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: 1659037
Sex: F
Age: 63
State: OH

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 08/31/2021
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 was in the pharmacy to receive her second dose of shingrix. Pushed down on the plunger and medication did not expel once in the patient arm. Was in the upper left deltoid muscle, pushed down on the plunger but medication did not expel. patient stated it was a little painful so took out the syringe and the medication was not being injected. 0.5 ml still in the syringe. Patient thought maybe the shot was a little high but No bruising or swelling visible. Mixed a second shingrix shot, patient had no issues with the second vaccine. No particles in the syringe that were visible. Patient stated the pain subsided, just normal pain associated with a shot with the second dose.

Other Meds:

Current Illness:

ID: 1659038
Sex: F
Age: 53
State: CA

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 08/31/2021
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: Dairy, eggs, sesame

Symptom List: Anxiety, Dyspnoea

Symptoms: 15 minutes following vaccine I began having tingling in my outer three fingers on left hand followed by numbness in hand, wrist and forearm. That evening I also had tingling in mouth, lips, tongue and teeth numbness. I also had lightheadedness (last about 5 days), head flushing (5 days), diarrhea (1 day), and elevated blood pressure. It has been almost two weeks, and I still have numbness and tingling on and off in both hands, fingers, wrists, forearms, numbness in teeth, and a burning sensation in both calves and ankles.

Other Meds: Vitamin C, Vitamin D, B-Complex, Vitamin E, Magnesium

Current Illness: none

ID: 1659039
Sex: M
Age: 44
State: CA

Vax Date: 08/17/2021
Onset Date: 08/25/2021
Rec V Date: 08/31/2021
Hospital: Y

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: 8/28/21 D- Dimer 1.41, CT Pulmonary angiogram - on 8/28/21 which showed a nonocclusive thrombus in posterior descending branch of right pulmonary artery. CBC , Pt. PTT, INR with in normal limits

Allergies: NONE

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

Symptoms: Patient developed chest pain 7 days post first dose of Moderna vaccine administered on 8/17/21. DEVEPOPED CHEST PAIN ON 8/25/21. Was seen in TTA on 8/28/21 for chest pain evaluation. Had CT angiogram on 8/28/21 which showed a nonocclusive thrombus in posterior descending branch of right pulmonary artery. He was started on Eliquis in the ER and is currently on it. Inamte was examined and , we do not see any risk factors for PE other than getting the vaccine recently. Tested negative for covid all the time since last year. Never had covid infection. Patient is currently in stable medical condition and discharged back to the facility.

Other Meds: NONE

Current Illness: NONE

ID: 1659040
Sex: F
Age: 50
State:

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

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

Lab Data:

Allergies: Simvastatin: rhabdomyolysis BuSpar: felt "foggy" Wellbutrin: nausea Ambien: did not tolerate Pfizer-BioNTech COVID-19 Vacc: tongue swelling, slurred speech

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: -patient received her first COVID-19 vaccine (pfizer) on 8/7/21; she was talking with the pharmacist about side effects that she experienced after her first dose -She had slurred speech about 30 minutes after the initial COVID vaccine

Other Meds: Praluent 150 MG/ML Solution Pen-injector ibuprofen Desvenlafaxine Succinate ER 100 MG Tablet Extended Release 24 Hour Solifenacin Succinate 5 MG Tablet

Current Illness:

ID: 1659041
Sex: M
Age: 79
State: GA

Vax Date: 02/04/2021
Onset Date: 07/26/2021
Rec V Date: 08/31/2021
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: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: PNEUMONIA, COVID-19 VIRUS INFECTION, ABDOMINAL. DIAGNOSIS: PNEUMONIA DUE TO COVID-19, ACUTE RESPIRATORY FAILURE WITH HYPOXIA. GI HEMORRHAGE, CHRONIC AFIB, HYPERTENSION, UNSPECIFIED FALL, CAMPYLOBACTER ENTERITIS, BACTEREMIA. NEGATIVE FOR INF A AND B, NEGATIVE FOR RSV. PUI PRESENTED WITH BLOODY STOOLS, ABDOMINAL PAIN, AND GENERALIZED WEAKNESS, SHORTNESS OF BREATH, COUGH. ADMITTED RECENTLY FOR FALL AND PNEUMONIA. GIVEN REMDESIVIR AND SOLUMETROL, DOXYCYCLINE,

Other Meds:

Current Illness:

ID: 1659042
Sex: M
Age: 15
State: PA

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 08/31/2021
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:

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

Symptoms: Patient experienced syncope and lost consciousness for a brief time after the immunization.

