VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 11/12/2021
** VAERS DATABASE Last updated: November 12, 2021**
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Manufacturers

Total Manufacturer
199,106MODERNA
36,710JANSSEN
5,381PFIZER\BIONTECH
2,555GLAXOSMITHKLINE BIOLOGICALS
1,469UNKNOWN MANUFACTURER
897MERCK & CO. INC.
627SEQIRUS, INC.
112DYNAVAX TECHNOLOGIES CORPORATION
91SANOFI PASTEUR
75NOVARTIS VACCINES AND DIAGNOSTICS
40EMERGENT BIOSOLUTIONS
14PAXVAX
12TEVA PHARMACEUTICALS
12PROTEIN SCIENCES CORPORATION
9PFIZER\WYETH
4BERNA BIOTECH, LTD.
4SMITHKLINE BEECHAM
3INTERCELL AG
1MEDIMMUNE VACCINES, INC.
1CSL LIMITED

COVID19 Lot Number

VAX LOT Total
2S9CL7,949
7,473
2,547
1,506
1,187
1,051
1,049
s0294561,043
866
IMM209861
816
UT7065MA766
657
579
U62828AA563
557
538
U6737AA516
515
S034636506
4F472471
458
P100253275449
444
276563436
429
418
4BH32414
MENVEO404
PP9L5362
UJ446AA337
319
306
290
271
49TM3270
R1B252M253
4F472179
933622147
C5763AA144
CW3116134
3Y7NL126
UNK114
113
ARBA141A105
104
103
96
300057A90
79
1F4EB73
R1B743M62
56
UJ090AA55
51
UH894AB46
45
UNK44
UNK42
42
EJ168638
Unknown36
35
34
32
32
26
el128424
24
A115A22
22
EN620222
21
UNK20
20
19
Z127A19
19
17
JEV18K95E15
12
111798PI12
10
A739088
No batch number8
3333324181078
6
6
TAR356
5
5
U6935AA5
UNK5
4
unknown4
3
2
55RB72
2
2
2
2
2
U7124AA2
JEV18A68E2
2
ABYB05BA1
1
1
1
1
AMVA436A1
1
1
TJ3521
A130A; VIS give1
1
U7140BB1
1
1
SP UP016AA1
1
1808P08802/ESV01
037K20A300,947
EL1284288,578
57,766
1,432

Incidents per State

State Total
82,750
CA62,821
FL38,209
TX36,512
NY34,921
PA23,646
IN23,622
IL20,597
MI19,590
OH19,426
NJ18,413
NC16,769
GA15,932
WA15,351
VA15,234
MA14,876
AZ14,206
MN12,940
MD12,656
CO11,908
WI11,425
MO10,240
TN9,685
OR8,768
KY8,437
CT8,300
SC6,700
OK6,293
AL5,692
LA5,025
IA4,825
KS4,821
UT4,637
NV4,374
NM3,967
AR3,807
ME3,161
NH3,096
NE2,918
MS2,859
ID2,785
WV2,469
HI2,459
PR2,417
MT2,414
RI2,076
DE1,868
AK1,830
VT1,734
DC1,715
ND1,388
SD1,269
WY866
GU118
VI69
AS47
MP29
MH8
XB6
FM4
QM3
XV2
XL1

ID: 1628712
Sex: M
Age: 49
State: PA

Vax Date: 01/07/2021
Onset Date: 08/17/2021
Rec V Date: 08/24/2021
Hospital:

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

Lab Data: 08/20/21 0800 COVID-19 (SARS CoV-2 RNA, RT-PCR) Collected: 08/17/21 0000 | Final result | Specimen: Swab from Nasopharynx COVID-19 POSITIVEAbnormal

Allergies: Sulfa (Sulfonamide Antibiotics)

Symptom List: Dysphagia, Epiglottitis

Symptoms: URI

Other Meds: lansoprazole (PREVACID) 30 mg capsule

Current Illness:

ID: 1628713
Sex: F
Age: 38
State: OR

Vax Date: 08/14/2021
Onset Date: 08/15/2021
Rec V Date: 08/24/2021
Hospital:

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

Lab Data: Dr won't do them

Allergies: Penicillin

Symptom List: Anxiety, Dyspnoea

Symptoms: Chest pains for 10 days now, swelling in my throat, migraines, dizzy stomach pains vomiting

Other Meds: Chantix and myo inositol

Current Illness: None

ID: 1628714
Sex: M
Age: 36
State:

Vax Date: 08/23/2021
Onset Date: 08/23/2021
Rec V Date: 08/24/2021
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: None

