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: 1632914
Sex: M
Age: 60
State: CA

Vax Date: 08/15/2021
Onset Date: 08/24/2021
Rec V Date: 08/25/2021
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:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient received first dose of moderna vaccine on 8/15/21 in her left arm. She came in on 8/24/21 in the evening stating that her arm had no redness or swelling, but then as of yesterday was red, swollen and felt warm to touch. I recommended otc options to help her with the discomfort. But I told her if it continues, gets worse or shows signs of infection she should visit her doctor. She was satisfied with this response

Other Meds:

Current Illness:

ID: 1632915
Sex: F
Age: 26
State:

Vax Date: 08/12/2021
Onset Date: 08/12/2021
Rec V Date: 08/25/2021
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:

Symptom List: Anxiety, Dyspnoea

Symptoms: She got the vaccinated at 6:30; she sat until 6:40. by 6:45 she had a reaction started breaking into hives and turning red, itching, sweating blood, pressure 142/101. They gave her the reaction medication. At 7:20 checked blood pressure again 135/89. And she left after that.

Other Meds:

Current Illness:

ID: 1632916
Sex: F
Age: 72
State: FL

Vax Date: 02/17/2021
Onset Date: 08/09/2021
Rec V Date: 08/25/2021
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: August 9th admitted to hospital. Various tests : echo, ekg, blood work, chest x-rays between August 9-13, 2021.

Allergies: Epinephrine, strawberries, pomagranites

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

Symptoms: Much later developed congestive heart failure. Put on lasix and oxygen for low oxygen levels.

Other Meds: Omeprazole, synthoid, trelegy, rouvastatin, metropolol, Cartia , Vitafusion hair-skin and nails, D3

Current Illness:

ID: 1632918
Sex: M
Age: 70
State:

Vax Date: 04/01/2021
Onset Date: 08/12/2021
Rec V Date: 08/25/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: per the EUA we have to report when the patient is admitted to hospital after vaccination.

Other Meds:

Current Illness:

ID: 1632919
Sex: M
Age: 14
State: OH

Vax Date: 08/19/2021
Onset Date: 08/24/2021
Rec V Date: 08/25/2021
Hospital: Y

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

Lab Data: Brain MRI/MRA (8/24) confirming acute/sub-acute infarct

Allergies: None

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

Symptoms: Pt developed acute ischemic stroke in L parietal region on 8/24/21. Was in gym class when developed slurred speech, acute-onset weakness in R arm, and b/l legs. Continues to have residual tingling of R hand, otherwise all other symptoms have resolved without intervention.

Other Meds: None

Current Illness: None

ID: 1632920
Sex: M
Age: 51
State: TX

Vax Date: 06/26/2021
Onset Date: 06/27/2021
Rec V Date: 08/25/2021
Hospital: Y

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: CT Scan, Stress test, ultra sound, full lab work up surrounding cardiac issues. 7/28-7/29/21. Lab results for cardiac arrest negative. BP was 180/120.

Allergies: None

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

Symptoms: Dose 1: Extreme anxiety and feeling of uneasiness, nausea, indegestion. pressure in chest/lungs. Subsided some but remained until second does. (used DM, anti inflamatories and rest) Dose 2: All symptoms from dose 1 but more intense and accute. Add tingling in limbs, more intense indegestion w.o eating, upper extremity pain/ache and headache. Your fill in form is not working and does not allow you to fill in all fields. My Hospital where I was admitted I spent two full days being monitored for heart attack (negative and extremely high BP and heart rate) About 50 points over normal.

Other Meds: Lisinopril, Metroprolol, Multi Vitamin

Current Illness: none

ID: 1632921
Sex: F
Age: 73
State: CA

Vax Date: 02/17/2021
Onset Date: 06/30/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: Multiple blood tests and several urinalyses. Kidney ultrasound and finally a Kidney biopsy. The ultrasound (July 27, 2021) and biopsy, (August 9, 2021) done in late July and early August showed nothing. Blood test and urinalysis done prior to biopsy indicated kidneys were returning to normal.