Other Meds:

Current Illness:

ID: 1659043
Sex: F
Age: 32
State: GA

Vax Date: 08/30/2021
Onset Date: 08/31/2021
Rec V Date: 08/31/2021
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: Kiwi, some citrus

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Extreme fatigue day of and pain in injection site. Next day site was swollen, itchy, and warm.

Other Meds: Methytrexate, folic acid, verapamil, venlafexene, infiximab

Current Illness:

ID: 1659044
Sex: F
Age: 64
State: CO

Vax Date: 08/29/2021
Onset Date: 08/29/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: 8/31/2021 saw doctor physical examine

Allergies: Tylenol

Symptom List: Pharyngeal swelling

Symptoms: First vaccines was Moderna but Moderna was not available. received Pfizer . one hour after had a really bad headache, body ache. pain behind the ear and jaw bone . jaw area sore to touch .

Other Meds: no

Current Illness: no

ID: 1659045
Sex: M
Age: 65
State: IL

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

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

Lab Data:

Allergies: sulfa, penicillin

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: bee stings on bottom of feet and back of his skull, cold and hot flashes, was in a semi coma for 5 hours

Other Meds: cymbastin, famotine, tighpraxa, dipaco, Neurontin

Current Illness: no

ID: 1659046
Sex: F
Age: 52
State:

Vax Date: 01/28/2021
Onset Date: 08/26/2021
Rec V Date: 08/31/2021
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 RECEIVED COVID-19 VACCINE PFIZER Dose 1 date: 01/28/2021 AND Dose 2 date: 02/18/2021. PATIENT TESTED POSITIVE TO COVID ON 8/26/21.

Other Meds:

Current Illness:

ID: 1659047
Sex: F
Age: 82
State: CA

Vax Date: 02/03/2021
Onset Date: 02/12/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: Biopsy 03/09/2021

Allergies: Sulfa Drugs

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

Symptoms: Pt. states that after receiving the 1st dose of Phizer 02/03/2021, started experiencing symptoms 02/12/2021 of Red blotchy rash on left hip, blotchy rash throughout of the body. Dermatologist visit Biopsy Litachen Plantus-Like Keratosis. 03/09/2021 Broke out with rash after 2nd dose. 7 months later rash in mouth still continuing.

Other Meds: N/A

Current Illness: N/A

ID: 1659048
Sex: M
Age: 58
State: IL

Vax Date: 02/24/2021
Onset Date: 03/01/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: ECG 03/17/2021. At 48 hr Holter monitor Starting March 19, 2021 showed 7265 PVC's, Bigeminy events 5, Trigeminy events 77,

Allergies: Bactrim Febrile reaction

Symptom List: Rash, Urticaria

Symptoms: Palpitations / PVCs one in at least every 23 heart beats within few days after the vaccination. Sometimes with pauses afterward. Since no significant symptoms of Chest pain, shortness of breath or weakness just observed. Symptoms gradually faded until resolved Mid August 2021.

Other Meds: Remicade 325 mg Q 8 weeks IVPB Tylenol 650 mg before Remicade given Diphenhydramine 50 mg before Remicade Given Loratadine 10 mg po Q AM Vitamin D3 5000 IU daily Stress Tab multiple vitamin as needed once daily

Current Illness: None

ID: 1659049
Sex: F
Age: 36
State: ID

Vax Date: 05/01/2021
Onset Date: 08/28/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: Nasal swab on 8/31/21, positive for covid.

Allergies:

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

Symptoms: Onset of child symptoms on 8/28/21, loss of taste and smell 8/30/21, positive covid test 8/31/21.