Allergies: not allergies

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

Symptoms: None

Other Meds: Unknown

Current Illness: none

ID: 1628715
Sex: F
Age: 66
State: NY

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

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

Lab Data: unknown

Allergies: NONE

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Administered Pfizer vaccine, about 7 minutes post vaccination, patient presented with feeling faint and clammy; approximately 2 minutes later patient began wheezing and feeling short of breath. RXT called 911, I administered 1 Epipen in right thigh (through patient's clothing). She began feeling as though she needed to use the restroom and/or vomit (she didn't vomit, but I accompanied her to the bathroom). Wheezing resolved after a few minutes, patient left with EMS via ambulance to be checked out at hospital. She was awake and alert and was able to answer all questions EMS asked her

Other Meds: UNKNOWN

Current Illness: NONE REPORTED

ID: 1628716
Sex: F
Age: 81
State: FL

Vax Date: 02/11/2021
Onset Date: 08/15/2021
Rec V Date: 08/24/2021
Hospital: Y

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

Lab Data:

Allergies: NKA

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

Symptoms: Fully vaccinated patient hospitalized with COVID-19.

Other Meds:

Current Illness:

ID: 1628717
Sex: F
Age: 33
State: FL

Vax Date: 07/28/2021
Onset Date: 08/01/2021
Rec V Date: 08/24/2021
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: missed period

Other Meds: multivitamin

Current Illness: none

ID: 1628718
Sex: F
Age: 42
State: TX

Vax Date: 08/23/2021
Onset Date: 08/23/2021
Rec V Date: 08/24/2021
Hospital:

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

Lab Data: n/a

Allergies: Severe grass and weed allergy Suspected penicillin allergy

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Mild tongue and throat swelling which subsided by day 2. Mild skin rash on both forearms.

Other Meds: None taken day of vaccination. Xyzal taken regularly otherwise.

Current Illness: no known

ID: 1628719
Sex: F
Age: 49
State: PA

Vax Date: 01/08/2021
Onset Date: 08/16/2021
Rec V Date: 08/24/2021
Hospital:

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

Lab Data: 08/16/21 1418 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 08/16/21 0908 | Final result | Specimen: Swab from Nasopharynx COVID-19 SARS-CoV-2 Overall Result DetectedCritical

Allergies: NKA

Symptom List: Pharyngeal swelling

Symptoms: UNKNOWN

Other Meds: NONE

Current Illness:

ID: 1628720
Sex: F
Age: 51
State:

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 08/24/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient became non responsive, sweaty, glance look and decreased bp. did not faint. took approximately 2 minutes and last 4-5 minutes.

Other Meds:

Current Illness:

ID: 1628721
Sex: M
Age: 39
State: WA

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 08/24/2021
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:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient lost consciousness, nystagmus, and twitching of body. Head jerked back. Patient sneezed and returned to consciousness. Unconsciousness lasted <1min. EMS called, patient determined to be okay to go home instead of hospital. Recommended he follow up with his primary care provider. He remained seated for about 15min before leaving the premises.

Other Meds:

Current Illness:

ID: 1628722
Sex: F
Age: 44
State: PA

Vax Date: 02/05/2021
Onset Date: 03/10/2021
Rec V Date: 08/24/2021
Hospital:

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

Lab Data: MSK Ulltrasound on 5/6/21 Voltaren Gel started on 5/18/21. CBD cream, Icy hot started 3/20/21. Physical Therapy started 6/22/21.

Allergies: Penicillin, Amoxicillin, Demoral, Aspirin and Iodine Contrast

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

Symptoms: Immediate pain and Nausea when vaccine was administered. Severe arm discomfort and swelling for a few days after vaccine administration. After a few weeks the pain did not go away and my range of motion in my left arm and shoulder were very limited. Could not lift arm above my head. I was unable to sleep comfortably and was taking OTC meds for pain as well as topical meds. I made an appt. 4/6/21 with my PCP when the pain was not going away. She prescribed me Prednisone 10 mg po tabs -- 4 tabs once daily x 1 day then 3 tabs once daily x 2 days then 2 tabs once daily x 2 days then 1 tab once daily x 1 day. She suggested I needed to see an orthopedic Dr. and have a musculoskeletal Ultrasound. She suspected SIRVA ( Shoulder Injury Related to Vaccine Administration) I made an appt with the orthopedic dr. on 5/18/21. He also suggested that I had bursitis from my vaccine given intrabursal and not intramuscular. I had an ultrasound and also did Physical Therapy for a few weeks. If the injury does not improve I would need a cortisone steroid shot.