Allergies: None known

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: 4 1/2 months after the second dose of Moderna, I developed severe swelling in my feet and ankles, and I was "spilling" large amounts of protein in my urine. My doctor could not pinpoint a cause.

Other Meds: Thyroxine, HCTZ, calcium, B12, multiple vitamin

Current Illness: None

ID: 1632922
Sex: M
Age: 72
State:

Vax Date: 04/01/2021
Onset Date: 08/10/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: per the EUA we have to report when the patient is admitted to hospital after vaccination. Patient was positive for COVID-19 Pneumonia

Other Meds:

Current Illness:

ID: 1632923
Sex: F
Age: 60
State: VA

Vax Date: 03/24/2021
Onset Date: 03/27/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: blood work

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Severe flare of Lupus symptoms that I have not had in 15 years. Sore stiff joints especially fingers, shoulders and hips. Symptoms lasted 6 weeks approx. Elevated ANA after it being normal for years.

Other Meds:

Current Illness:

ID: 1632924
Sex: M
Age: 35
State: MI

Vax Date: 08/02/2021
Onset Date: 08/21/2021
Rec V Date: 08/25/2021
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: None known

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Rash appeared on inner right thigh 8/21, approx 18 days after first shot. Second rash appeared on upper right buttocks 8/22. Both rashes blistered within 24 hours. Shingles was diagnosed via doctor visit and Valtrex was prescribed. At time of reporting, three separate patches of shingles exist. Inner right thigh, right knee, and upper right buttocks. Pain of the blistered areas is intermittent and moderate.

Other Meds: None

Current Illness: None

ID: 1632925
Sex: F
Age: 52
State: GA

Vax Date: 01/20/2021
Onset Date: 01/26/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: CT scan message results from doctor said mildly enlarged lymph nodes, but none of them would necessarily be considered suspicious or abnormal.

Allergies: sulfa allergies to grass, trees, and other pollens and allergy to ant bites

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

Symptoms: tiredness achy from vaccine I believe unrelated to vaccine, I have had a CT scan and message results from doctor said mildly enlarged lymph nodes, but none of them would necessarily be considered suspicious or abnormal.

Other Meds: Allergy shots for allergies to grass, trees, and other pollens and allergy to ant bites albuterol for asthma as needed zyrtec rolaids/tums if needed

Current Illness:

ID: 1632926
Sex: F
Age: 41
State: IL

Vax Date: 02/16/2021
Onset Date: 06/15/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: MRI July 5th - positive inflammatory legion at T-5

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: Complete numbness from waist down. Motor function still normal, but all sensory function gone. Has been diagnosed as transverse myelitis. Have gone through one round of high-dose IV methylprednisolone for 5 days. Currently only have partial recovery.

Other Meds: Iron 325 mg B-12 500 mcg Biotin 10,000 units Vitamin D 4,000 units

Current Illness: None

ID: 1632927
Sex: M
Age: 48
State: IA

Vax Date: 04/06/2021
Onset Date: 05/20/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: patient reports he has had MRI.

Allergies:

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

Symptoms: nausea, headache, fatigue reported on 5/20/21. headaches that will not go away started on 7/15/21. tremors on 8/19/21.

Other Meds:

Current Illness:

ID: 1632928
Sex: F
Age: 58
State: FL

Vax Date: 08/01/2021
Onset Date:
Rec V Date: 08/25/2021
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: Took my own heart rate at home. I am an athlete.

Allergies: Cymbalta

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

Symptoms: My normal heart rate of 45-50 shot up to 72! It stayed that way for a couple of days. At first it was very scary since I didn't know when it would slow.