Other Meds: Prenatal vitamins

Current Illness:

ID: 1659050
Sex: M
Age: 15
State: PA

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

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

Lab Data:

Allergies:

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

Symptoms: Patient experienced syncope and lost consciousness for a brief time after the immunization.

Other Meds:

Current Illness:

ID: 1659051
Sex: M
Age: 44
State: NJ

Vax Date: 07/26/2021
Onset Date: 07/29/2021
Rec V Date: 08/31/2021
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: Joint pain in legs and neck that is unresolved

Other Meds: Olmesartan 40 mg Zinc Red yeast rice CoQ10 Vitamin D

Current Illness: None

ID: 1659052
Sex: M
Age: 43
State: NC

Vax Date: 01/16/2021
Onset Date: 01/16/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: Lab work

Allergies: Penicillin

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

Symptoms: Later on that night of receiving the vaccine I felt fatigued and had blurred vision. The next day in the morning I tried to go to work, but I had to leave because the blurred vision got worse. I was uncoordinated, had weakness, was excessively sleepy, had confusion, and had trouble of cognition.

Other Meds: Lipitor 20mg, 1xday; Cymbalta 60mg, 1xday; Gabapentin 900mg, 3xday

Current Illness:

ID: 1659053
Sex: F
Age: 75
State: LA

Vax Date: 08/03/2020
Onset Date: 08/04/2021
Rec V Date: 08/31/2021
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: Penciline Plavix Bactrim Meteionzie Sulfa drugs Oxycodone Nucynta Oxycod-app Darvocet Arrithmizine Codeine Doxycycline Celebrex Zocar Sklixine Allegar Clainex crestor Cipro Microbats Zyrtec sweet corn eggs Black seeds Tomatoes Soy products

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

Symptoms: After the first vaccination patient stated that she was having brain fogs. She was going to the hair dresser who had been doing her hair for years and could not figure out how to get to her house. She could not even remember leaving the house. She stayed home that following Thursday and on the following Friday she was still having a brain clutter,

Other Meds: Surosemide 20mg Potassium 10mg Asprin 325mg Probiotic Metropral ccer tab 50mg Calcium 1000mg Multivitamins Ezetimibe 10mg

Current Illness:

ID: 1659054
Sex: M
Age: 31
State: TN

Vax Date: 08/26/2021
Onset Date: 08/27/2021
Rec V Date: 08/31/2021
Hospital: Y

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

Lab Data: Left Heart Cath 8/27/2021 shows LVEF 45% with normal coronaries; CTA chest consistent with aspiration.

Allergies: No Known

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 8/27/2021. Cardiac arrest. Ventricular tachycardia. Possible Post COVID-19 vaccine myocarditis vs. cardiac vasospasm. Amiodarone, therapeuric cooling, Levophed. Aspiration pneumonia secondary to cardiac arrest

Other Meds: None

Current Illness: None known

ID: 1659055
Sex: F
Age: 33
State:

Vax Date: 08/24/2021
Onset Date: 08/25/2021
Rec V Date: 08/31/2021
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: Increased off feelings in chest -- resting heart rate increased from 62bpm to a range of 90 - 107bpm, for roughly 5 or so days. No treatment given. Resting heart rate returned to normal after about a week.

Other Meds:

Current Illness:

ID: 1659056
Sex: F
Age: 21
State: AL

Vax Date: 08/26/2021
Onset Date: 08/26/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: none known

Allergies: none

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

Symptoms: FRM VAERS "PATIENT REPORTED A HISTORY OF PASSING OUT FROM NEEDLES. IMMEDIATELY AFTER GIVING THE VACCINE PATIENT REPORTED FEELING FINE. A FEW MINUTES AFTER IMMUNIZATION DELIVERY, THE PATIENT REPORTED FEELING ILL, THEN PATIENT BEGAN TO SHAKE FOR A FEW SECONDS (LIKE THE BEGINNING OF A SEIZURE). PHARMACY INTERN LATER REPORTED SHE SAW PATIENTS "EYES ROLL BACK", WHEN PATIENT STOPPED SHAKING SHE COMPLAINED OF CHEST PAIN. WE CALLED 911. PATIENT REPORTED SHE WAS NOT HAVING ANY DIFFICULTY BREATHING OR SCRATCHY/SWOLLEN THROAT. PATIENT'S ARM AT INJECTION SITE LOOKED NORMAL, NO RASH OR SWELLING. I HELPED PATIENT TO LAY DOWN, ELEVATED FEET, AND GAVE PATIENT ICE PACK FOR NECK WHILE WAITING ON PARAMEDICS. PARAMEDICS REPORTED PATIENT'S VITALS WERE STABLE AND SHE WAS CLEAR FROM THEIR PERSPECTIVE. PATIENT CONTINUED TO RECOVER IN PHARMACY FOR ~1-1.5 HR UNTIL SHE LEFT.

