VAERS 2021 Database www.vaers.hhs.gov

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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: 1656412
Sex: F
Age: 18
State: SC

Vax Date: 08/30/2021
Onset Date: 08/30/2021
Rec V Date: 08/30/2021
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: NKDA

Symptom List: Dysphagia, Epiglottitis

Symptoms: PT'S FAINTED WITHIN ~ 1 MINUTE AFTER ADMINISTRATING VACCINE, FOUND ON THE FLOOR IN PRONE POSITION (FACE DOWN). IMMEDIATELY WENT TO PT'S ASKED HER IF SHE CAN HEAR ME, CHECK HER PULSE FOR RESPONSE, PT'S RESPONDED WITHIN FEW SECONDS, ASKED PT'S HOW SHE IS FEELING, WHAT IS HAPPENING TO HER, PT'S WANTED TO SIT UP AGAINST THE WALL FOR SUPPORT, HELPED HER GET UP SLOWLY TO SIT UP AGAINST THE WALL, PT'S SAID WAS OKAY TO SIT AGAINST THE WALL, ASKED IF WANTS ME TO CALL 911, PT'S SAID NO AND PT'S WANTED TO CALL HER MOM (MOM IS PHARMACIST), PT'S FAINTED AGAIN IN FORNT OF ME, HELPED HER LAYDOWN, WITHIN FEW SECOND PT'S RESPONDED, ASKED PT'S IF SHE FELT ANY SWELLING ON HER TONGUE OR MOUTH, PT'S SAID NO, PT'S FELT LIGHT HEADED BUT SAID WAS GETTING BETTER, ASKED HER IF SHE CAN AND WANTED TO TAKE DIPHENHYDRAMINE 25 MG CAPSULE, PT'S WAS OKAY TO TAKE DIPHENHYDRAMINE 25 MG CAPSULE (EXPIRATION: 01/2023, LOT #194300), TOOK DIPHENHYDRAMINE 25MG CAPSULE @ ~ 1300. CHECKED PT'S BLOOD PRESSURE @ ~ 1305 88/53 MMHG, PULSE 59/MIN WHILE SITTING DOWN, ASKED PT'S TO LAY DOWN ON THE FLOOR (PROVIDED SLEEPING MATT) WITH HER LEGS/ FEET ELAVATING ON CHAIR FOR BETTER BLOOD CIRCULATION, PT'S UNDER MY WATCH THE ENTIRE TIME. PT'S CALLED HER MOM AND EXPLAINED HER SITUATION WHILE PUTTING PHONE ON SPEAKER, WHILE I LISTEN TO HER CONVERSATION AND HELP HER. CHECKED BP AGAIN @ ~ 1310 WHILE PT'S LAYING DOWN BP: 94/61, PULSE 67/MIN, ~@ 1325 BP: 95/72, PULSE 62/MIN, ~@ 1330 BP: 101/72, PULSE 63/MIN, ~@ 1340 BP: 102/72, PULSE 63/MIN. PT'S BP GETTING BETTER, BACK TOWARDS NORMAL. ASKED PT'S IF SHE GOT INJURED, PT'S SAID NO SHE DID NOT GOT INJURED. PT'S MOM ARRIVED @ ~1345 EXPLAINED HER SITUATION AGAIN, ASKED HER IF SHE HAS ANY QUESTION OR CONCERN, MOM HAD NO QUESTION. MOM WAS AWARE OF THE COMMON SYNCOPE EFFECTS IN ADOLSCENTS AGE 12 TO 18 YEARS OLD. MOM HELP PT'S GET UP FROM THE FLOOR, PT'S SIT ON THE FLOOR FEW MINS AND PT'S LEFT WITH THE MOM FROM THE PHARMACY @ ~ 1350. THROUGH OUT I (PHARMACIST) WAS PRESENT WITH/ ARROUND PT'S CHECKING ON HER AND AKSED HER IF SHE WANTED TO CALL 911. PT'S ACTIVELY TALKING TO ME THROUGH OUT AFTER HER SECOND FAINT. WHEN PT'S LEFT FROM PHARMACY WITH MOM, PT'S WAS FINE TO LEAVE THE PHARMACY WITH HER MOM @ ` 1350.

