaid in, yet those heal up fast (within 24 hours). The flu shot heals up fast (within 24 hours). This Moderna shot does NOT.

Other Meds: Remicaid (infusion every 8-10 weeks), Methotrexate (skipped do On the Methotrexate (2.5 mg, 5 tabs 1x weekly) I was told to skip a dose due to taking the Covid-19 vaccine. I did. Metoprolol Succ ER 50 MG Tab (1x PM) Lisinopril Tab 5 MG (1x

Current Illness: Ligiment/Tendon problems I thought were healed b4 this.

ID: 1592532
Sex: F
Age: 39
State: VA

Vax Date: 08/19/2021
Onset Date: 08/20/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Unevaluable event

Symptoms: Enlarged lymph nodes in armpit area. Size of golfball.

Other Meds: Symbacort Zyrtec

Current Illness: None

ID: 1592533
Sex: M
Age: 44
State: CA

Vax Date: 07/23/2021
Onset Date: 07/23/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: no

Symptom List: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: This was not an adverse reaction event. Patient had gotten the Johnson/Johnson vaccine on 6/9/21 at pharmacy and then came in and omitted information about his vaccine history as well as last name and then got the Moderna vaccine #1 at pharmacy on 7/23/21. Patient came in on 8/20/21 to get Moderna #2 and this incident was discovered. Patient noted that he had no side effects at all after receiving the Moderna #1 vaccine.

Other Meds: no

Current Illness: no

ID: 1592535
Sex: F
Age: 56
State: MI

Vax Date: 07/30/2021
Onset Date: 07/30/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Injection site pain, Pain

Symptoms: Fatigue 5 days Shoulder across back 1 day Headache dizziness nausea 21!!! Days

Other Meds: C-Naltrexone Cannabis Vitamin D Zinc

Current Illness: None

ID: 1592536
Sex: F
Age: 20
State: PA

Vax Date: 08/16/2021
Onset Date: 08/16/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: don't know

Symptom List: Injection site pain, Menorrhagia

Symptoms: patient fainted minutes after shot administered. emergency services called after it was determined patient hit her head during fall.

Other Meds: don't know

Current Illness: none

ID: 1592537
Sex: F
Age: 76
State: NV

Vax Date: 02/13/2021
Onset Date: 02/13/2021
Rec V Date: 08/20/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: Penicillin, Lisinopril, Statin sensitivity, Sulfa family, Iron infusion(slight itch)

Symptom List: Arthralgia, Chills, Headache, Mobility decreased, Myalgia

Symptoms: Emphysema and was given oxygen and inhalers for treatment (Anora Ellipta, Albuterol HSA) Ongoing issue.

Other Meds: Magnesium, Isosorbide, Omeprazole, Calcitriol, Zinc, B-12, Febuxostat, Aspirin 81mg, Levothyroxine, Torsemide, Carvedilol, Glipizide, Atorvastatin, Colchicine, Hydralazine, Potassium CLCR, Lantus, Humalog, Fluticasone Propionate, Azelastine

Current Illness:

ID: 1592538
Sex: M
Age: 50
State: IN

Vax Date: 08/16/2021
Onset Date: 08/18/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None known

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: No adverse event, patient/spouse reported having no symptoms or side effects 3 days after vaccination. Patient came for "second covid vaccination" and was processed through system as Pfizer vaccine instead of the Moderna vaccine he had received for initial dosage due to several factors/miscommunication. Patient received Pfizer vaccine on 8-16-21 instead of the 2nd Moderna dose that he expected, but he did not vocalize which vaccine just brought in his card at last step of process. Intern administering vaccine did not remember to confirm with patient/double check the vaccine card and administered Pfizer vaccine (which was processed through Rx system mistakenly due to miscommunication with patient). Patient/spouse were concerned about receiving different manufacturers/differnet mRNA vaccines so VAERS report has been filed to report error. No adverse effects or side effects from vaccination, patient was just concerned that they received 1 dose of Moderna then 1 dose of Pfizer 4 weeks later instead of both Moderna doses.

Other Meds: N/A to covid-19 vaccination, not immunocompromised

Current Illness: N/A

ID: 1592539
Sex: F
Age: 50
State: MO

Vax Date: 01/03/2021
Onset Date: 02/08/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: SEPTA--HIVE AVIANE BC--DVT/PE

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: HAD NO PERIOD IN FEBRUARY, MARCH I HAD A FEW DAYS OF VERY LIGHT SPOTTING, APRIL PERIOD EXTREMELY HEAVY (ALMOST WENT TO THE ER) MAY, JUNE, JULY WERE HEAVY BUT NOT AS BAD AS APRIL. ALSO HAD LARGE CLOTS AND SHARP RLQ PAIN, APRIL, MAY, JUNE & JULY. HAD FOLLOW UP WITH GLAUCOMA SPECIALIST IN JUNE AND FOUND MY EYE PRESSURE TO BE HIGH. I HAVE HAD NO PROBLEMS WITH MY PRESSURES SINCE STARTING ON GLAUCOMA MEDICATION 7-10 YEARS AGO