Other Meds: not known

Current Illness: not known

ID: 1659057
Sex: F
Age: 30
State: WA

Vax Date: 08/28/2021
Onset Date: 08/29/2021
Rec V Date: 08/31/2021
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: Blood Pressure 97/47 & Heartrate of 54 bpm on 8-30-2021 at 3:15pm. Blood pressure cuff reading an irregular heartbeat. Stopped taking metoprolol (which I take for inappropriate Sinus Tachycardia/POTS) to ensure it didn't go down any further. I have been monitoring my HR and BP for months, and this has NEVER happened until I received my covid shot. I wasn't taking the Metoprolol but only 1 time a day since 8-29-2021 because I was feeling so poorly. Currently reading a BP of 100/54 with a HR of 66bpm off meds 4 days post vaccine, with an irregular heartbeat and palpitations. Average HR on meds is around 75bpm, off meds is normally 110bpm.

Allergies: Yeast, corn, soy, latex, dust mites, pollen (grass, plants, trees), hay, avocado, kiwi, coconut, mild opiate allergy, unknown environmental allergies (in cosmetics, lotions, detergents,etc)

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

Symptoms: Day 1: almost fainted in the pharmacy. Slept for an hour when I got home (not normal for me), hot firm injection site, fever, extreme exhaustion Day 2: fever, chills, hot firm arm, heart palpitations, exhaustion Day 3: fever, chills, hot firm arm, heart palpitations, bradycardia, exhaustion, irregular heartbeat Day 4: same as above, still ongoing

Other Meds: Metoprolol 25 MG, 2 times a day Prenatal Vitamin, Nature Made brand Cetirizine, 1 daily Benadryl, 50mg before vaccination

Current Illness: None

ID: 1659058
Sex: M
Age: 25
State: AZ

Vax Date: 08/30/2021
Onset Date: 08/30/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: Not applicable

Allergies: Zyrtec

Symptom List: Unevaluable event

Symptoms: Patient was waiting in the lobby after the vaccination was given. It has been about 5-10 minutes since his shot when he started shaking and eventually fainted. He came to relatively quickly but still seemed out of it. He started sweating and vomited twice. He did not experience any sort of itching or trouble breathing. 911 was called and the fire department arrived on the scene within about 5 minutes from the call. He was monitored and eventually was able to be released to go home. His family member was with him throughout the encounter.

Other Meds: Unknown

Current Illness: Unknown

ID: 1659059
Sex: F
Age: 36
State: CA

Vax Date: 03/01/2021
Onset Date: 03/01/2021
Rec V Date: 08/31/2021
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: BANNANAS; RASPBERRIES; GRAPES; CORITIDIN; MELOXICAM; DICLOSENAC; SULFA ANTIBIOTICS

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

Symptoms: Scratchy throat, fatigue, icky feeling, flu like symptoms, feverish.

Other Meds: ALBUTERAL; LEXAPRO; LEXOXYL; LISINOPRIL; ALLOPURINOL; KELNOR; SYMBICORT; B6

Current Illness: SINUS INFECTION

ID: 1659060
Sex: F
Age: 27
State: WA

Vax Date: 08/30/2021
Onset Date: 08/31/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Injection site pain, Pain

Symptoms: Hallucinations, chest pain. SOB. Itching.