Other Meds: NO

Current Illness:

ID: 1656413
Sex: F
Age: 68
State: AK

Vax Date: 08/01/2021
Onset Date: 08/29/2021
Rec V Date: 08/30/2021
Hospital: Y

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

Lab Data:

Allergies: nkda

Symptom List: Anxiety, Dyspnoea

Symptoms: bells palsy type symptoms, blinkiking left eye right sided facial droop

Other Meds: VENTECLOX,ACYCLOVIR

Current Illness: cll

ID: 1656414
Sex: F
Age: 58
State: MD

Vax Date: 05/29/2021
Onset Date: 06/24/2021
Rec V Date: 08/30/2021
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: MRI ( 08/07/21)

Allergies: N/A

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

Symptoms: Left shoulder hurts, pinching nerve feeling, can't elevate arm past 45 degrees. I did an MRI and it shows muscle atrophy and hole present, needs immediate surgery.

Other Meds: Janumet, Calcium, and Vitamin D3

Current Illness: Diabetes

ID: 1656415
Sex: F
Age: 43
State: CA

Vax Date: 08/02/2021
Onset Date: 08/03/2021
Rec V Date: 08/30/2021
Hospital:

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: days after receiving vaccine, pt developed achy joints, rash all over, as well as welts. patient discussed with rph prior to express desire to receive second dose to complete series. rph informed pt that pt should further discuss with md second dose (pt already discussed side effects but not risks vs benefit of second dose).

Other Meds:

Current Illness:

ID: 1656416
Sex: F
Age: 47
State: VA

Vax Date: 08/13/2021
Onset Date: 08/14/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: na

Allergies: pencillin

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

Symptoms: multiple hives around injection site, flushing, panic attack

Other Meds: Lisinopril 40mg, Albuterol 90 mcg/inh, Escitalopram 10 mg, Xiidra 5%, advair 100/50, pantoprazole 20 mg 2 x a week, pepcid ac, calcium with magnesium, zinc and vit d and a multi vitamin

Current Illness: no

ID: 1656417
Sex: F
Age: 11
State: WA

Vax Date: 07/21/2021
Onset Date: 07/21/2021
Rec V Date: 08/30/2021
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: No Adverse events were experienced by this pt or reported.

Allergies: Unknown

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

Symptoms: EUA at this date was for 12 years and older. This pt was 11 years and 4 months old. No reported adverse reactions occurred. Reporting to VAERS due to EUA use & pt's age.

Other Meds: Unknown

Current Illness:

ID: 1656418
Sex: M
Age: 65
State: NC

Vax Date: 02/13/2021
Onset Date: 02/13/2021
Rec V Date: 08/30/2021
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: Iodine; bee venom; codeine; shell fish; fish

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: DROWSINESS, NAUSEA, DIAREA, FATIGUE, ARM PAIN.

Other Meds: Tylenol; Alprazolam; Amiodarone; Aspirin; Atorvastatin; Calcium; Cholecalciferol; Cyclobenzaprine; Epinephrine; Escitalopram Oxalate; Ferrous Sulfate; Flonase; Furosemide; Hydrochlorothiazide; Creo DR; Methimazole; Multivitamin; Neomycin -

Current Illness: None

ID: 1656419
Sex: F
Age: 65
State: CA

Vax Date: 01/30/2021
Onset Date: 01/30/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data:

Allergies: NA

Symptom List: Pharyngeal swelling

Symptoms: Headache; Lethargy

Other Meds: Valsartan 320mg; Alendronate Sodium 70mg; Levothroxine 75mcg; Spiriva Handihaler; Albuterol Pro Air; Gluchosamine Condroitin; COQ10; Vitamin B12; Multivitamin w/Iron; Probiotic; Lansoprazole; Cacium D3; Cranberry

Current Illness: NA

ID: 1656420
Sex: F
Age: 28
State: KY

Vax Date: 12/23/2020
Onset Date: 08/28/2021
Rec V Date: 08/30/2021
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: None stated.

Other Meds:

Current Illness:

ID: 1656421
Sex: M
Age: 70
State: PA

Vax Date: 02/17/2021
Onset Date: 02/19/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: Xray of left hip on 8/13

Allergies: Mild seasonal hay fever

Symptom List: Diarrhoea, Nasal congestion

Symptoms: 9 days of severe joint and muscle pain beginning two days after the 2nd dose (shot on 2/17, pain 2/19). Left hip pain began in March when I started playing golf. Pain increased as the season progressed until it became unbearable on August 10. I saw Dr. in Orthopedics on 8/13. Following xray, he diagnosed moderate to severe arthritis in the left hip. I believe the second Moderna shot accelerated exacerbated the arthritis.