Other Meds: Fluoxetine, Trazodone, Movantik, Fentanyl lozenge, Pepcid AC, Acyclovir, Trokendi, EstroGel, Activella generic, Multi. Vitamin, Super B, Vitamin C, Vitamin E,

Current Illness: Fibromyalgia,

ID: 1632929
Sex: F
Age: 54
State: CA

Vax Date: 07/31/2021
Onset Date: 08/06/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: 8/6/2021 blood test, covid test, CT scan 8/9/21 blood test

Allergies: NONE

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

Symptoms: My legs were hurting, couldn't focus, very lightheaded and dizzy, tingling on my left side of body, couldn't eat, very nauseous, and clammy

Other Meds: NONE

Current Illness: NONE

ID: 1632930
Sex: F
Age: 22
State: IA

Vax Date: 08/11/2021
Onset Date: 08/11/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: Pt has gonorrhea and chlamydia testing and vaginitis DNA probe testing pending.

Allergies: NKDA

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

Symptoms: Pt notes her menstrual period has gone on for 16 days, which is unusual for pt. Her period started on 8/9/21 and continues to today (8/25/21). Pt is worried that this could be r/t her COVID Vaccine that she got on 8/11/21. Pt's Nexplanon was placed on April of 2021. It is unclear if this is r/t her recent Nexplanon placement vs other cause.

Other Meds: Nexplanon in place, Miralax

Current Illness: Strep pharyngitis on 7/20/21

ID: 1632931
Sex: F
Age: 44
State: CA

Vax Date: 08/19/2021
Onset Date: 08/21/2021
Rec V Date: 08/25/2021
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: Penicillin and Cipro

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

Symptoms: Left arm Injection site swelling and discoloration increasing in size 6 days after 2nd Pfizer dose

Other Meds: None

Current Illness: None

ID: 1632932
Sex: F
Age: 64
State: CA

Vax Date: 05/01/2021
Onset Date: 08/04/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: I received 2 Pfizer COVID-19 vaccines - 4/10/2021 and 5/1/2021 at the Fairgrounds. I have tried to report this information to the CDC VAERS online and keep getting bounced. As I had been asked to present at a conference in in October I wanted to make sure I had antibodies. My PCP ordered the SARS CoV 2AB (igG) Nucleo Capside QI lab test on August 4, 2021. No detectable antibodies were found (titer < 1.0). As I have no underlying immune-compromised conditions there is no plausible medical reason for the lack of an antibody response. Therefore, I thought this should be reported. Perhaps there is a problem with the refrigeration or other handling of the lots involved with my vaccination.

Other Meds:

Current Illness:

ID: 1632933
Sex: M
Age: 55
State: CA

Vax Date: 03/29/2021
Onset Date: 04/29/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: mri- ct scan- angiogram-

Allergies: penicillin

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: chest pains, cardiomioposy, myocarditis, heart palpitations

Other Meds:

Current Illness:

ID: 1632934
Sex: M
Age: 43
State: AL

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 08/25/2021
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: Tenderness in arm with redness immediately around the site. Not unbearable.

Other Meds: Paxil 10 mg daily

Current Illness:

ID: 1632935
Sex: M
Age: 14
State: OR

Vax Date: 08/20/2021
Onset Date: 08/21/2021
Rec V Date: 08/25/2021
Hospital: Y

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:

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

Symptoms: Patient developed myocarditis with acute chest pain and peak troponin of 11. He required 2 nights of hospitalization. He symptomatically improved within 48 hours with troponin trending down to 6. He had normal echo.

Other Meds:

Current Illness:

ID: 1632936
Sex: M
Age: 50
State:

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data:

Allergies: walnuts, hickory

Symptom List: Unevaluable event

Symptoms: The first two days the site of injection was extremely painful. over the course of the last few months the pain is intermittent and sporadic. it is not entirely debilitating, but does sometime cause issues when lifting and typing. The pain/discomfort is always at the sight of injection. it has been 4 months and the pain discomfort is at least a few days a week. It has migrated from a pain to more of a discomfort. Personally not enough to stop the vaccine, but it is enough to for me to think long and hard as to a booster. Also all this happened after the 2nd shot. The first there was a little discomfort same place but not much.