Other Meds: Nexium as needed

Current Illness: None

ID: 1628723
Sex: F
Age: 30
State:

Vax Date: 01/11/2021
Onset Date: 08/22/2021
Rec V Date: 08/24/2021
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:

Symptom List: Rash, Urticaria

Symptoms: Employee called with positive test results on 8/22/21. Advised to isolate and update mgmt. has not yet been contacted. Onset of symptoms started on 8/20/21. Isolation until 8/30/21. Last day of work 7/30/21. Sick day on 8/24/21. did not participate in the study but would like the antibody test. Scheduled testing. Advised that she can get tested after her isolation period is over.

Other Meds:

Current Illness:

ID: 1628724
Sex: F
Age: 74
State: FL

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 08/24/2021
Hospital: Y

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

Lab Data: A lot of test that began on Thursday, August 12 until present and beyond. I do not know the names or the tests or the dates. The hospital has a record of that.

Allergies: Tylenol with Codeine - Biaxin - Sulpha Drugs and cream - Statin Drugs - Lipitor/Provocol - Some shellfish - Tussionex Ext-el Sus cough syrup

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

Symptoms: On August 11, 2021, I noticed that my legs were becoming numb. By the next morning, I could not walk or stand up. I was paralyzed from my belly button to my tippy toes My legs and feet felt like pins and needles! I was in excruciating pain. I was rushed to Hospital where I am now presently in the Inpatient Rehabilitation Center.

Other Meds: ammoninium lactate 12% lotion 225g - Celecoxib 200 Mg capsule - Emerita Pro-Gest progesterone cream 1 patch once per week - Esomeprazole Magnesium Dr 40 Mg - Estradiol 0.0375 MG DIS ALV patch - Gabapentin 300 MG capsule 3 capsules per day -

Current Illness: None

ID: 1628725
Sex: M
Age: 32
State: MD

Vax Date: 01/09/2021
Onset Date: 08/19/2021
Rec V Date: 08/24/2021
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: 08/19/21 1715 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 08/19/21 0859 | Final result | Specimen: Swab from Nasopharynx COVID-19 SARS-CoV-2 Overall Result DetectedCritical 08/19/21 1715 COVID-19 PCR Collected: 08/19/21 0859 | Final result | Specimen: Swab from Nasopharynx

Allergies: NKA

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

Symptoms: Cough Sore throat

Other Meds: NONE

Current Illness:

ID: 1628726
Sex: F
Age: 59
State: MD

Vax Date: 08/23/2021
Onset Date: 08/23/2021
Rec V Date: 08/24/2021
Hospital:

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

Lab Data: None

Allergies: Some pain medications

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

Symptoms: Persistent Fever around 100 degrees, extreme body aches, chest pain last night only feber and extreme body aches persist)

Other Meds: Multivitamin D3 Vitamins B12 Vitamins Entyvio

Current Illness: Crohn's Disease GERD

ID: 1628727
Sex: F
Age: 48
State: MI

Vax Date: 08/23/2021
Onset Date: 08/24/2021
Rec V Date: 08/24/2021
Hospital:

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

Lab Data: none

Allergies: PENICILLIN

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

Symptoms: Period started within 24 hours of getting vaccine. Initially very heavy. My period was due for another 12 days.

Other Meds: APPLE CIDER VINEGAR CAPSULES, CALTRATE, RAINBOW LIGHT WOMEN'S MULTI-VITAMIN, ASHAGAWANDA ROOT CAPSULES, ANCIENT NUTRITION WOMEN'S SBO+PROBIOTIC, MEMBER'S MARK ALLER-ZYR, YOUTHEORY: IMMUNE+ DAILY WELLNESS

Current Illness: NONE

ID: 1628728
Sex: F
Age: 48
State: LA

Vax Date: 07/20/2021
Onset Date: 07/30/2021
Rec V Date: 08/24/2021
Hospital:

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

Lab Data:

Allergies: n/a

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

Symptoms: Pt said she developed a red rash at injection site and it was down her arm about half way. she noted the rash lasted about 3-4 days. Pt also stated that after the first injection that she missed her menstrual cycle for the month.

Other Meds: n/a

Current Illness: n/a

ID: 1628729
Sex: F
Age: 24
State: UT

Vax Date: 08/18/2021
Onset Date: 08/19/2021
Rec V Date: 08/24/2021
Hospital:

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

Lab Data: I went and saw my doctor because my hemoglobin was at 9.1 prior to this vaccine and so we did a CBC.