Other Meds: Crestor 10mg Amlodipine (Norvasc) 10mg Losartan 50mg Famotidine (OTC) 20mg Claritin (OTC) 10mg Aleve (OTC) 220mg CoQ-10 200mg Calcium 600mg Centrum Silver Men Ocuvite Guaifenesin 400mg Glucosamine Chondroitin

Current Illness: None

ID: 1656422
Sex: M
Age: 41
State: CA

Vax Date: 05/24/2021
Onset Date: 08/01/2021
Rec V Date: 08/30/2021
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:

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

Symptoms: Breakthrough Covid infection, DVT

Other Meds:

Current Illness:

ID: 1656423
Sex: F
Age: 50
State: OH

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

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

Lab Data: No

Allergies: Codeine; Morphine; Bactrim

Symptom List: Rash, Urticaria

Symptoms: I had a headache for three weeks. I had a fever for almost three weeks. I was extremely tired - felt like I had mono had Body aches; joints ached horribly bad; arm was sore. Horrible abdominal pain and diarrhea and all of those symptoms was continuous for the first three weeks. I called my primary care doctor and My GI doctor. The GI doctor called me an anti-spasm medicine to help with intestinal pain I was having. Dicyclomine - that is what I got on. That was 10 mg three times a day - one before each meal. That did not suffice for the pain. I started those seven days before the second vaccine which was on July 28th. Last week, I had called back to GI doctor, and I told him I needed a steroid and he called me in a Entocort (steroid) - 3 mg. Started on August 17th. I take three in the morning. I am supposed to take it until I see the doctor again which will be 30 days. Two capsules four times a day - two before each meal and two before bed of the Dicyclomine. It has helped a lot to do these two now. It helps with some of the abdominal pain and with the diarrhea. I'm still very loose with stools but it's not diarrhea anymore. So, I've had some improvement.

Other Meds: Bupropion; Omeprazole; Leflunomide; Chloroquine; Topiramate 50 (Generic for Topamax); Flonase

Current Illness: No

ID: 1656424
Sex: F
Age: 62
State: NE

Vax Date: 04/22/2021
Onset Date: 07/05/2021
Rec V Date: 08/30/2021
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:

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

Symptoms: Moderna COVID19 Vaccine EUA Admitted inpatient for planned total joint replacement, no complications

Other Meds:

Current Illness:

ID: 1656425
Sex: F
Age: 93
State: NJ

Vax Date: 02/26/2021
Onset Date: 03/17/2021
Rec V Date: 08/30/2021
Hospital: Y

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

Lab Data: June 10 2021....biopsy of skin tissue

Allergies: no

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

Symptoms: Several weeks after second shot I experienced severe itching, hives and raised red blotches....After two months of suffering blisters emerged and I was diagnosed with bullous pemphigoid an auto immune disease affecting the skin where the body`s immune system attacks the protein between the top two skin layers.

Other Meds: xanax

Current Illness: none

ID: 1656426
Sex: M
Age: 30
State: IL

Vax Date: 05/14/2021
Onset Date: 05/15/2021
Rec V Date: 08/30/2021
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: Had chills and headache that lasted for 3 hours.

Other Meds: Concerta 54mg

Current Illness: none

ID: 1656427
Sex: F
Age: 55
State: CA

Vax Date: 04/23/2021
Onset Date: 07/05/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: 7/5/2021: CBC w/Diff, Comprehensive Metabolic Panel, Creatine Kinase, Tropinin-I, Urinalysis UA Rflx Microscopic Culture -- all normal

Allergies: Sensitive to aspirin, bad side effects from Claritin

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

Symptoms: I suffered mental confusion that lasted approximately 2 1/2 hours (from 6pm to approx 8:30pm). Initially I thought it might be exercise-related (I had just completed a 35-minute bike ride in temperatures in the high 80's), but I have never experienced confusion like this after any type of short exercise. My husband provided water, sports drink (with electrolytes), and some crackers, but after an hour the symptoms hadn't lessened so he took me to the ER, where doctors performed a range of tests -- all of which indicated I didn't have any noticeable blood, heart, or neurological issues. On reflection, the feeling I had was very similar to a bout of mental confusion I had a few days after my FIRST Pfizer/BioNTech vaccination (on April 2, 2021, at the same location noted above). I had attributed that first incident to the vaccine, because I had heard that some people experienced mental confusion following their vaccination. I don't KNOW that this second episode was related to the vaccine, but the symptoms were similar to those I experienced in April.