Other Meds: BUPROPION XL, LATANOPROST EYE DROPS, LEVOTHYROXINE, LISINOPRIL, METOPROLOL SUCCINATE ER, PANTOPRAZOLE, XARELTO, ZYRTEC, VITAMIN D, ZINC, COLAGEN POWDER, FIBER SUPPLEMENT

Current Illness: NONE

ID: 1592541
Sex: M
Age: 38
State: IN

Vax Date: 08/07/2021
Onset Date: 08/09/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: N/A

Symptom List: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: Started having constant chest pain on left side from middle of chest into armpit. Pains then started shooting down left arm. Elevated heart rate and elevated blood pressure and headache Went to ER, and EKG was performed and found it wasn't a heart attack and was told to follow up with my Primary Care Physician Still have elevated blood pressure (higher than normal), still have chest pains occasionally (about 10-12 times a day but don't last longer than 10 minutes

Other Meds: Levothyroxine Losartin Lisinopril Daily Vitamin Probiotic Vitamin C Vitamin D

Current Illness: N/A

ID: 1592542
Sex: F
Age: 37
State: TX

Vax Date: 08/03/2021
Onset Date: 08/03/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Gluten

Symptom List: Nausea

Symptoms: Within 10 minutes of receiving the vaccine, I felt that I was going to pass out. I had to sit down on the floor in pharmacy. Within the next few hours, I experienced mild chest pain , mild to moderate head ache, and flu like symptoms. In addition, most of the left side of my face went numb like Bell?s palsy (forehead, cheek, lips and tongue on the left). I got the vaccine on a Tuesday. On Wednesday and Thursday my 10 month old breastfed baby started experiencing hives on her face and body. Her ears were red on the tips. Her hands and fingers were red and swollen hot to the touch. I took her to urgent care where she got an oral steroid. She tested negative for any respiratory virus. It is now a few weeks later and I still have a spot on the left side of my lips with no feeling. I am experiencing extreme fatigue where it is difficult to stay awake throughout the whole day.

Other Meds: Prenatal vitamin

Current Illness: None

ID: 1592543
Sex: F
Age: 35
State: PR

Vax Date: 05/07/2021
Onset Date: 06/29/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Injection site pain

Symptoms: Ever since I got the 2nd dose, I feel a heaviness in my womb area, and it does not match with any part of the menstrual or ovulating cycle. What worries me the most is that, besides activating wild Urticaria bursts, at night my arms, legs and whole body goes numb, as if I was about to pass out. My breath fades away and it feels like I have no control over my body. The heart rate increases and when I finally am able to breathe again, my whole body jolts out of the bed, feeling like I almost died. I see flashing lights, colorful dots, head feels heavy, and also experiment a loud whistle sound before my ears clog. The exact area where I got the second shot starts "palpitating". I didn't experiment any of these before. I am terrified of getting a third shot because of these symptoms that started since June. I'm just scared it might get worse over time. The only thing that calmed down was the Urticaria with Aveno Psoryasis oat lotion, but the other things keep on happening.

Other Meds: Immune System Vitamin C and Zinc Gummies

Current Illness: None

ID: 1592544
Sex: F
Age: 52
State: IL

Vax Date: 06/01/2021
Onset Date: 06/27/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Erythromycin

Symptom List: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Hives showing up beginning right before first shingles vaccine but well after my 2nd Covid vaccine (almost one month). These hives itch, are red, hot, and raised. They come on all over my body and come and go. They are getting worse. I have no new detergent, soaps, food, etc. Some hives look like chicken pox but some large, covering half my back.

Other Meds: Cymbalta, calcium with D, Fiber gummies, alorazapam, B12 shots, Levothyroxine, Gabapentin, Januvia, Duloxetine, Rosuvaatain, Omeprazole, Verapamil, Lisinopril, Miralax, Betamethasone

Current Illness: Fibromyalgia, major depressive episode, anxiety, back and hip pain.