Other Meds: Sudafed, Claritin, ibuprofen. As needed for allergies and inflamation

Current Illness: None

ID: 1632937
Sex: F
Age: 71
State: CA

Vax Date: 03/04/2021
Onset Date: 07/04/2021
Rec V Date: 08/25/2021
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

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

Symptoms: I developed shingles even after being vaccinated with shibgles vaccine

Other Meds: Amlodapine losartan vitamin d calcium

Current Illness: None

ID: 1632938
Sex: F
Age: 60
State: CA

Vax Date: 06/01/2021
Onset Date: 06/14/2021
Rec V Date: 08/25/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: Stomach problems, stomach pain.

Other Meds: Metformin

Current Illness:

ID: 1632939
Sex: F
Age: 80
State: KY

Vax Date: 03/17/2021
Onset Date: 08/24/2021
Rec V Date: 08/25/2021
Hospital: Y

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

Lab Data:

Allergies: Amantadine, penicillin

Symptom List: Injection site pain, Menorrhagia

Symptoms: Covid-19 infection; SOA, weakness. O2 stats dropped below 90% currently requiring 2 L O2

Other Meds: APAP, ASA, atorvastati, colestipol, Ampyra, furosemide, glucosamine-chondroitin, modafinil, potassium chloride, omeprazole

Current Illness:

ID: 1632940
Sex: F
Age: 59
State: MS

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: N/A

Allergies: Shellfish, Nuts, Bactrim, Sulfa, Pennicillin

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

Symptoms: Pt. states that after receiving the 1st dose of Phizer 02/08/2021, started experiencing symptoms 02/08/2021 that evening of headaches, pain throughout the body, chills, dizziness, fever lasting 6 days, weakness (Treated with Benadryl), tongue and lip swelling. Swelling subsided within a week's time but still continuing to experience dizziness, body aches, and allergic reaction to new foods. (Tip of the tongue or lips) begin to swell or tingle.

Other Meds: N/A

Current Illness: N/A

ID: 1632941
Sex: F
Age: 36
State: MO

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 08/25/2021
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: UNKNOWN

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: PATIENT CALLED BACK 1-2 HOURS AFTER VACCINATION REPORTING THROAT HURTING AND LOCALIZED SWELLING OF THE LEFT SIDE OF HER FACE

Other Meds: SYMBICORT, PROAIR, CITALOPRAM, BUSPIRONE, ARIPIPRAZOLE

Current Illness: UNKNOWN

ID: 1632942
Sex: F
Age: 84
State: VA

Vax Date: 03/16/2021
Onset Date: 04/01/2001
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: MRI, 2. Ct scans of brain, multiple blood tests, full cardiac evaluation, urology evaluation, usual neurological tests all during these 5 months 2 trips to ER

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Vertigo, blurred vision, headache, pain in legs, dense brain fog, some memory loss ,trembling mostly in legs. These have continued just short of 5 months

Other Meds: Klonopin

Current Illness: None

ID: 1632943
Sex: M
Age: 66
State: SC

Vax Date: 08/07/2021
Onset Date: 08/07/2021
Rec V Date: 08/25/2021
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: Lab workup was done

Allergies: penicillin, codeine

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

Symptoms: I had a reaction that lasted 35-40 min, and started right after I got the vaccine shot. I had Elbow pain, chest pain, vision loss, and shortness of breath

Other Meds: Albuteral, cornasapan, multiperil, metformin

Current Illness: None

ID: 1632944
Sex: F
Age: 53
State:

Vax Date: 08/21/2021
Onset Date: 08/22/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: ekg 8-25-21 normal

Allergies:

Symptom List: Nausea

Symptoms: left axillary pain and lymphadenopathy

Other Meds:

Current Illness:

ID: 1632945
Sex: F
Age: 57
State: SC

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: Blood pressure monitored. please see item 18 for reading.