Other Meds: Flonase

Current Illness: none

ID: 1656428
Sex: M
Age: 37
State: CA

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

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

Lab Data: None

Allergies: None

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

Symptoms: About 15 minutes after my vaccine I felt my left side of the face go numb. It fells like after having dental work and your mouth face is numb. It is still felling the same since the time of the vaccine.

Other Meds: None

Current Illness: None

ID: 1656429
Sex: F
Age: 42
State: CA

Vax Date: 02/18/2021
Onset Date: 03/11/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: (06/08) Heart monitor at home discovered I had PACS, (4/19/2021) EKG, (5/13) Doppler Echo Transthoracic

Allergies: NKA

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Worsening and more often heart palpitations. Doc wanted to give beta blocker for it but refused for a number of reasons and history. Stay hydrated and diet change. Still has issues to this day. Trying to find alternatives to prescription drugs for issue. As of 8/30/2021 had 3 acute heart palpitations by 02:00PM EST.

Other Meds: None

Current Illness: None

ID: 1656430
Sex: M
Age: 0
State: MI

Vax Date: 08/30/2021
Onset Date: 08/30/2021
Rec V Date: 08/30/2021
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: sweating and increased heart rate

Other Meds:

Current Illness:

ID: 1656431
Sex: F
Age: 67
State: OH

Vax Date: 08/26/2021
Onset Date: 08/26/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Vaccine was mixed with smaller dose of saline than 1.8 ml , no reaction to report as of today

Other Meds: none

Current Illness: none

ID: 1656432
Sex: M
Age: 67
State: FL

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 08/30/2021
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: shortness of breath, dizzy, tired, slurred speach, dropped blood pressure

Other Meds:

Current Illness:

ID: 1656433
Sex: F
Age: 70
State: AZ

Vax Date: 06/17/2021
Onset Date: 06/22/2021
Rec V Date: 08/30/2021
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: Fatigue, no energy, tiredness, sores in the inside of the mouth and around the outside, PCP provided steroid ointment. Dermatologist confirmed yeast infection in mouth. Hot flashes, fever, nauseated, severe headache, and body aches.

Other Meds:

Current Illness:

ID: 1656434
Sex: F
Age: 15
State: IN

Vax Date: 08/27/2021
Onset Date: 08/30/2021
Rec V Date: 08/30/2021
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: None

Allergies: NKDA

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

Symptoms: Patient has had a severe headache today and loss of taste.

Other Meds: Strattera

Current Illness: Mild runny nose.

ID: 1656435
Sex: F
Age: 69
State: OR

Vax Date: 02/12/2021
Onset Date: 02/12/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: None

Allergies: bees

Symptom List: Injection site pain, Pain

Symptoms: No initial reaction. Four hours after vaccine injection I got severe hives, started on the back of my neck and then extended over my torso and face. Went to ER in city the next day, 2/13/21. We confirmed it was hives, didn't doc as reaction but simply as treated hives. Received prescription for EPI pen and dosage of five days of Prednisone. He said I was over the worst part and should not need Prednisone but fill scrip if necessary. The next day 12/14 my hives were much worse, spreading over my body, itching, fever, swollen face and ears. Started Prednisone and it took the full five days for hives to be mostly gone. Used benedryl cream topically, Motrin. ER doc said report to primary, which I did that week; was told not do anything and not to report as it was just hives, a typical non-life threatening reaction. This primary dr later told me to get the vaccine, not to worry about any further allergic reaction. I haven't to date taken a second dose per CDC site.

Other Meds: Wellbutrin

Current Illness: none

ID: 1656436
Sex: F
Age: 22
State: KY

Vax Date: 08/02/2021
Onset Date: 08/30/2021
Rec V Date: 08/30/2021
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: Patient stated at the time of her second Moderna vaccine that she has been on her period ever since receiving the first dose 4 weeks ago. She states that she is usually very regular but is not on any type of birth control. She mentions that she did have 2 or 3 days out of the 4 weeks that she did not bleed. She does not have a primary care physician at the time. She decided not to get the second dose at this time, instead wanting to wait on it.