Allergies: Penicillin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: After taking my second dose of the moderna shot my body did very well for the first few hours. However, I woke up in the middle of the night and was hallucinating. It felt as if my body was floating but I wasn?t in my body and I could hear someone talking outside. I woke up from a vivid dream of someone telling me to breathe harder and not give up. Once I woke up I could feel myself breathing hard. I had an accident in the bed, and my whole sheets were drenched of sweat. I got up to the bathroom and I passed out on the floor. I woke up in my bed and checked my oxygen. It was at 83, and my pulse was at 155 (I have a pulse ox at home). My temperature was at 102, and I know that can happen with this vaccine. I sat up for a few hours to get my oxygen and temp to calm down.

Other Meds: Serquil 13.5mg- .5 tab/ night Methphendate 5mg: 2.5 tab in morning - 2.5 tab at night

Current Illness: No

ID: 1628730
Sex: F
Age: 58
State: CA

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

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

Lab Data: N/A

Allergies: N/A

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: ADMINISTRATION ERROR : Pt received 1st dose Phizer 08/03/2021, then received 2nd dose Moderna 08/24/2021. No noted symptoms/ No noted Primary visit.

Other Meds: N/A

Current Illness: N/A

ID: 1628731
Sex: M
Age: 46
State: OH

Vax Date: 02/02/2021
Onset Date: 04/14/2021
Rec V Date: 08/24/2021
Hospital: Y

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

Lab Data: CT scans x 4 for this I have MRI. getting colonoscopy in 2 days. EGD while in hospital. Has had multiple CBC, BMP, urine culture, blood culture, CRP, renal panel, and others.

Allergies: None

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

Symptoms: In April pt had a bout of uncomplicated diverticulitis--went to ER. Then May 30th had severe abd pain again--this time to ER again and had perforated diverticulitis. Required 10 days in hospital. Now pt still having abd pain. Dx with "smoldering diverticulitis" as is now required to get a sigmoid colectomy--as this is the treatment for such a condition. Just wanting to report this as inflammatory conditions have been reported after covid and the vaccine. Just wanting you to look into this in particular.

Other Meds: Vitamin B2, Magnesium, and multivitamin

Current Illness: none

ID: 1628732
Sex: F
Age: 39
State: MN

Vax Date: 04/01/2021
Onset Date: 08/21/2021
Rec V Date: 08/24/2021
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: none

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

Symptoms: sorethroat and sinus congestion. Has some chills but not fever. Mild cough without any SOB, CP or pedal edema. symptoms started on 8/21/21

Other Meds: Allerga allergy; Flonase, Metoprolol, Naphcon A 0.3% solution

Current Illness: none

ID: 1628733
Sex: F
Age: 51
State: PA

Vax Date: 01/11/2021
Onset Date: 08/22/2021
Rec V Date: 08/24/2021
Hospital:

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

Lab Data: 08/23/21 1511 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 08/22/21 1110 | Final result | Specimen: Swab from Nasopharynx COVID-19 SARS-CoV-2 Overall Result DetectedCritical 08/23/21 1511 COVID-19 PCR Collected: 08/22/21 1110 | Final result | Specimen: Swab from Nasopharynx

Allergies: Betadine [Povidone-iodine]Hives / Urticaria Butalbital-acetaminophen-caff Indigestion / GI upset

Symptom List: Unevaluable event

Symptoms: PRE PROCEDURE SCREENING 08/22/21 8/23/2021 3:26 PM EDT ----- Regarding: Positive COVID-19 test result Hi Dr., I wanted to let you know that you referred this patient for upper endoscopy and she was scheduled to have the procedure done within the next few days.. However her COVID-19 test result came back positive. I called her. She is currently asymptomatic. Because of positive COVID-19 test result, we will have to cancel the procedure for now.

Other Meds: EPINEPHrine (EPIPEN 2-PAK) 0.3 mg/0.3 mL injection syringe fluticasone (FLONASE) 50 mcg/actuation nasal spray MULTIVITAMIN ORAL olopatadine (PATADAY) 0.2 % ophthalmic solution pantoprazole (PROTONIX) 40 mg DR tablet SUMAtriptan (IMITRE

Current Illness:

ID: 1628734
Sex: F
Age: 29
State: AZ

Vax Date: 08/11/2021
Onset Date: 08/15/2021
Rec V Date: 08/24/2021
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: Testing scheduled for 8/26/2021.