Allergies: Hydrocodone, lisinopril

Symptom List: Injection site pain

Symptoms: Patient came into the office after waiting for approx 30 minutes after covid vaccine. She said she noticed that her mouth and lips felt slightly swollen and tingly. After speaking with patient she gave the following reaction. 5 minutes after receiving the vaccine she noticed tingling in her hands that last about 1 minute. 30 minutes after while in the car (patient had labs drawn while waiting) she felt slight puffiness in her lips and lower face along with tingling. She then came back into the office. Patient was negative for headache, dizziness, nausea, blurred vision. Blood pressure was checked @ 11:50 and was reading 178/104 manual. Patient was given water and escorted to a room to wait. 12:00 BP: 168/73- patient reports the facial tightness and tingling are getting a little better. 12:10 162/80- patient reports tingling is now almost gone, still no other complaints. Patient was evaluated by Dr and told since her BP was coming down and she was feeling better, she could go home. I recommended to patient to stay out of work today and take a benadryl. Dr gave same instructions and wrote a work note for patient. I encouraged patient to call with any further problems or concerns.

Other Meds: Albuterol, HCTZ, meloxicam, montelukast

Current Illness:

ID: 1632946
Sex: F
Age: 58
State: CA

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data:

Allergies: Penicillin, sulfur

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

Symptoms: Rapid heartbeat (pounding), headache

Other Meds: Synthroid, Calcium, B Complex, Vitamin C, Multi Vit

Current Illness: Remission ThyCa, MVP w/Regurg, Heart Murmur, Asthma

ID: 1632947
Sex: M
Age: 55
State: WA

Vax Date: 05/20/2021
Onset Date: 05/22/2021
Rec V Date: 08/25/2021
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: Tinnitus starting on 22 May 2021 and continuing until today 25 Aug 2021.

Other Meds: None.

Current Illness: None

ID: 1632948
Sex: M
Age: 88
State: NJ

Vax Date: 02/04/2021
Onset Date: 08/22/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: Rapid test + for Covid on 8/24

Allergies: not known

Symptom List: Tremor

Symptoms: Client was vaccinated with Moderna vaccines on February 4 and March 4, 2021 at a large public health clinic site. Client tested rapid positive for Covid on 8/24 and had symptoms starting 8/22: low grade fever and myalgia. Reported as a breakthrough Covid illness in a person who was fully vaccinated.

Other Meds: not known

Current Illness: not known

ID: 1632949
Sex: M
Age: 13
State: WA

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 08/25/2021
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: none

Symptom List: Erythema, Pruritus

Symptoms: Vaccine 2nd dose was administered by vaccinator 14 days apart

Other Meds: none

Current Illness: none

ID: 1632950
Sex: F
Age: 68
State: WA

Vax Date: 02/17/2021
Onset Date: 07/14/2021
Rec V Date: 08/25/2021
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: Not applicable

Allergies: No

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

Symptoms: I experienced the inability to concentrate/think (felt like the days just went on and on without a distinctive beginning or ending). I also begin to see the appearance of red spots that wrapped around from my spine to approximately 1" above the belly button and continued to my right side. I went to my doctor 07/21/2021 and diagnosed me with Shingles which have been extremely painful since then.

Other Meds: No

Current Illness: No

ID: 1632951
Sex: F
Age: 1
State: AZ

Vax Date: 08/16/2021
Onset Date: 08/25/2021
Rec V Date: 08/25/2021
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: None

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

Symptoms: quarter sized hard lump

Other Meds: None

Current Illness: None

ID: 1632952
Sex: F
Age: 30
State: CA

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: Time: 1305 BP: 114/70 Pulse: 59 RR: 14 O2: 96%

Allergies: Shellfish (facial edema, skin rash)