Other Meds: Zinc, Vitamin D, baby aspirin

Current Illness: none

ID: 1659061
Sex: M
Age: 31
State: TX

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data:

Allergies: Augmentin (Rash)

Symptom List: Injection site pain, Menorrhagia

Symptoms: Pfizer BioNTech COVID-19 Vaccine EUA / Moderna COVID-19 Vaccine EUA: Mixed Series Patient received Moderna Vaccine on 8/4/2021 and the Pfizer Vaccine on 8/31/2021.

Other Meds:

Current Illness:

ID: 1659062
Sex: F
Age: 35
State: MN

Vax Date: 02/12/2021
Onset Date: 08/31/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: Covid PCR nasopharyngeal swab

Allergies: Erythromycin High 01/31/2019 Hives (High) Reglan [metoclopramide] Not Specified 02/11/2019 Other (Specify in Comments) Jittery, and hyper Hydrocodone Low 09/11/2018 Nausea and Vomiting

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

Symptoms: Patient contracted Covid. Unsure of exact date as prior to testing today, patient was tested on 8/16/2021. At that time she tested negative for Covid, but positive for RSV. She returned to this clinic because she was not feeling any better after two weeks. Retest now showed positive for Covid.

Other Meds: albuterol HFA (PROVENTIL,PROAIR,VENTOLIN) 108 (90 Base) MCG/ACT inhaler Inhale 2 puffs orally every 4 to 6 hours as needed for shortness of breath, wheezing or cough Shake well before using. Multiple Vitamins-Minerals (MULTIVITAMIN THERAPEU

Current Illness: N/A

ID: 1659063
Sex: F
Age: 38
State: OR

Vax Date: 01/22/2021
Onset Date: 08/07/2021
Rec V Date: 08/31/2021
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: PCR test

Allergies: none

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Tested positive for SARS-CoV-2 after being fully vaccinated with mRNA vaccine

Other Meds: vitamin D

Current Illness: none

ID: 1659064
Sex: M
Age: 62
State: PA

Vax Date: 06/22/2021
Onset Date: 06/25/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: Numerous.... request medical file

Allergies: Allergic to Undo in.

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Constant metallic taste in mouth, wanting to retch, Red rash / extreme itching over entire body Loss of balance, feeling off balance Swelling of feet, ankles, and legs

Other Meds: OTC -Vitamins, Potassium, Magnesium, SCRIPT- Descovy PRep

Current Illness:

ID: 1659065
Sex: F
Age: 32
State: AZ

Vax Date: 08/24/2021
Onset Date: 08/26/2021
Rec V Date: 08/31/2021
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:

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

Symptoms: I personally experienced a sudden onset of paresthesia from my right fingertips up to my elbow on my right arm. It was associated with a severe headache and floaters in my vision. The paresthesia persisted for 15 minutes. The floaters lasted for approximately 30 minutes. And the headache lasted for three days. There were no relieving factors.

Other Meds:

Current Illness:

ID: 1659066
Sex: F
Age: 75
State: TX

Vax Date: 08/25/2021
Onset Date: 08/28/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: none

Allergies: none

Symptom List: Nausea

Symptoms: stomach cramps, especially when my stomach isn't really full; general malaise for Saturday - Monday

Other Meds: Aspirin 81, Fomotidine 20, Gabapentin 800, Hydrocodone 10/325, Levothyroxine 100, Meloxicam 7.5, Pravastatin 40, Prolia injection 7-29-21, Vitamin D3 5000, Docusate Calcium 240, Miralax, Vitamin E 800, HEB Multivitamin, Refresh Relieva

Current Illness:

ID: 1659067
Sex: F
Age: 20
State: CT

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 08/31/2021
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: Injection site pain

Symptoms: shortly after receiving covid vaccine, pt complained of light headedness and was blacking out. she felt weak and said she was going to pass out. pt sat for a few minutes and had some water and a snack and felt better.

Other Meds:

Current Illness:

ID: 1659068
Sex: F
Age: 22
State: AL

Vax Date: 08/19/2021
Onset Date: 08/26/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: none known

Allergies: none reported

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

Symptoms: patient called and reported new itchy, rash at injection site one week after immunization delivery. per patient, she did not experience any injection site reaction immediately following immunization. Patient was advised to follow up with MD/PCP.