Allergies: None

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

Symptoms: Broke out in rash covering my back, neck, chest, and shoulders. Rash resembled red circular rings, ranging in sizes up to about 1 inch in diameter, splattered all over said area. The Rash was somewhat itchy. Doctor prescribed antihistamines and cortozone creams. Rash started on the back and back of neck and shoulders then as days went on it progressed to chest, front of neck and front shoulders. Other symptoms since the vaccine include headache and minor shakey hands. As of today, 8/24/21, rash has not fully resolved.

Other Meds: None

Current Illness: None

ID: 1628735
Sex: F
Age: 41
State: PA

Vax Date: 07/30/2021
Onset Date: 08/10/2021
Rec V Date: 08/24/2021
Hospital:

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

Lab Data: 08/11/2021 I had an emergency doctors visit. Urine test was given which was neither negative or positive for a urinary track infection. Urine was cloudy and a little blood was found.

Allergies: No

Symptom List: Injection site pain, Pain

Symptoms: I had burning and cramping when I urinated. Pains in the bottom left side of my stomach and sometimes the right side too.

Other Meds: Farxiga 5MG tablets, vitamin D3

Current Illness: No

ID: 1628736
Sex: M
Age: 76
State: TN

Vax Date: 02/18/2021
Onset Date: 03/10/2021
Rec V Date: 08/24/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: After 3 weeks, I got Eczema on my face, body and feet.

Other Meds: Coumadin; metoprolol; Xarelto; cetirizine

Current Illness:

ID: 1628737
Sex: M
Age: 12
State: CA

Vax Date: 08/10/2021
Onset Date: 08/10/2021
Rec V Date: 08/24/2021
Hospital:

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

Lab Data: None

Allergies: None

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

Symptoms: Pt is 12yo who received a Dtap vaccine instead of a Tdap for his age. No complications to pt. Pt mother and MD were notified right away.

Other Meds: None

Current Illness: None

ID: 1628738
Sex: F
Age: 86
State: MO

Vax Date: 01/05/2021
Onset Date: 08/13/2021
Rec V Date: 08/24/2021
Hospital: Y

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

Lab Data: 8/13/21 SARS-CoV-2 Antigen Positive (Long Term Care Facility) 8/24/21 RT-PCR Positive (Hospital) No other tests or laboratory results were reported.

Allergies: Amlodipine Besylate, Atorvastatin, Crestor, Lipitor, Omeprazole

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Admission to Hospital on 8/23/21 for cough, decreased oxygen saturation, and acute respiratory failure. Reported by hospital that she has cough, SOB, difficulty breathing. At this time, it is reported that she has not been admitted to the ICU and has not required mechanical ventilation.

Other Meds: None reported

Current Illness: None reported

ID: 1628739
Sex: M
Age: 38
State: LA

Vax Date: 08/11/2021
Onset Date: 08/22/2021
Rec V Date: 08/24/2021
Hospital:

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

Lab Data: Confirmed negative COVID test via PCR on 08/24/21

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Starting 08/22/21 inner ear canal on both ears and scalp started to itch around 1900 or 2000. Later at night around 0300 tops of feet and palms of hands and back started to itch. Noticed a rash and welts in various spots along left trunk and groin area. Ithcing on tops of feet and hands continued on 08/23 and 08/24. Flat welt-like rash along groin area. Sunburn looking rash on shoulder and across upper chest. Itching comes and goes. Left and right armpit area also with a mildly soar rash that itches when touched.

Other Meds: Creatine monohydrate, anhydrous caffeine, tumeric extract

Current Illness: None

ID: 1628740
Sex: M
Age: 51
State: CA

Vax Date: 03/20/2021
Onset Date: 04/23/2021
Rec V Date: 08/24/2021
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: Doctors visits.

Allergies: None

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

Symptoms: Starting about 5 days after my vaccine, I noticed soreness in my neck. It continued into my upper back and now I have long term tingling in my arms. I went to an orthopedic doctor about it, and he said he has seen such symptoms due to a massive inflammatory response caused by the vaccine.

Other Meds: None

Current Illness: None

ID: 1628741
Sex: F
Age: 60
State:

Vax Date: 05/11/2021
Onset Date: 05/17/2021
Rec V Date: 08/24/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Patient presented to the ED and was subsequently hospitalized for acute hepatic encephalopathy within 6 weeks of receiving COVID vaccination.