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient is a 30 year old female who presents following administration of a first dose of Pfizer COVID19 vaccine in the right deltoid. She states that about 15 minutes following administration of the vaccine that she started to experience intermittent numbness/tingling in her right arm and hand. She denies history of a similar episode. She denies decreased range of motion, muscle weakness, and pain. She relates past medical history of ankylosing spondylitis and Crohn?s disease of which she is controlling with diet/exercise. She is not currently taking any medications. She denies history of Guillain-Barre Syndrome. Confirms allergies to shellfish. She otherwise denies chest pain, difficulty breathing, swelling of the face/lips/tongue/throat, skin rash/itching, cramping abdominal pain, nausea, and vomiting. GEN: Alert and oriented x 4, NAD. HEAD: NCAT EYES: PERRL, EOMI ENT: Ears normal, Nose normal, OP normal, no evidence of angioedema NECK: Supple, without LAD. CV: RRR, no m/r/g PULM: Clear to auscultation bilaterally, no accessory muscle use ABD: Soft, no tenderness. SKIN: No rashes, skin warm and dry. Injection site present in the correct anatomical position. No erythema or edema of the injection site. MSK: FROM, MS 5/5, brisk capillary refill at the distal digits bilaterally NEURO: decreased touch sensation in the right arm, consistent with radial nerve distribution. Alert and oriented x 4, CN 2-12 grossly intact, no ataxia, gait steady Paresthesias following vaccine administration. Patient demonstrated full range of motion, 5/5 muscle strength of the bilateral arms. Recommended patient to seek medical attention should she develop severe right arm pain, right arm muscle weakness, or loss of range of motion. Also explained signs/symptoms of Guillain-Barre Syndrome to patient and instructed her to seek medical attention should she develop any. Reiterated to patient to continue using her right arm and that she may take NSAIDs for arm discomfort as needed. Instructed patient to consult their PCP regarding the post-vaccination reaction. Patient instructed to go to emergency department should she develop chest pain, difficulty breathing, swelling of the face/lips/mouth/tongue/throat, or cramping abdominal pain with nausea/vomiting. Patient demonstrated understanding of post-vaccination instructions.

Other Meds: None

Current Illness: Ankylosing spondylitis, Crohn's disease

ID: 1632953
Sex: M
Age: 21
State: IL

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 08/25/2021
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:

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

Symptoms: IMMEDIATELY AFTER GIVING THE VACCINE, THE PATIENT SAID HE WAS GETTING NAUSEOUS THEN PASSED OUT IN THE CHAIR, THEN HAD A SEIZURE WHICH LASTED APPROXIMATELY 15-30 SECONDS (SMALL JERKY MOVEMENTS AND MADE SNORING SOUNDS). 911 WAS CALLED. PT SPONTANEOUSLY REVIVED WITHOUT RECOLECTION OF THE INCIDENT. HE WAS PALE AND CLAMY, AND VOMITED A SMALL AMOUNT. HE DID RECALL THAT BEFORE LOSING CONSIOUSNESS, HE FELT NAUSEOUS AND HAD TUNNEL VISION. EMT CAME, AND PATIENT REFUSED CARE. AFTER WAITING 30 MINUTES, PT THEN LEFT.

Other Meds:

Current Illness:

ID: 1632954
Sex: M
Age: 69
State: WI

Vax Date: 07/22/2021
Onset Date: 07/22/2021
Rec V Date: 08/25/2021
Hospital: Y

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: Hospitalized on July 24th and released on the 26 th. He had scans, lab work, EKG, MRI of brain, nothing else explained it. He didn't want the vaccine in the first place, he had COVID in March but felt pressured into it. He barely recovered from COVID and still had mental fog and muscle fatigue but his PCP insisted that he get it asap and only wanted Pfizer. He continues to suffer and will be a long hauler. Now looking for a Neuro-psych that could help, he now has panic attacks and major anxiety, non of which he had before. His quality of life has definitely been altered.