Other Meds:

Current Illness:

ID: 1656437
Sex: F
Age: 52
State: VA

Vax Date: 08/14/2021
Onset Date: 08/15/2021
Rec V Date: 08/30/2021
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, was not recommended for in office appointment Three phone calls, two with the nurse and was told to follow CDC Guidelines.

Allergies: I have medicines I prefer not to take, but nothing that has caused a full blown allergic reaction.

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

Symptoms: Received the shot Saturday morning about 9:45 and woke up the next morning with chest pains (same pains I had when I had Covid) I rested throughout Saturday and Sunday, but ended up having to take Advil for the pain. I called my doctor's office the next week to inquire about an appointment and if I should go through with the second shot due to the reaction, and they told me to follow the CDC Guidelines (with no appointment scheduled). I looked up the information on the CDC website and it says to report. I cannot comfortably get a second dose with that severe of chest pains. I heard (from the pharmacist herself that the second dose of the Moderna is where most people had the reaction.

Other Meds: Vitamin D, Vitamin C, B Complex, Magnesium Citrate, K2 and electrolyte powder 1x per day

Current Illness: N/A

ID: 1656438
Sex: M
Age: 17
State: TX

Vax Date: 08/30/2021
Onset Date: 08/30/2021
Rec V Date: 08/30/2021
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:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient reported nausea, and felt lightheaded. Vitals BP 110/82, Pulse 62, O2 99%. Monitored additional 15 minutes symptoms were gone. Stated he felt better and was cleared.

Other Meds:

Current Illness:

ID: 1656439
Sex: F
Age: 51
State: CA

Vax Date: 02/19/2021
Onset Date: 07/31/2021
Rec V Date: 08/30/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Breakthrough Covid infection

Other Meds:

Current Illness:

ID: 1656440
Sex: M
Age: 23
State: NJ

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 08/30/2021
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: None

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

Symptoms: Patient adversely received Moderna as dose #2 in COVID-19 vaccination series. Remained asymptomatic while in observation area. Spoke with patient's mother on 8/26/21, 1 day post vaccination, patient c/o mild soreness at injection site.

Other Meds: None declared.

Current Illness: None declared.

ID: 1656441
Sex: F
Age: 47
State: VA

Vax Date: 03/23/2021
Onset Date: 03/24/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data:

Allergies: clarithromycin

Symptom List: Nausea

Symptoms: sharp pains ran up spine, pain in right hand, numbness in half of foot, knee problems in both knees soreness in joints. hand went total purple and went numb

Other Meds: claritin

Current Illness: no

ID: 1656442
Sex: M
Age: 64
State: ND

Vax Date: 08/18/2021
Onset Date: 08/19/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: COVID-19 TEST 08/23/2021

Allergies: No

Symptom List: Injection site pain

Symptoms: On 08/18/2021, right after the injection, I tasted metal in my mouth. On 08/20/2021, I had fever chills. I came down with a sore throat, and cough and it progressively got worse. On Monday, A coworker at work was positive for COVID. I went to urgent care to get tested on, 08/23/2021, for COVID-19 and it was positive, and I started quarantine. On 08/27/2021, I went to urgent care to get the immunotherapy vaccine. It took care of my fever, muscle pain, headache, abdominal pain and I am not as fatigue as I was. I still have the cough. I have mostly recovered from the AEs; the cough still remains.

Other Meds: Olmesartan Medoxomil; fenofibrate; Zolpidem tartrate; metoprolol succinate; lorazepam; omeprazole

Current Illness: No

ID: 1656443
Sex: F
Age: 29
State: TX

Vax Date: 08/27/2021
Onset Date: 08/27/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: Accidently administered Pfizer-BioNTech on 01/15/192. Patient wanted an additional dose of Moderna. Patient was notified of the error immediately.

Other Meds:

Current Illness:

ID: 1656444
Sex: M
Age: 36
State: ND

Vax Date: 08/28/2021
Onset Date: 08/28/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: No medications administered.

Allergies: No allergies reported.

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

Symptoms: Patient recieved his first dose Pfizer this afternoon and within about 8 minutes shouted he wasn't feeling good. He was pale and diaphoretic. Initial pulse was high 40s to low 50s. He kept saying he felt nauseous. Heartrate rebounded within minutes. States he had not eaten anything yet today. I gave him a nutrigrain bar and water bottle. Within 20 minutes his color returned to pinkish color, o2 was 97% and pulse was 77 when he left vaccine site. He was in our care for approximately 45 minutes.