Other Meds: not known

Current Illness: not known

ID: 1659069
Sex: F
Age: 38
State: CA

Vax Date: 02/12/2021
Onset Date: 07/12/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: Mri of spine normal/ vascular scan to rule out blood clots showed fluid from bakers cyst behind both knees and calves/ blood test with high CRp and esr, otherwise normal, culture normal / X-ray of si joints with inflammation/orthopedic follow up / genetic test related to likelihood of reactive arthritis pending after orthopedic follow up.

Allergies: Amoxicillin

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

Symptoms: Reactive Arthritis and burst bakers cysts behind knees/si joint inflammation about 5 months after 2nd shot. Assumed to be related to possible GI /salmonella infection (though GI symptoms were only very mild and never tested) but other infections/vascular issues ruled out for leg swelling and pain. Treated with antibiotic/elevation/ice/rest/physio and slow improvement. Was unable to walk ~ 1 month. Still ongoing pain knees and all around knees in the morning. Not certain if rel?d to vaccine but was a major issue and I?ve never experienced a reaction like this and have had food poisoning twice before in my life. Reported to vaccine reporting system and was suggested to report it Vaers even if not sure of causality.

Other Meds: No

Current Illness: No

ID: 1659070
Sex: F
Age: 59
State: CA

Vax Date: 04/21/2021
Onset Date: 08/23/2021
Rec V Date: 08/31/2021
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: ultrasound - nothing (04/25)

Allergies: antibiotics

Symptom List: Tremor

Symptoms: started menstrul cycle, pnemonia came back , high fever, several bloodclots,

Other Meds:

Current Illness:

ID: 1659071
Sex: M
Age: 0
State: VA

Vax Date: 08/26/2021
Onset Date: 08/27/2021
Rec V Date: 08/31/2021
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: Emergency room and told to just keep giving fever reducers

Allergies: Seizure Fever Odd outburst Sleep troubles

Symptom List: Erythema, Pruritus

Symptoms: He had his routine 6 month.m vaccines that lead to seizure and concerning behaviors along with fevers Prior every other time his vaccines left him with a fever. And issue sleeping, not wanting to eat and clingy., Every time I?ve brought this up I?ve been told vaccines can?t cause anything from my doctor at this point though it doesn?t add up and I?m here reporting the seizure for the safety of my child. We are still awaiting to see more specialists including neurology.

Other Meds: 6 month routine vaccine. He isn?t on anything special just a dairy allergy.

Current Illness: Fevers Odd behaviors Sleep troubles

ID: 1659072
Sex: F
Age: 50
State: MT

Vax Date: 02/08/2021
Onset Date: 08/10/2021
Rec V Date: 08/31/2021
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: SARS-CoV-2 RNA Resp Ql NAA+probe DETECTED Ordered Test: SARS-CoV-2 RNA Resp Ql NAA+probe Ordered Test Codes: 94500-6 (LN LOINC)/ Status: Final Specimen Source: SOFT TISSUE SAMPLE Specimen Site: ENTIRE NASOPHARYNX(181200003) Specimen Collection Date/Time: 2021-08-10 07:26:00.0 SARS-CoV-2 RNA Resp Ql NAA+probe DETECTED Ordered Test: SARS-CoV-2 RNA Resp Ql NAA+probe Ordered Test Codes: 94500-6 (LN LOINC)/ Status: Final Specimen Source: SOFT TISSUE SAMPLE Specimen Site: ENTIRE NASOPHARYNX(181200003) Specimen Collection Date/Time: 2021-08-28 09:15:00.0

Allergies: ? Bee Venom Anaphylaxis ? Honey Swelling

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

Symptoms: Case completed the 2 dose Covid vaccine series on 2/8/21, then was hospitalized for Covid Pneumonia on 8/10/21

Other Meds: acetaminophen (TYLENOL) 500 mg tablet Take 500 mg by mouth every 8 hours as needed for Pain (seldom use) 1-2 tablets every 8 hours as needed for pain . amLODIPine (NORVASC) 2.5 mg tablet TAKE ONE TABLET BY MOUTH ONCE DAILY Patient ta