Allergies: Sulfa, Bactrim, Shell fish, PCN , IVP dye, Purell, red dye

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

Symptoms: Initially a sore arm, then elevated blood pressure and headache, within four hours. During the night unable to walk, fell out of bed, extreme muscle weakness, loss of appetite, and felt "off" Blood sugar was fine, blood pressure very high 180/100, then came frequent urination, every 15 minutes and unable to think very well. Each symptom progressed in the exact same order as when he had COVID and landed in the hospital due to hypoxia, blood clots, SOB and unable to walk. Took him to ER before the later had occurred. When he got there he was dehydrated, D-Dimer off, EKG not normal, and his COVID swab was negative but acted the same way he did when he had COVID, mental confusion and all.

Other Meds: Tresiba, Bydurian, Lyrica, Rosuvastatin, Hydrochlorothiazide, Metoprolol, Losartan, Vitamin D, Daily ASA 81 mg, Vitamin E & C

Current Illness: None

ID: 1632955
Sex: F
Age: 30
State: TN

Vax Date: 08/22/2021
Onset Date: 08/22/2021
Rec V Date: 08/25/2021
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 known

Symptom List: Pain in extremity

Symptoms: In the same evening of doses 1 and 2 I developed left sided chest pressure and burning that radiated down my left arm. The dose 2 episode additionally radiated into my left neck and jaw. I have had an increase in heart palpitations. I have had a headache since the day after the 2nd dose (August 22 was the day of 2nd dose). Separately from the above I had metallic taste in my mouth minutes within injection on both doses that lasted until later in the day.

Other Meds: Loratidine and oral contraception

Current Illness: None

ID: 1632956
Sex: M
Age: 57
State: PA

Vax Date: 06/03/2021
Onset Date: 06/01/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data:

Allergies: Allergic to statins

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

Symptoms: The shoulder that was injected has limited motion and extreme pain when the limit of the motion is reached. The pain persists for up to a minute after the movement that caused the pain. I can't sleep in certain positions due to the pain. I search for positions to hold my arm that have no pain. This has been going on for well over a month.

Other Meds: B-12

Current Illness: None

ID: 1632957
Sex: M
Age: 39
State: TX

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: unknown

Allergies: None reported

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

Symptoms: Patient reports tingling and numbness in his left arm within 4 hours of vaccine administration. The numbness and tingling has continued as of 8/25/21 (1 week post vaccination). He informed the pharmacist that he has gone to his doctor who instructed him not to receive the 2nd dose of the vaccine, but gave no further instructions.

Other Meds: None available

Current Illness: none reported

ID: 1632958
Sex: F
Age: 36
State: MD

Vax Date: 02/13/2021
Onset Date: 02/16/2021
Rec V Date: 08/25/2021
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: sulfa drugs

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

Symptoms: About 3 days after the 2nd vaccine, I started getting a number of itchy bumps on my left arm. Over the next few days, it started to spread to my other arm, torso and legs. They were very itchy. I consulted a doctor via telehealth and was prescribed a short course of prednisone, which did not help. My rash continued to get worse and I made another appointment to see a dermatologist. The dermatologist commented that it looked like a viral rash. I was prescribed a course of 21 days of prednisone and a topical steroid cream. My rash did resolve after the 2nd round of medications.

Other Meds: Apriso

Current Illness: none

ID: 1632959
Sex: F
Age: 25
State: TX

Vax Date: 08/24/2021
Onset Date: 08/25/2021
Rec V Date: 08/25/2021
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: Employee received the Pfizer vaccine dose #1 on 08/24 at the vaccine event. The injection was in the left upper arm in deltiod. Started have symptoms the next day after vaccination (8/25): Swollen lymph node under arm, fatigue, and warm to touch. Has been off of work since 08/25. Advise to call back if symptoms worsen and get better if a follow up call. As well to put cold compress on site and take ibuprofen or Tylenol

Other Meds:

Current Illness:

ID: 1632960
Sex: F
Age: 37
State: MI

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data: No tests done

Allergies: montelukast sodium= Headache Moderna covid 19 vaccine= Itching

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Employee reported Itchy throat, Tongue felt swollen, Rash on Bil arms a few hours after receiving vaccine

Other Meds: symbicort inhaler, albuterol inhaler, zyrtec 10 mg, prednisone 10 mg, accolate 20mg

Current Illness: None

ID: 1632961
Sex: M
Age: 15
State:

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 08/25/2021
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: Rhythm electrocardiogram, Hemogram II, Serum Glucose

Allergies: No

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

Symptoms: 10 minutes later after taking the vaccine COVID-19 PFIZER my son started to feel stomach pain, feeling of vomit, dizziness, sweating, his hands were cold, and he got pale. He asked me to take him to the bathroom and when he was there I asked the nurse for help, he lost consciousness. They took him to the stretcher and hooked him to some equipment. He regained consciousness but he was still without strength, pale, nauseous, we waited another 20 minutes and took him home. At 11 in the morning, he had a medical appointment. I took him to the doctor and they did some test.

Other Meds: Acetaminophen

Current Illness: None

ID: 1632962
Sex: F
Age: 64
State: WI

Vax Date: 04/23/2021
Onset Date: 04/23/2021
Rec V Date: 08/25/2021
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: Unknown

Allergies: None listed on patient form

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Client received an unneeded 3rd dose of the COVID vaccine on 04/23/2021. Client had received two previous doses of Moderna on 03/25/2021 and 04/22/2021. Client reported on her vaccine administration form that she had not received any previous doses of Moderna. When we checked the Immunization Registry on 4/23/2021, we identified that the client had previously received a dose of the COVID vaccine. On 4/23/2021, the only COVID vaccine listed for the client on the Wisconsin Immunization Registry was for a dose administered on 03/25/2021. The 04/22/2021 dose was not yet entered by the other vaccination site.

Other Meds: Unknown

Current Illness: Unknown

ID: 1632963
Sex: F
Age: 49
State: FL

Vax Date: 08/18/2021
Onset Date: 08/19/2021
Rec V Date: 08/25/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: PATIENT REPORTS SHE WOKE UP DAY AFTER VACCINE 8/19/21 WITH HEADACHE/LIGHT HEADEDNESS THAT WENT AWAY AFTER 3 HOURS BUT RECURRED OFF AND ON SINCE VACCINE; PATIENT ALSO REPORTS SHORTNESS OF BREATH DAY AFTER VACCINE 8/19/21 AND THAT GOT NOTICEABLY WORSE 4 DAYS POST VACCINE AND HAS BEEN CONSISTENT SINCE "CANNOT GET A FULL CLEANSING BREATH;" PATIENT ALSO REPORTS RASH DESCRIBED AS DOTS ON TRUNK OF BODY, CHEST, BACK, HIPS, NECK STARTED 8/20/21 AND LASTED UNTIL 8/22/21 GRADUALLY FADING AWAY. THE SHORTNESS OF BREATH IS MOST CONCERNING AS SHE IS A RUNNER AND HAVING TROUBLE WITH CATCHING HER BREATH WITH REGULAR ACTIVITIES.

Other Meds:

Current Illness:

ID: 1632964
Sex: M
Age: 50
State: CO

Vax Date: 03/26/2021
Onset Date: 03/27/2021
Rec V Date: 08/25/2021
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: Unknown

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

Symptoms: On 03/26/2021 I received my first vaccination of Moderna (Lot # 016B21A - Exp 09/13/2021. After the shot I broke out in a terrible rash and had difficulty breathing (wheezing) shortly after getting the shot (late afternoon) and it got worse the next day. I did research online and the recommendation was to not get the second shot if I experienced these symptoms. I did not seek medical treatment but followed the CDC guidelines.

Other Meds: Diazepan, Citalopram, Hydroxyzine, Finasteride, multivitamins, Collagen Peptides, Matcha, and Turmeric Powder

Current Illness: NA

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am