Other Meds:

Current Illness:

ID: 1628742
Sex: F
Age: 47
State: PA

Vax Date: 01/11/2021
Onset Date: 08/20/2021
Rec V Date: 08/24/2021
Hospital:

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

Lab Data: 08/23/21 2300 COVID-19 (SARS CoV-2 RNA, RT-PCR) Collected: 08/20/21 0000 | Final result | Specimen: Swab from Nasopharynx COVID-19 POSITIVEAbnormal

Allergies: LisinoprilCoughing

Symptom List: Injection site pain

Symptoms: Dx Headache ? Vomiting ? Nasal Congestion ? Chills ? Generalized Body Aches ? Sore Throat

Other Meds: atorvastatin (LIPITOR) 40 mg tablet flash glucose sensor (FREESTYLE LIBRE 14 DAY SENSOR) insulin aspart U-100 (NovoLOG Flexpen U-100 Insulin) 100 unit/mL (3 mL) insulin pen insulin glargine,hum.rec.anlog (BASAGLAR KWIKPEN U-100 INSULIN)

Current Illness:

ID: 1628743
Sex: F
Age: 28
State: MD

Vax Date: 08/13/2021
Onset Date: 08/15/2021
Rec V Date: 08/24/2021
Hospital:

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

Lab Data: EKG within normal range, waiting on chest x ray and for primary care doctor to order more tests. Will possibly be heading to the emergency room for more testing tonight.

Allergies: amoxicillin, pepsid, latex

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

Symptoms: Chest pain, shortness of breath, heart palpitations, pain and numbness in arms, pain in shoulders and collar bone. All symptoms began 2 days after vaccination.

Other Meds: none

Current Illness: none

ID: 1628744
Sex: F
Age: 61
State: OH

Vax Date: 08/07/2021
Onset Date: 08/15/2021
Rec V Date: 08/24/2021
Hospital:

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

Lab Data: n/a

Allergies: codeine penicillin wheat

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

Symptoms: extreme stomach pain still on going, feels like I am being punched in the stomach felt weak & like I had the flu, hot flashes

Other Meds: Levothyroxin 25mcg multivitamin Coq10 vitamin c b complex essential enzymes probiotics

Current Illness: none

ID: 1628745
Sex: F
Age: 63
State: NY

Vax Date: 02/18/2021
Onset Date: 04/01/2021
Rec V Date: 08/24/2021
Hospital:

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

Lab Data: 6/30/21: Protein electrophoresis, comp metabolic; creatine kinase; CBC with differential ; Vit B12; TSH; Lactic acid; phosphatidylserine AB; cardiolipin; carnitine; anti phosphatidyl ethanolamine AB. 4/27/21: Lactic acid and ammonia. 7/7/21: Comp metabolic; CBC with differential ; Vit B12; TSH, T4, T3, thyroid antibodies; homocystein; cortisol; DHEA; pregnenolone

Allergies: Femara, Sulfa drugs, lavender, seasonal allergies and other environmental allergies

Symptom List: Tremor

Symptoms: Significant worsening of ME/Chronic Fatigue Syndrome. More exertional malaise, fatigue, brain fog, poor attention and concentration. Was already unable to work but now unable to go up stairs or walk down the block or stand in line without significant worsening of fatigue . Have needed to get handicap sticker for car; Clear decline over where I was in December of 2020.

Other Meds: Trazadone, Escitalopram, Vitamins D, C, B's; Gabapentin; Omega 3's; nasacort; L-Lysine; Burdock Red root compound; Kanchanar guggulu, Adaptocrine; magnesium, calcium; curcumin

Current Illness: Dental surgery for failed implant with chronic infection 2/8/21

ID: 1628746
Sex: F
Age: 81
State: MN

Vax Date: 05/12/2021
Onset Date: 06/17/2021
Rec V Date: 08/24/2021
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:

Symptom List: Erythema, Pruritus

Symptoms: Patient presented to the ED and subsequently hospitalized for CVA within 6 weeks of receiving COVID vaccination.

Other Meds:

Current Illness:

Date Died: 08/08/2021

ID: 1628747
Sex: F
Age: 76
State: TX

Vax Date: 02/10/2021
Onset Date: 07/27/2021
Rec V Date: 08/24/2021
Hospital: Y

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: 07/27/2021: troponin 0.035; 07/27/2021: CRX scattered bilateral interstitial opacities; 07/27/2021: COVID positive

Allergies: Escitalopram, potassium, sulfonamide antibiotics

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

Symptoms: Pfizer BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 1/20/2021 and 2/10/2021. On 7/27/2021, patient presents to the ED with weakness and fatigue after being diagnosed with COVID-19 1 day prior. On arrival to the ED, patient O2 saturation 88%, 2LNC initiated. Patient admitted to the hospital for COVID-19, hypoxemia, and elevated troponin. Patient received remdesivir x 5 days, convalescent plasma 1 unit, tocilizumab 800 mg x 1 dose, dexamethasone, azithromycin, ceftriaxone. Patient developed new onset atrial fibrillation on 8/7/2021. Throughout hospitalization patient continued to decompensate and eventually expired on 8/8/2021.