Current Illness: ? Barrett esophagus 1/13/2016 ? Chronic superficial gastritis with bleeding 11/2/2016 ? Diastolic CHF (HCC) 10/2017 ? DKA (diabetic ketoacidoses) (HCC) hospitalization 1/2018, 2/2018, 4/19 ? Elevated troponin 10/2017 in setting of admission for suspected sepsis; echo without wal motion abnormalities; low risk nuclear stress test ? ESRD (end stage renal disease) (HCC) 04/20/2018 dialyzes T-Th-Sa ? Fracture of second metatarsal bone of right foot 4/23/2016 ? Hepatitis C ? Hyperlipidemia ? Hypertension ? Hypoglycemic reaction 08/30/2016 recurrent hypoglycemia as of 1/2018 ? Methamphetamine abuse (HCC) ? Nephrotic syndrome 2017 ? Type I diabetes mellitus (HCC)

ID: 1659073
Sex: F
Age: 26
State: RI

Vax Date: 08/30/2021
Onset Date: 08/31/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Chest pain, shortness of breath, back pain, body aches

Other Meds: Multivitamin

Current Illness:

ID: 1659074
Sex: F
Age: 26
State: NY

Vax Date: 08/24/2021
Onset Date: 08/25/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: NONE

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: B/L arm pain, upper back and chest pain.

Other Meds: None

Current Illness: None

ID: 1659075
Sex: F
Age: 45
State: OK

Vax Date: 08/30/2021
Onset Date: 08/31/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: First vaccine my lymph nodes enlarged on the injection side. Got lab work done and a neck ultrasound to check my lymph nodes

Allergies: Doxycycline Levaquin

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

Symptoms: Less than 24 hours of the vaccination I started experiencing cold sweats, felt lethargic. After walking I I felt muscle aches, as the day progressed I began experiencing severe joint pain. Started near injection site and then traveled into my shoulders and up into my neck, I started running a fever and then pain keeps intensifying now in my legs. I feel chest wall tightness muscular in nature. Pain 9/10.

Other Meds: Propranolol Wellbutrin

Current Illness: None

ID: 1659076
Sex: F
Age: 58
State: TX

Vax Date: 08/28/2021
Onset Date: 08/28/2021
Rec V Date: 08/31/2021
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: N/A

Allergies: n/a

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

Symptoms: Immediate swelling at injection site, later fatigue and feverish headache.

Other Meds: none

Current Illness: n/a

ID: 1659077
Sex: F
Age: 53
State:

Vax Date: 08/19/2021
Onset Date: 08/20/2021
Rec V Date: 08/31/2021
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: Bullous hypersensitivity reaction characterized by erythema, induration, swelling and tense bullae on left arm

Other Meds:

Current Illness:

ID: 1659078
Sex: F
Age: 56
State: AL

Vax Date: 08/25/2021
Onset Date: 08/27/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: Saw doctor. Put on Valtrex

Allergies: Sulfa

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

Symptoms: High fever for 36 hours Mouth blisters in the roof of my mouth

Other Meds: Losartan Bariatric vitamins Paxil Chlorthalidone Carvedilol Bupropion

Current Illness: None

ID: 1659079
Sex: F
Age: 11
State: WI

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: No adverse event reported - patient was only 11 years old at time of vaccination. Family was anxious to get child vaccinated, supplied incorrect date of birth on forms provided.

Other Meds:

Current Illness:

ID: 1659080
Sex: F
Age: 66
State: NV

Vax Date: 08/12/2021
Onset Date: 08/12/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: 08-30-2021 Assessment: High Blood Pressure, Shingles. Doctor explained he had diagnosed 4 other patients with exact symptoms following the covid19 vaccination.

Allergies: N/A

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

Symptoms: Excruciating pain in shoulder blade and surrounding shoulder area front and back side of body. Eventually resulting in an outbreak of a rash. Diagnosed at urgent care 08-30-2021 as an outbreak of Shingles.