Other Meds: N/A

Current Illness: No reported illnesses.

ID: 1656445
Sex: F
Age: 18
State: CA

Vax Date: 05/08/2021
Onset Date: 05/08/2021
Rec V Date: 08/30/2021
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: None known

Symptom List: Tremor

Symptoms: Patient has history of regular and consistent menstrual cycle until May 2021 (no previous history of irregular cycle or missing periods). Second dose of Pfizer covid vaccine was given May 8th and the patient has not had a menstrual cycle since. She has had amenorrhea for 4 full months at the time of reporting.

Other Meds: NONE

Current Illness: None

ID: 1656446
Sex: M
Age: 49
State: PR

Vax Date: 08/30/2021
Onset Date: 08/30/2021
Rec V Date: 08/30/2021
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: N/A

Symptom List: Erythema, Pruritus

Symptoms: He received two previous doses. He ask for his second dose like the card indicated. Once one of the technicians enter to database noticed it was the third one. This patient is not an immunocompromise patient .

Other Meds: N/A

Current Illness: N/A

ID: 1656447
Sex: F
Age: 17
State: OH

Vax Date: 08/11/2021
Onset Date: 08/11/2021
Rec V Date: 08/30/2021
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:

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

Symptoms: PATIENT AGE WAS 17 YEARS. . MOM HAD MARKED MODERNA ON PAPER AND HAD VERBALLY REQUESTED THAT AND VACCINATOR DID NOT CATCH THAT THE PATIENT WAS ONLY 17. MODERNA VACCINE WAS ADMINISTERED. DISCUSSIONS HAVE TAKEN PLACE WITH MOM MAKING HER AWARE SHE SHOULD NOT HAVE BEEN GIVEN MODERNA. SHE HAS NOT HAD ANY REPORTED SIDE EFFECTS.

Other Meds:

Current Illness:

ID: 1656448
Sex: F
Age: 63
State: IN

Vax Date: 01/25/2021
Onset Date: 07/12/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: 7/30/2021--Stool sample for parasites and e coli

Allergies: none

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

Symptoms: 7 months after 1st shot--ongoing diarrhea

Other Meds: Vitamin D, calcium, estradiol cream, Dim-plus (estrogen-like natural herb)

Current Illness: none

ID: 1656449
Sex: M
Age: 37
State: TN

Vax Date: 08/20/2021
Onset Date: 08/21/2021
Rec V Date: 08/30/2021
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: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Heart palpitations that brought me to my knees felt like I was having a mini heart attack. I could feel my heartbeat through my entire body

Other Meds: N/A

Current Illness: None

ID: 1656450
Sex: F
Age: 51
State: NY

Vax Date: 04/06/2021
Onset Date: 04/09/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: ultrasound

Allergies: vancomycin

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

Symptoms: fat necrosis

Other Meds: levothyroxine 100mcg

Current Illness: none

ID: 1656451
Sex: M
Age: 44
State: MN

Vax Date: 06/09/2021
Onset Date: 08/30/2021
Rec V Date: 08/30/2021
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:

Allergies:

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

Symptoms: POSITIVE COVID TEST 8/30/21

Other Meds:

Current Illness:

ID: 1656452
Sex: M
Age: 74
State: CA

Vax Date: 07/05/2021
Onset Date: 08/10/2021
Rec V Date: 08/30/2021
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:

Symptom List: Pain in extremity

Symptoms: Breakthrough Covid Infection,

Other Meds:

Current Illness:

ID: 1656453
Sex: M
Age: 74
State: MN

Vax Date: 08/20/2021
Onset Date: 08/23/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: Documented rhythm using Kardia device on iphone. No formal ECG was done at the time. My cardiologist was out of town and by the time we talked on the phone AF had resolved.

Allergies: pollen

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

Symptoms: Prolonged episode of atrial fibrillation beginning approximately 3 days after vaccine and lasting approximately 40 hours. I had ablation procedure in March 2021 and had no known episodes of AF until the onset of this one . The episode self-resolved and has not recurred. I did have fever, fatigue, body aches following the vaccine beginning about 16 hours after the vaccine and lasting approximately 24 hours. First two vacccine doses were Jan 27 and Feb 17. I had been having intermittent AF at that time, thus the abalation in March. I did not associate AF with the vaccine doses at that time. New CLL diagnosis was made at the time of the ablation.