Other Meds: Ascorbic acid 500 mg daily, acetaminophen 325-650 mg q6h PRN, Azelastine 0.15 % (205.5 mcg) spry Apply or instill 2 Sprays into both nostrils two times daily, carbidopa-levodopa 25-100 mg tablet Take 1 Tab by mouth three times daily, Choles

Current Illness:

ID: 1628748
Sex: F
Age: 53
State: GA

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

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

Lab Data: N/A

Allergies: N/A, Pharmacy is not her regular pharmacy

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

Symptoms: The patient stated that she was dizzy and passed out when the first Pfizer vaccine was administered. She received the second dose of the Pfizer vaccine on 8/24/21. I told her to take a seat after I administered the vaccine. She turned red and fell down on her knees while still seated in the chair. I asked her if she can still breath and she said yes. I gave her a pillow to lay on. Five minutes later, the EMT workers arrived and took her blood pressure and vital signs. They asked her more questions and the EMT workers left. She thanked me for calling 911 and walked out the store..

Other Meds: N/A, Pharmacy is not her regular pharmacy

Current Illness: N/A, Pharmacy is not her regular pharmacy

Date Died: 07/07/2021

ID: 1628749
Sex: M
Age: 73
State: WA

Vax Date: 03/05/2021
Onset Date: 06/15/2021
Rec V Date: 08/24/2021
Hospital: Y

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

Lab Data: 6/21/2021 COVID-19 positive PCR pneumonia confirmed by Xray

Allergies: UNK

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient with multiple underlying conditions presented to hospital with severe LE pain on 6/15/2021. Recently treated for cellulitis (6/15/2021). SOB and poor po intake were baseline x 1 year 2/2 cancer and PE. 1L o2 at baseline. Difficult to distinguish any possible COVID sx from other causes, unknown onset of sx. Tested negative upon admission and positive on Hospital Day 3. Hospital course complicated by hypoxemia 2/2 COVID PNA and HF exacerbation, hallucination. Transferred to ICU 6/27-6/30 recieved dexamethasone, remdesivir, piperacillin/tazobactam and then again 7/6. 7/6 asystole/PEA arrest with ROSC achieved after 20 min of CPR and 4 x epinephrine. Intubated 7/6. Increasing pressor requirements, transitioned to comfort care.

Other Meds: Imatinib mesylate for cancer

Current Illness:

ID: 1628750
Sex: F
Age: 47
State: PA

Vax Date: 01/12/2021
Onset Date: 08/15/2021
Rec V Date: 08/24/2021
Hospital:

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

Lab Data: 08/19/21 1441 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 08/18/21 2002 | Final result | Specimen: Swab from Nares. COVID-19 SARS-CoV-2 Overall Result DetectedCritical. 08/19/21 1441 COVID-19 PCR Collected: 08/18/21 2002 | Final result | Specimen: Swab from Nares

Allergies: NKA

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

Symptoms: NO TASTE OR SMELL CONGESTION AND COUGH; Nasal Congestion; Cough.

Other Meds: hydroCHLOROthiazide (HYDRODIURIL) 12.5 mg tablet; nystatin (MYCOSTATIN) powder

Current Illness:

ID: 1628751
Sex: F
Age: 53
State:

Vax Date: 12/18/2020
Onset Date: 01/01/2021
Rec V Date: 08/24/2021
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: urticaria, chronic. comes and goes. ongoing for > 6 mo necessitating almost daily allergy medication

Other Meds:

Current Illness:

ID: 1628752
Sex: M
Age: 19
State: IL

Vax Date: 08/22/2021
Onset Date: 08/22/2021
Rec V Date: 08/24/2021
Hospital:

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

Lab Data: no

Allergies: no

Symptom List: Pain in extremity

Symptoms: tense muscle on arm right where injection happened. hard ball half of inch big in between neck and shoulder. body ache, headache

Other Meds: no

Current Illness: no

ID: 1628753
Sex: F
Age: 40
State: WI

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

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

Lab Data: None

Allergies: None

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

Symptoms: Patient was inadvertently given an unreconstituted dose of the vaccine. Due to human error the vial was not reconstituted and I gave her the 0.3ml dose. The error was caught by staff administering the next vaccine. Patient was called and advised of error and told to watch out for worsening symptoms. At the time of notification patient had no side effects or symptoms at all. Patient was told to go to Emergency Department if any severe symptoms develop and she was advised in detail what common symptoms to look for. She was also told to let her employer know if she develops mild symptoms. Patient expressed understanding.