ID: 1592545
Sex: M
Age: 23
State: IN

Vax Date: 07/13/2021
Onset Date: 07/13/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: NONE

Symptom List: Chills, Dizziness, Nausea, Pain, Tachycardia

Symptoms: 2 HOURS AFTER RECEIVING SHOT MY SON WAS DIAPHORETIC,PASTY,PALE AND FELT DIZZY,CHEST AND UPPER BACK PAIN AND HEART PALPITATIONS WITH TACHYCARDIA AND CHILLS. FOR THE NEXT 2 DAYS HE HAD INCREASED HEART RATE UPON STANDING WITH CHEST TIGHTNESS AND UNABLE TO TAKE A "SATISFYING BREATH"HE IS STILL SUFFERING WITH CHEST TIGHTNESS AND INCRE

Other Meds: NONE

Current Illness: NONE

ID: 1592546
Sex: F
Age: 63
State:

Vax Date: 01/12/2021
Onset Date: 08/18/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: Pt. tested positive on 8/18/2021; she was asymptomatic that day. In afternoon of 8/19/2021 developed symptoms and called hotline and was swabbed on 8/20/2021- results pending. Covid positive after vaccination

Other Meds:

Current Illness:

ID: 1592547
Sex: F
Age:
State: MD

Vax Date:
Onset Date: 08/20/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: None stated.

Other Meds:

Current Illness:

ID: 1592548
Sex: F
Age: 50
State: CA

Vax Date: 08/16/2021
Onset Date: 08/16/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies: Diphenhydramine Codeine

Symptom List: Injection site erythema, Injection site induration, Injection site pruritus, Injection site swelling, Myalgia

Symptoms: Inflammatory reaction in various nerves in head and neck causing pain and numbness myalgia in legs and arms numbness and tingling in hands and feet Lasting 5 days as of this report Treated with nsaids, acetaminophen, flexeril

Other Meds: Prednisone Cymbalta Ibuprofen Propranolol

Current Illness: Sinusitis

ID: 1592549
Sex: F
Age: 60
State: MO

Vax Date: 05/17/2021
Onset Date: 07/19/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: Tinnitus

Other Meds: Vitamin B12; Vitamin D

Current Illness:

ID: 1592550
Sex: F
Age: 39
State: AL

Vax Date: 08/01/2021
Onset Date: 08/05/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Sensitivity to sulfa antibiotics

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Severe headache for 16 days following vaccination. Ibuprofen not sufficient to dull pain. Sometimes headache causes lack of sleep. Also had chills and fatigue for 6 days.

Other Meds: Vitamin d, b complex, zinc

Current Illness: None

ID: 1592551
Sex: F
Age: 29
State: OK

Vax Date: 08/17/2021
Onset Date: 08/19/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Injection site erythema, Injection site pain, Injection site swelling

Symptoms: *SPORADIC* Light headedness, difficulty breathing, racing heart. Sporadically throughout the day/ night. Not related to physical activity. Lasts from 10-30 minutes.

Other Meds: Escitlopram 10mg, sunflower lecithin, post partum vitamin

Current Illness: Mild allergy congestion

ID: 1592552
Sex: F
Age: 15
State: KS

Vax Date: 08/20/2021
Onset Date: 08/20/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Chills, Feeling cold, Feeling hot, Myalgia, Pain

Symptoms: Patient felt dizziness and passed out after moving to the post-immunization waiting area. Pharmacist lowered patient to ground and layed her on her back and monitored pulse and respirations. Patient became responsive to voice commands after about 30 to 60 seconds. Remainded laying down alert for a few minutes and still felt dizziness. After a few more minutes felt comfortable to sit up and move back to sitting in a chair. Patient waiting sitting for a while longer and drank some water. Eventually patient left under her own power with no other known issues.

Other Meds:

Current Illness:

ID: 1592553
Sex: M
Age: 14
State: IL

Vax Date: 08/20/2021
Onset Date: 08/20/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: CAT HAIR

Symptom List: Pain in extremity

Symptoms: Immediately after administering dose 2 of the Pfizer COVID vaccine, patient fainted in his chair (did not fall off chair, stayed seated with head tilted back). Patient had some slight jerking movements and loss of consciousness for approximately 3-5 seconds. Patient quickly regained consciousness and was confused for approximately 5 seconds but then realized where he was and was responsive to questions. Patient stayed seated with head between legs for 15 minutes, then started feeling nauseous and began to vomit. EMS/911 was called to evaluate patient. Patient felt good and was cleared to leave.

Other Meds: NONE

Current Illness: NONE

ID: 1592554
Sex: M
Age: 49
State: NY

Vax Date: 08/20/2021
Onset Date: 08/20/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 2
Vax Route:
Vax Site:

Lab Data:

Allergies: NONE REPORTED

Symptom List: Abdominal pain upper, Abnormal behaviour, Adverse reaction, Anger, Asthma

Symptoms: Patient was very nervous about getting the shot. He would not look at the needle. He got the shot then went to sit out side for 20 minutes to watch for reaction. In 5 minutes he was slumped over in the chair. When I tapped him on the shoulder he did not respond. I repeatedly tapped him on the shoulder and he woke up but was very confused. When I asked him his name he could not answer me. After a minute or two ,he was still confused but knew his name. He was very sweaty and seemed agitated. He did not have any difficulty breathing and I told him to take slow deep breaths. We had called 911. EMT to assess the patient. His BP was low and he was still sweaty. EMT kept monitoring him. He did not want to go to the hospital and did not want pharmacy or EMT to contact anyone. EMT monitored patient. Patient had left his driver's license on a chair when he was being watched by the EMT. He came back and looked in good health when he picked up his license. He said it was due to him being scared of needles.