Other Meds: dofetilide, rivaroxaban, vit D, acetaminophen

Current Illness: atrial fibrillation, chronic lymphocytic leukemia

ID: 1656454
Sex: F
Age: 73
State: CA

Vax Date: 02/02/2021
Onset Date: 02/16/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: Urine and blood work

Allergies: Shellfish; Tree Nuts; Peanuts; Iodine; Penicillin

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

Symptoms: Joint and muscle pain in shoulder, hips, and neck. Extreme fatigue.

Other Meds: No

Current Illness: No

ID: 1656455
Sex: F
Age: 50
State: LA

Vax Date: 07/16/2021
Onset Date: 07/17/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: ECHO, CT head, EKG, CXR, Cardiac enzymes, d-dimer, PT/INR ordered 8/30/2021

Allergies: NKDA

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

Symptoms: left sided upper and lower body weakness, HA, left eye blurred vision; onset 7/17/2021 until today Testing ordered today 8/30/2021

Other Meds: Aspirin 81mg qd, Pepcid prn, flonase prn, mirtazapine 7.5 mg oral tablet qhs, IBU 600 prn

Current Illness: 7/1/2021 Endocervical curettage Diagnostic hysteroscopy dilation and curettage for postmenopausal bleeding and abnormal pap

ID: 1656456
Sex: F
Age: 25
State: NC

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

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

Lab Data: NONE

Allergies: NO ALLERGIES LISTED

Symptom List: Vomiting

Symptoms: PATIENT FAINTED SOON AFTER RECEIVING VACCINE, HOWEVER DOES NOT SEEM TO BE RELATED TO ADVERS EFFECTS OF THIS VACCINE

Other Meds: UNKNOWN

Current Illness: NONE

ID: 1656457
Sex: M
Age: 29
State: IL

Vax Date: 08/30/2021
Onset Date: 08/30/2021
Rec V Date: 08/30/2021
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: pt was light headed after 10 min of receiving a shot and then he came to pharmacy window, and passed out. Pharmacy called 911 and at the same time immunizer was alongwith the pt , all ready to inject epipen but pt said he is feeling better, pt declined paramedics to go to ER and he was fine, he said he did nt eat as well

Other Meds:

Current Illness:

ID: 1656458
Sex: F
Age: 32
State: CA

Vax Date: 05/01/2021
Onset Date: 05/01/2021
Rec V Date: 08/30/2021
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: none known

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

Symptoms: Patient has no history of headaches. The patient reports severe headaches starting the day after the Moderna covid vaccine morning and night for 3 weeks. Following this more intense daily 3 week period, headaches persisted multiple times a week for 3 months afterwards. Still has some random headaches.

Other Meds: none

Current Illness: none

ID: 1656459
Sex: M
Age: 68
State: IL

Vax Date: 06/17/2021
Onset Date: 06/17/2021
Rec V Date: 08/30/2021
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: None. I'm a very good observer and I know what happened. I monitored myself very carefully as soon as I came out. This wasn't planned, but when I got into sun, I knew something wasn't right and started to question my observations. It was in fact very very bright.

Allergies: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Sunlight sensitivity. Was like having my eyes dilated. Was extreme when I walked outside after receiving the shot, hut has lessened somewhat. To date I still have the light sensitivity. A different color to sunlight is noticeable. Also I'm feeling heighten tension to surroundings like noise, making me somewhat anxious. More so at times, than other times. I think this is related to weather (humidity, barometeric pressure, temperature) . I've noticed on humid days when it's sunny, I just as soon lay low. Was never like this before the shot. -- I would also add that I have walked out of those building for the last 20 years and have never had a reaction to sunlight like what I experiences. My two sons were with me at time and I noticed them squinting and covering their eyes.

Other Meds: None

Current Illness: None

ID: 1656460
Sex: M
Age: 14
State: ID

Vax Date: 08/29/2021
Onset Date: 08/30/2021
Rec V Date: 08/30/2021
Hospital:

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

Lab Data: None yet, to date will be evaluated at hospital

Allergies: None

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

Symptoms: Fever, chills, dizzy, passed out at school, nausea/vomiting

Other Meds: NA

Current Illness: NA

ID: 1656461
Sex: F
Age: 88
State: CA

Vax Date: 02/10/2021
Onset Date: 08/10/2021
Rec V Date: 08/30/2021
Hospital: Y

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: breakthrough covid infection,

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am