Other Meds: Xarelto 20mg, Atorvastatin 80mg, Hair skin and nails, Tart Cherry extract, Tumeric, Peppermint extract,

Current Illness: Mgus

ID: 1659081
Sex: F
Age: 58
State: OR

Vax Date: 01/17/2021
Onset Date: 03/01/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: EKG, holter, heart ultrasound

Allergies:

Symptom List: Vomiting

Symptoms: Chronic palpitations, ear ringing, vertigo. From second dose on 2/15/21

Other Meds: Thyroid

Current Illness: None

ID: 1659082
Sex: F
Age: 30
State: MA

Vax Date: 03/02/2021
Onset Date: 03/02/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: Blood work, CT scan

Allergies: Chicken; coconut; gluten; oak; nut; sunflower; seafood; bananas; kiwi; pumpkin; prescription ear drops

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: My pulse increased. About 45 to 50 minutes my pulse went through the roof. I started feeling really lightheaded. I felt like I could not breathe. Then I pulled off the road and seat out in the cold without a jacket for about 15 minutes until I could control my breathing. Then I went to the urgent care to check my vital sign. It was normal at that point. That night, I got a fever and ache arms for two days. I started to feel better on the March 4th, I had to much energy. Where I could not sleep. Then day, I started having heart problems. So, I went to the ER. They did blood work, but everything was normal. I only sleep for 2 hours between Friday and Saturday. I had severe insomnia for 6 to 8 weeks. I took medication for it. Once or once of every other week, I will still have that boost of energy where I could not sleep. They went away. Then in June, the insomnia came back worst. I had stomach problems, the heart problems and breathing problem came back as well. On June 25th, I experience my pulse sky rolling, and lightheaded again. I struggled to eat meals. I continued to have heart problems and insomnia. August 5th, I lost 15 lbs. because I could not eat anything. On August 8th, I went to ER because of my heart rate was high. I had a CT scan. I been dx with serve gastritis. They also discover endometriosis and access on my ovaries'. They are unsure what is causing my gastritis. At this point I can't eat, sleep and got endometriosis..

Other Meds: Zyrtec; Singular

Current Illness:

ID: 1659083
Sex: F
Age: 68
State: AZ

Vax Date: 08/17/2021
Onset Date: 08/30/2021
Rec V Date: 08/31/2021
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: Contrast dye

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

Symptoms: Covid arm. Upper left arm with itchy raised rash in the outline of a deck of cards. Used benadryl and hydrocortisone cream

Other Meds: Venlafaxine Atorvastatin Cheated magnesium, calcium and zinc D3. Curcumin

Current Illness: None

ID: 1659084
Sex: M
Age: 48
State: GA

Vax Date: 08/16/2021
Onset Date: 08/16/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Joint pain right elbow still persistent opposite arm of vaccine injection sight

Other Meds: Skyrizi, Tylenol

Current Illness:

ID: 1659085
Sex: F
Age: 64
State: MD

Vax Date: 03/01/2021
Onset Date: 03/19/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: Venous ultrasounds on upper and lower extremities revealed no blood clots

Allergies: NSAIDS, Penicillin, injected dyes for radiology

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

Symptoms: About 3 weeks after dose 1, I woke up and had trouble with balance that lasted a month at it's worse. I still have bouts of it. Also, my legs from the shin down to my toes became painful and a little swollen. That has not gone away. Also, my veins in my right arm and chest are puffy.

Other Meds: Vit D3 Omeprazole Vit B6/B12//Folic

Current Illness:

ID: 1659086
Sex: F
Age: 47
State: CA

Vax Date: 01/14/2021
Onset Date: 02/01/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: TSH, thryoid UTZ

Allergies: suture material, implanted metals

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

Symptoms: Patient with history of hypothyroidism >10 years began experiencing symptoms of hyperthyroidism (decreased TSH, palpitations, insomnia, 15lb weight loss, anxiety, etc.) that accelerated after the second COVID vaccination. Required significant adjustment in levothyroixine for several months until symptoms began to resolve approximately 6-8 months later.

Other Meds: Levothyroxine 75mcg daily, Coreg CR 20mg daily, cozar 12.5mg twice a day, vitamin d 2000iu daily, multivitamin daily, keppra 500mg daily, keppra 250mg daily,

Current Illness: none

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am