Other Meds: Adapalene Topical 0.1% Gel Topically

Current Illness: None.

ID: 1628754
Sex: M
Age: 54
State: KY

Vax Date: 04/30/2021
Onset Date: 05/02/2021
Rec V Date: 08/24/2021
Hospital:

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

Lab Data: n/a

Allergies: n/a

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

Symptoms: After both shots had muscle cramps and very fatigued.

Other Meds: Atenolol, Synthriod,Protonix,Cymbalta, Amolodephine, Advil

Current Illness: n/a

ID: 1628755
Sex: M
Age: 28
State: OR

Vax Date: 08/16/2021
Onset Date: 08/19/2021
Rec V Date: 08/24/2021
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: none that i know of

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

Symptoms: Developed a ringing in my right ear. Never had tinnitus before so this was very new. Its now going on day 6 with ringing in my ear. Cause me to lose sleep.

Other Meds: Multi-vitamin

Current Illness: none

ID: 1628756
Sex: M
Age: 15
State: AZ

Vax Date: 08/14/2021
Onset Date: 08/14/2021
Rec V Date: 08/24/2021
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:

Symptom List: Vomiting

Symptoms: Severe Muscle pain occurred from the time of vaccination for 2 days. Rash appeared days following the injection, 2 weeks later and it hasn't changed at all. Red bumps, around the area where shot was given.

Other Meds: 60mg. Vyvanse

Current Illness:

ID: 1628757
Sex: M
Age: 67
State:

Vax Date: 08/03/2021
Onset Date: 08/01/2021
Rec V Date: 08/24/2021
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:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient has bruise on vaccination site for 3 weeks

Other Meds:

Current Illness:

ID: 1628758
Sex: F
Age: 59
State: IA

Vax Date: 08/23/2021
Onset Date: 08/23/2021
Rec V Date: 08/24/2021
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: None

Allergies: Codeine

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

Symptoms: Patient denied previous Covid vaccines during screening and consent review. After dose administered, informed administering clinician that she had already received 2 doses of Moderna Covid vaccine. After discussion with PCP and state epi, determine that patient does not meet guidelines for immunocompromised although is taking long-term corticosteroids.

Other Meds: Magnesium oxide, acetaminophen, buspirone, Vitamin D3, Vitamin B12, Sennosides with docusate sodium, fludrocortisone, folic acid, gabapentin, midodrine, multivitamin with minerals, naltrexone, omeprazole, quetiapine, tetrahydrolozine, trazo

Current Illness: Urinary tract infection

ID: 1628759
Sex: F
Age: 47
State: PA

Vax Date: 01/13/2021
Onset Date: 08/21/2021
Rec V Date: 08/24/2021
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: 08/23/21 0239 COVID-19 (SARS CoV-2,RNA Molecular Amplification) Collected: 08/22/21 1953 | Final result | Specimen: Swab from Nasopharynx COVID-19 SARS-CoV-2 Overall Result DetectedCritical 08/23/21 0239 COVID-19 PCR Collected: 08/22/21 1953 | Final result | Specimen: Swab from Nasopharynx

Allergies: NKA

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Cough Congestion or running nose

Other Meds: carisoprodol (SOMA) 350 mg tablet cetirizine (ZyrTEC) 10 mg tablet diclofenac sodium (VOLTAREN GEL) 1 % gel DULoxetine (CYMBALTA) 60 mg capsule fluticasone (FLONASE) 50 mcg/actuation nasal spray gabapentin 300 mg oral capsule hydrOXYc

Current Illness:

ID: 1628760
Sex: M
Age: 26
State: AR

Vax Date: 08/05/2021
Onset Date: 08/07/2021
Rec V Date: 08/24/2021
Hospital:

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

Lab Data: N/A

Allergies: None

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

Symptoms: Extreme aching, soreness, and pain. Mainly in hips but throughout the legs as well. Lasted approximately 4 days. Sought no outside treatment at the time.

Other Meds: Lisinopril. Hydroclorothyazide.

Current Illness: None

ID: 1628761
Sex: F
Age: 17
State: WA

Vax Date: 08/21/2021
Onset Date: 08/21/2021
Rec V Date: 08/24/2021
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: Wrong vaccine administered to patient less than 18 years old. Given Moderna instead of Pfizer. No adverse reactions observed or reported by patient/mother.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am