Other Meds: NONE REPORTED

Current Illness: NONE

ID: 1592555
Sex: F
Age: 57
State: IL

Vax Date: 08/16/2021
Onset Date: 08/16/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Shellfish, peanuts

Symptom List: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: I had severe chest pain and could not breathe. I also experienced swelling in my face, hands and feet. My throat felt like it closed and I also felt like I needed oxygen. I had to stand up and was breathing very hard for several minutes and nauseous. This went on for three days, on and off throughout each day. I almost went to emergency room

Other Meds: none

Current Illness: none

ID: 1592556
Sex: M
Age: 63
State: PA

Vax Date: 08/10/2021
Onset Date: 08/11/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: No

Symptom List: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: next evening experience pain on right side down near my kidney floated up right side back and forth from liver to kidney on 5th day experienced burning and slowly decreased till the 8th day

Other Meds: multivitamin zinc vitamin D

Current Illness: no

ID: 1592557
Sex: F
Age: 22
State: NY

Vax Date: 08/19/2021
Onset Date: 08/20/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Amoxicillin, meloxicam, kohns hotdogs, dial soap

Symptom List: Vomiting

Symptoms: Noticed little red mark at injection site the night I received it. Then had a horrible migraine 3 hours later. Next morning (20th, 2021), the injection site had a bigger red mark. Later that day (around 3), saw an additional 2 larger red marks. The arm was warm, near the injection site, but cooler for the rest of the arm. Doctor gave me Claritin and Benadryl for 3-7 days. Was going to give steroids, but couldn?t because I?m on Ocrevus for MS.

Other Meds: Baclofen 5 mg 3x a day, June fe

Current Illness:

ID: 1592558
Sex: M
Age: 15
State: WA

Vax Date: 08/20/2021
Onset Date: 08/20/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: n/a

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: patient received 1st dose of Pfizer, didn't feel good after and briefly fainted, code white called to pharmacy. gave patient water and some snacks, felt better as he had not eaten this morning. mom disclosed that he had passed out with giving blood before and when he wakes up too fast (this was disclosed after he fainted). patient waited roughly 30 min total and was then fine, mom went with manager to buy chicken in the deli and patient felt better after he ate.

Other Meds: n/a

Current Illness: n/a

ID: 1592559
Sex: F
Age: 21
State: HI

Vax Date: 08/20/2021
Onset Date: 08/20/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Cephalexin, contrast dye, ibuprofen, vancomycin.

Symptom List: Back pain, Cold sweat, Headache, Nausea, Vomiting

Symptoms: Pt c/o SOB, nausea, dizziness, chest felt tight and felt like throat was closing. 1st EPI pen given @ 137pm . Pt took a puff of her personal Albuterol inhaler and EMS called @ 140pm. APRN'S assessed pt. Symptoms still present 2nd EPI pen given @ 147pm. Pt symptoms got better when Fire Dept arrived at 155pm. Ambulance came at 205pm pt taken to ER.

Other Meds: none

Current Illness: none

ID: 1592560
Sex: F
Age: 35
State: TX

Vax Date: 08/11/2021
Onset Date: 08/14/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: After two days of receiving first dose I woke up Saturday morning with ringing in right ear and was muffled with some hearing loss. Test proved some hearing loss in right ear due to viral infection. (I was not sick before the vaccine.) Went to ENT and prescribed me steroids. Taking them for two weeks. Hopefully pain and ringing subsides!

Other Meds: TriSprintec Hair skin and nails vitamins

Current Illness:

ID: 1592561
Sex: F
Age: 32
State: FL

Vax Date: 08/16/2021
Onset Date: 08/16/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

Symptom List: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: Approximately 7 hours after receiving the vaccine experienced chills and fever accompanied with headache for 36 hours. Severe body aches started 12 hours post vaccine

Other Meds: Multivitamin Vitamin D2 2000 IU three times a week

Current Illness: Tested positive for covid 7/26/2021. Out of quarantine and symptom free at time of vaccination. Mandated by work.

ID: 1592562
Sex: M
Age: 30
State: FL

Vax Date: 08/20/2021
Onset Date: 08/20/2021
Rec V Date: 08/20/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Hot flush, Myalgia, Nausea, Tension headache

Symptoms: Patient received 1dose of the JJ vaccine approximately 3 minutes later patient complained of being dizzy......patient lost consciousness for about 20 seconds came to then began to sweat. Ambulance was called and arrived within 4 minutes. Patient was evaluated then transported to local hospital to be checked out.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm