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: 1659339
Sex: F
Age: 67
State: WV

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: Vasovagal syncope - We helped the patient to the floor at her request, gave her a pillow to lay her head on, gave her cold water to drink, and fanned her with a clip board. After about 10 minutes, she was able to get up and sit in a chair by herself. She looked a lot better and the color had retuned to her face. She mentioned that she has a phobia of needles, as well as anxiety disorder. She also mentioned that she has not eaten since lunchtime. We got her a candy bar at her request. We had her wait about another 15-20 minutes minutes after she ate her candy bar and drank her water, after which she felt that she was able to leave safely.

Other Meds:

Current Illness:

ID: 1659340
Sex: F
Age: 38
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: 025L20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: Head CT, EKG, troponin, CBC, CMP, Mg, Tsh, D-Dimer, Covid test, HCG all within normal limits

Allergies: NKDA

Symptom List: Anxiety, Dyspnoea

Symptoms: Syncope. Pt received 3rd Moderna vaccine dose in preparation for Methotrexate therapy for her Rheumatoid arthritis. Felt mylagias and "flu" like symptoms in the evening. Around 4:30 am went to the bathroom and had a syncopal event, possible seizure.

Other Meds: Prednisone

Current Illness: Rheumatoid Arthritis

ID: 1659342
Sex: M
Age: 60
State: NC

Vax Date: 05/21/2021
Onset Date: 08/12/2021
Rec V Date: 08/31/2021
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: CT, Ct with contrast, MRI 8/12/21

Allergies: Parmesan cheese - anaphylaxis clarithromycin - anaphylaxis Loratadine - anaphylaxis

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

Symptoms: Transient Ischemic Attack (TIA). Treated at Hospital. Symptoms: weakness on left side, loss of balance, slurred speech, left facial droop, tiredness and confusion, loss of short term memory (do not remember most of event) Stroke protocol at ER, limited observation at ER and released due to lack of bed availability and symptoms stabilized.

Other Meds: Apixaban 5 mg 2x, Ezetimibe 10 mg 1 x, gabapentine (300/300/600 mg), levocetirizine 5 mg 1x, pantoprazole 40 mg 1x, cyanocobalamin 1000 mcg 1x, vitamin d3 50 mcg As needed: epipen , albuterol, oxyCodone 5 mg, diltiazem 30 mcg, naproxen 50

Current Illness: None

ID: 1659343
Sex: M
Age: 11
State: CO

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: unknown
Dose Series: UNK
Vax Route:
Vax Site:

Lab Data: random blood glucose 104 done 8/31/2021 at time of event

Allergies: Peanut, soy, latex

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient became pale and dizzy after receiving menveo and HPV vaccines in office. He vomited x 1, did not lose consciousness He was assisted to the floor with his legs elevated. VS obtained - HR reassuring, breathing easily BP was low however he came in with the same BP and was to have it measured again before leaving clininc. Blood glucose was normal. Tdap vaccine was deferred Episode lasted about 15 minutes in total. Color returned to face and patient stated that he felt better. Was observed sitting up in chair for 10 minutes prior to walking out of clinic with his mom Tx consisted of repositioning, placing cool compress on head, sips of apple juice, reassurance

Other Meds: none

Current Illness: none

ID: 1659452
Sex: F
Age: 69
State: FL

Vax Date: 01/01/2021
Onset Date: 02/05/2021
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: None

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

Symptoms: Loud roaring in both ears after 2nd shot in Januart - but severe tinnitus after 3rd Pfizer "booster" shot in August for immunocompromised patient.

Other Meds: Azathioprine (Imuran) Amlodopine VitaminD3

Current Illness: None

ID: 1659453
Sex: F
Age: 50
State: PR

Vax Date: 08/27/2021
Onset Date: 08/28/2021
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: No

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

Symptoms: Nodules in the neck area of the clavicle swollen. Front and back chest pain. Chikungunya-like muscle aches, headache, pain in joints fingers, wrist, hips, and feet. General pain in the body especially in the neck towards the head by the back of the neck. Pain in the left arm.

Other Meds: Simvastatin

Current Illness: No

ID: 1659455
Sex: F
Age: 33
State:

Vax Date: 08/19/2021
Onset Date: 08/22/2021
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: MRI, CTI and blood tests on Aug 30th

Allergies: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: A chronic headache, tiredness and sleepiness for 12 days after vaccination. In ER, after MRI and CTI and blood tests, i was diagnosed with Migraine and sinusitis was prescribed

Other Meds: Panadol Advance after vaccination

Current Illness: None

ID: 1659456
Sex: F
Age: 33
State: AR

Vax Date: 08/14/2021
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data: rapid Covid test- negative PCR Covid test- positive

Allergies: Aspirin; Statins; Imitrex; Pollen

Symptom List: Pharyngeal swelling

Symptoms: Right after the shot I had flu like symptoms. I came in contact with someone who tested positive for COVID on 08/25/2021. I was put in quarantine and I felt like I was having pneumonia. I went to the doctor, and they tested me for COVID. The rapid test came back negative but the PCR came back positive.

Other Meds: Depakote; Seroquel; Zoloft; Prednisone

Current Illness: None

ID: 1659457
Sex: F
Age: 48
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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: Gluten, certain antibiotics

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Minutes after shot my left deltoid started to twitch. 10 minutes after shot I became light headed and passed out for 15-30 seconds. I was clammy, nauseous and sweaty. I was unable to sit up without intensifying symptoms for 45 minutes. An ice pack and water were brought to me. Pharmacist asked me how I felt a couple of times and said low blood pressure was a known side effect. Was able to leave. Felt nauseous on the way home, extremely fatigued and my left arm was numb and tingly down to my fingertips. Started to have chills and muscle ache and slight headache. Slept for an hour when I came home. 4 hours after the shot I am still nauseous and tired with slight headache.

Other Meds: Magnesium

Current Illness: None

ID: 1659458
Sex: M
Age: 25
State: VA

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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: none

Allergies: NONE

Symptom List: Diarrhoea, Nasal congestion

Symptoms: At around 6:20pm patient began to lose consciousness. We moved him on the ground and laid him flat. He then woke up upon blacking out for 15 seconds. patient complained that he did not have any water since the morning. He was sweating profusely. EMS was called and arrived to the scene within 10 minutes. Patient said he was fine and refused to be taken to the emergency room. Patient returned to normal within a few minutes after the incident.

Other Meds: NONE

Current Illness: NONE

ID: 1659459
Sex: M
Age: 27
State:

Vax Date: 08/23/2021
Onset Date: 08/23/2021
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: No

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

Symptoms: I had pain on armpit and a little bit swelling , uncomfortable around the heart area and rush on my throat

Other Meds: I had pain in armpit after that it was a little vet swelling for 5 days when I got vaccine I feel uncomfortable around the heart area I got swelling on the throat and chest

Current Illness:

ID: 1659460
Sex: F
Age: 36
State: CA

Vax Date: 08/27/2021
Onset Date: 08/27/2021
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:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Exhaustion still 5 days later. Just been sleeping. Having hard time breathing, catching my breath. Have not gone to dr yet.

Other Meds:

Current Illness:

ID: 1659461
Sex: M
Age: 13
State: KY

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: IM
Vax Site: LA

Lab Data:

Allergies: no known allergies

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

Symptoms: About 10 min after the shot pt started vomiting and feeling nausea pt denied being dizzy just upset stomach but mentioned they also felt a little weak. Offered to call 911 but pt guardian refused. Stayed with pt until they got up and left to go to the bathroom upfront they never returned to the pharmacy.

Other Meds: unknown

Current Illness: no known illness

ID: 1659462
Sex: M
Age: 33
State: CA

Vax Date: 02/18/2021
Onset Date: 03/01/2021
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: claritin

Allergies: amoxicillin

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

Symptoms: tinnitus on L and heavy sensation in L face including tongue but no swelling, numbness, tingling, or weakness

Other Meds:

Current Illness: none

ID: 1659463
Sex: M
Age: 32
State: CA

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: NKDA

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

Symptoms: Patient was administered expired vaccine by MA. Vaccine expired 7/22/21. No adverse events noted. Patient notified of situation and was very understanding.

Other Meds: fluticasone 50 mcg, levothyroxine 25 mcg

Current Illness: None

ID: 1659464
Sex: M
Age: 46
State: GA

Vax Date: 07/27/2021
Onset Date: 07/27/2021
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: na

Allergies: na

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

Symptoms: Pt came in and stated he had not received a covid vaccine- that this would be his first. We only had moderna at the time so we gave him the Moderna vaccine and scheduled him for his 2nd appt. When our report came up of patients that missed their 2nd dose, we looked on the website to make sure he had not received the 2nd dose at another pharmacy. It then showed us he supposedly received a Pfizer vaccine on July 1. We called the wife and she said she knows nothing about another covid vaccine and she should have been notified because he is disabled. She is checking with the hospital tomorrow to see if they gave him one because she had not taken him anywhere else for the vaccine

Other Meds: na

Current Illness: na

ID: 1659465
Sex: F
Age: 26
State: SC

Vax Date: 08/13/2021
Onset Date: 08/15/2021
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: None as of yet

Allergies: None

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

Symptoms: Tingling, numbness in legs and arms over weeks? random abdominal cramping

Other Meds: None

Current Illness: None

ID: 1659466
Sex: F
Age: 56
State: IN

Vax Date: 08/21/2021
Onset Date: 08/23/2021
Rec V Date: 08/31/2021
Hospital:

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

Lab Data: none

Allergies: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Left side of head down neck and to elbow sensation

Other Meds: none

Current Illness: none

ID: 1659467
Sex: F
Age: 47
State: PR

Vax Date: 08/31/2021
Onset Date: 08/31/2021
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: none

Allergies: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: After minutes of vaccine administration, she felt dizz, was paley and pressure in the chest, for around 15 minutes. We provide alcohol pads and call 911 because symptos and signs.

Other Meds: none

Current Illness: none

ID: 1659468
Sex: F
Age: 73
State: CO

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 08/31/2021
Hospital: Y

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

Lab Data: ER and Hospital - five days Then had to get a Pacemaker and Hospitalized for two days that time - May 22, 2021 July 14th - was hospitalized for two days for Cryoablation

Allergies: Aspirin; Codeine

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

Symptoms: Three hours later, I got a real bad headache and had it for about a week. I took Tylenol for it. Fever also - had it the rest of the first day of the vaccine. I didn't have the ability to do my regular daily things for three days. I felt really bad. Afib symptoms - I was admitted to the hospital ER (2/15/2021) twice and I had Afib symptoms and my heart was severe (it was stopping to beat for over 5 seconds). My PPM would go from 53 to 157 in split second and then it would go into pause where my heart would stop beating. That happened where I was in the hospital for 4 days. They couldn't get it under control so they gave me a pacemaker - Date of Pacemaker was May 22. And then they continued (my Afib continued). July 14th - after getting pacemaker, I had a Cryoablation - .( I had the second 2/24/2021 - Lot #EN6203.) I have a heart monitor for my pacemaker and I continue to have some palpitations and some events but nothing that I have had to go back to the hospital for. And I guess that is normal for my condition. From that, now I'm on the same ones and added: Amiodarone - 200 mg; Xarelto - 20 mg.

Other Meds: Omeprazole - 40 mg; Escitalopram -20 mg; Atorvastatin - 10 mg

Current Illness: Was diagnosed with Afib - December 27, 2020

ID: 1659470
Sex: M
Age: 24
State: GA

Vax Date: 08/30/2021
Onset Date: 08/31/2021
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:

Allergies:

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

Symptoms: pain/soreness in left arm Back pain

Other Meds: Pantoprazole, Fluoxetine, Multivitamin, Fish Oil, Gabapentin

Current Illness: Cold/sinus infection

ID: 1659471
Sex: M
Age: 28
State: NM

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

Symptom List: Unevaluable event

Symptoms: Starting with a headache the next morning at 0700, by 0900 I had a 102? fever. I maintained the fever, chills, and body aches through the next 18 hours. Everyday since over the last 8 days i have had a headache that will not go away.

Other Meds: None

Current Illness: None

ID: 1659472
Sex: F
Age: 53
State: MA

Vax Date: 05/03/2021
Onset Date: 06/01/2021
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: Doctor at the emergency room said it was heart arrhythmia, Specifically SVT (Supraventricular tachycardia). This occured on Wednesday August 25, but have not been feeling well since June. I visited my primary doctor on July 1, 2021 as I was already not feeling well.

Allergies: None

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

Symptoms: Had 200 BPMS per EKG on ambulance and was treated intravenously by ambulance medic to stabilize heart rate. Felt dizzy, short of breath, shaking, like I was going to faint, heart beating super fast. Went to emergency room via ambulance. Doctors say it was a heart arrhythmia, Specifically SVT. I was kept there for 24 hours for observation and additional testing. Not a stroke nor blood clot. I have been prescribed Metoprolol to control the arrhythmia going forward.

Other Meds: Alendronate - 70 mgs - Once a week for osteoporosis Vitamin D supplements

Current Illness: None

ID: 1659473
Sex: M
Age: 63
State: MA

Vax Date: 04/06/2021
Onset Date: 04/08/2021
Rec V Date: 08/31/2021
Hospital: Y

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

Lab Data: Blood tests, CT scan, X-ray, emergency room admission report, series of followup blood and genetic testing done by the infectious specialist to determine the cause of the blood clots are all available through the patient record portal.

Allergies: None

Symptom List: Injection site pain, Pain

Symptoms: Severe pain in the left side of the chest. Intermittent pain throughout the next day. Confirmed via x-ray, blood test and ct-scan as blood clot in lungs (pulmonary embolism). Facility where tests were conducted: Hospital. Admitted immediately to Emergency Unit for treatment. Have been on daily blood thinner since this incident. There was no adverse reaction to the second dose of the Pfizer vaccine.

Other Meds: Pravastatin, Fenofibrate, Tamsulosin (Flomax), Vitamin D

Current Illness: None

ID: 1659474
Sex: F
Age: 27
State: CA

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: SYR
Vax Site: LA

Lab Data: Tested negative for COVID-19 on 8/31/21 at 1:30PM

Allergies: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Normal known side effects of vaccine for first 24 hours: fever, body aches, chills, fatigue. Then at about 48 hours I developed a bad cough, nasal congestion, ear congestion, headache. Then at 56 hours lost taste. Then at 80 hours lost smell. I have tested negative for COVID as of today, 6 days post vaccine and 3.5 days post unusual symptoms so it is not that. Lost of taste and smell continue to persist as well as cough, nasal congestion and horrible ear pain.

Other Meds: Ibuprofen, Portia birth control

Current Illness: None

ID: 1659475
Sex: F
Age: 58
State: NY

Vax Date: 08/29/2021
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:

Allergies: Keflex toradol penicillin strawberries, do chocolate, fresh tomatoes

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

Symptoms: (Sore, swollen arm 8/29/2021). (muscle aches 8-31-2021)

Other Meds: Verapamil montelukas estradiol levothyroxine Percocet gabapentin famotadine

Current Illness: Migraines, bronchial asthma

Date Died: 07/10/2021

ID: 1659476
Sex: F
Age: 83
State: CA

Vax Date: 03/31/2021
Onset Date: 04/24/2021
Rec V Date: 08/31/2021
Hospital: Y

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

Lab Data: Full blood work up and when she was transferred to the hospital they did their blood work up on her White Blood Cell counts, Platelet count and everything else that indicated she had Leukemia

Allergies: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: she became very tired after the shot and never regained her energy and ended up in the ER for a UTI but there was a lot of blood in her urine. After running blood work and multiple tests she was diagnosed with AML just shy of 4 weeks from the time the shot was administered.

Other Meds: Lisinopril Multi-Vitamin

Current Illness: None

ID: 1659478
Sex: F
Age: 26
State: IA

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:
Dose Series: UNK
Vax Route: IM
Vax Site: RA

Lab Data: None at this time.

Allergies: NKDA

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient developed hives and was "so hot" that she threw up.

Other Meds: unknown

Current Illness: None

ID: 1659479
Sex: F
Age: 23
State: AZ

Vax Date: 01/20/2021
Onset Date: 01/01/2021
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: RA

Lab Data: Urgent care checked vitals, but ran no tests 1/25/2021.

Allergies: None.

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

Symptoms: I began having chest pain on 1/23/2021. I had never experienced chest pain before. Chose to ignore it. Pain persisted and intensified with periods shortness of breath. I visited an urgent care on 1/25/2021 for chest pain. The doctors listened to my chest and decided that because of my age, I probably had a sore muscle. No imaging or tests were performed. No one asked if I had been vaccinated recently (this was in January, so most average people were not). I got a COVID test at the urgent care because I worried it could?ve been that. The test came back negative. The chest pain went away, but have noticed ongoing periods of shortness of breath. I didn?t know myocarditis became a listed potential side effect of the vaccine until recently. I am certain my chest pain was caused by the vaccine. If I had known this was a since-known adverse effect of the vaccine I would?ve reported at the time, but because of how practitioners treated me in January, I thought I was overreacting.

Other Meds: N/A

Current Illness: None.

ID: 1659480
Sex: F
Age: 59
State: CA

Vax Date: 08/27/2021
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: RA

Lab Data: NA

Allergies: unknown

Symptom List: Nausea

Symptoms: Rash on body

Other Meds: unknown

Current Illness: unknown

ID: 1659481
Sex: M
Age: 44
State: CA

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: None Reported

Symptom List: Injection site pain

Symptoms: At 3:15PM vaccine was administered Intramuscularly into Left Deltoid and advised to remain seated in post vaccination observation waiting area for 15 minutes. At 3:20PM patient reported feeling faint, upon observation patient appeared Pallor (pale skin and lips) and to be sweating. Patient reported no loss of speech, no dizziness, no vertigo and no trouble breathing. Blood Pressure was taken and was within normal limits. Ice Pack was given. Around 3:30pm Patient reported feeling neck /jaw pain, Blood Pressure was taken and was within normal limits, Ibuprofen 200mg was administered. Roughly 3:45pm Patient's spouse requested EMS, while EMS was being Activated Patient DENIED EMS. Roughly 4pm Patient requested to Leave observation area and to return home. One final Blood Pressure reading was taken and within normal limits.

Other Meds: None Reported

Current Illness: None Reported

ID: 1659482
Sex: F
Age: 17
State: PR

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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: none

Allergies: none

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

Symptoms: 5 minutes after vacinne, patient felt dizzy.

Other Meds: none

Current Illness: none

ID: 1659483
Sex: F
Age: 60
State:

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: 011j20a
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: None

Allergies:

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

Symptoms: Patient received 0.3ml of undiluted Pfizer product approximately 5x dose. Patient experienced no adverse effects for about 4-5 hours. Around 7 hours post dose, patient reported a tingling, pins & needles sensation similar to a pinched nerve experience 10-11 years ago. About 28 hours post injection, patient reported soreness at injection site, fever (unknown reading), myalgia and GI distress. Patient sounded tired, understandably, but not in distress.

Other Meds:

Current Illness:

ID: 1659485
Sex: F
Age: 50
State: MA

Vax Date: 08/27/2021
Onset Date: 08/28/2021
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 - Doctor recommended ibuprofen or tylenol to help with twitching and to keep an eye on condition via a phone call. This just started occurring within the past few days.

Allergies: None

Symptom List: Tremor

Symptoms: Immediately after dose was giver there was the feeling of a very painful" jolt" in my arm 12 hours later I was awoken by severe twitching in my left arm, later that night my right back was twitching, subsequent nights random muscles twitch lasting 2 to 3mins. 8/31 I started experiencing tingling plus pins and needles in my hands and feet

Other Meds: Lo-e, BCAA's, multi-vitamin, hair skin & nails, Vitamin C and D,

Current Illness: None

ID: 1659486
Sex: F
Age: 49
State: CA

Vax Date: 02/25/2021
Onset Date: 02/25/2021
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: EKG Blood work X-ray Heart monitor Stress test Echocardiogram Holter monitor for 2 weeks

Allergies: Wheat; Barley; Dairy

Symptom List: Erythema, Pruritus

Symptoms: Full body rash. The rash kept appearing and disappearing. Rash was itchy, blotchy, and red. Rapid heart rate and high BP. Chest pains. Nausea, Menstrual cycle did not start on time and has been irregular. I bled heavily for 30 days, which started on April 29, 2021. My period skipped in June 2021. I went to the Emergency Room on June 28, 2021. I went to see a cardiologist on July 6, 2021 and I have seen him several times since then.

Other Meds:

Current Illness:

ID: 1659487
Sex: F
Age: 33
State: TX

Vax Date: 08/28/2021
Onset Date: 08/29/2021
Rec V Date: 08/31/2021
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: None

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

Symptoms: Recurring heart palpitations, chest burning, and shortness of breath, in addition to the more common side effects.

Other Meds: None

Current Illness: None

ID: 1659488
Sex: F
Age: 56
State: MD

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: not sure

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

Symptoms: Pt complained of racing heart after administration. Called 911

Other Meds: Not sure

Current Illness: Not sure

ID: 1659490
Sex: F
Age: 41
State: MI

Vax Date: 08/14/2021
Onset Date: 08/19/2021
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, just trying Motrin which always works for any previous headaches but not working with this one.

Allergies: none

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: daily severe headache with right sided neuropathy and extreme fatigue lasting over one week starting within 5 days of vaccine. It is still occurring and not letting up. No prior issues with these symptoms before vaccine

Other Meds: none

Current Illness: none

ID: 1659491
Sex: F
Age: 36
State: IL

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: 011J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Felt dizzy starting 10 minutes after shot, 30 minutes after shot felt disoriented, 45 minutes after the shot had some numbess/tingling in my left arm that lasted 10 seconds, an hour after the shot my vision started to go blurry, i had zig zag black and white lines from the central part of my vision down, it did not move when i moved my eyes around, present when I closed my eyes almost like when you have your picture taken and the flash is still visible in your vision, unable to focus my eyes, had a wave like distortion, it moved upwards in my visual field slowly, lasted until 6:30pm, I called pharmacy who said they had never had this reaction, if it got worse go to ER, then called my primary care dr who also had no explanation and said if it didn't go away to come see him in the morning, Never experienced this before, no headache with vision disturbance. Had episode of diarrhea at 6:45pm. Still feeling somewhat disoriented.

Other Meds: Vyvanse 50mg PO daily

Current Illness: None

ID: 1659492
Sex: M
Age: 16
State: TN

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:

Allergies: NONE

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

Symptoms: NONE MEDICATION ERROR PATIENT IS 16 YEARS OF AGE. MASS VACCINATION EVENT AND FAMILY REQUESTED JANSSEN FOR BOTH PEOPLE BEING VACCINATED. VOLUNTEER HEALTH PROVIDER ADMINISTERED JANSSEN TO BOTH INDIVIDUALS AND ONE WAS 16 YO

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1659493
Sex: F
Age: 52
State: HI

Vax Date: 03/05/2021
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: IM
Vax Site: LA

Lab Data:

Allergies: unknown

Symptom List: Pain in extremity

Symptoms: covid-19 test was positive. EE had congestion, headache and malaise

Other Meds: unknown

Current Illness: unknown

ID: 1659494
Sex: M
Age: 18
State: FL

Vax Date: 08/24/2021
Onset Date: 08/24/2021
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: None as this date/time

Allergies: None

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

Symptoms: Patient (my son) office visit was to receive: 1. PDD Test (TB-Bubble) 2. Influenza Seasonal QIV only. While administering the PDD Test (TB-Bubble) on his left-lower forearm (Intradermal) the NP inadvertently administered a Johnson & Johnson COVID-19 Vaccine - in the wrong location - not Intramuscular - and without request or awareness of the patient, who had already had Covid-19 (07/02/2021 - 07/09/2021). Once injected there was immediate reaction with a large rise/bubble at the injection site and high level of pain described by the patient. The NP immediate realized the deviation and informed the patient of what had occurred. The NP then proceeded to the 1. PDD Test (TB-Bubble) in the right lower forearm 2. Influenza Seasonal QIV, despite the known deviation. The NP did not provide the: Manufacture, Lot, or NDC related to the COVID-19 Vaccine for this visit (this information was excluded from his"IMMUNISATIONS Administered in the Summary of Care) The NP also refused to provide a Vaccine Card or any documentation of the event. It was until a follow-up visit to get the PPD test read that he was informed that the Manufacture of the COVID-19 Vaccine was Johnson & Johnson (but still was never provided: Lot, NDC or Vaccine Card or any documentation of the related to the COVID-19 Vaccine event). On 08/24/2021 I reported to this to pharmacy and they opened CASE. Note: They have not made contact with me and I have not been successfully in making contact with them. On 08/31/2021 I reported to this to "Johnson & Johnson" and they opened REQUEST (and J&J documented a report).

Other Meds: None

Current Illness: COVID-19 (via natural transmission)

ID: 1659495
Sex: F
Age: 27
State: WA

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: None

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

Symptoms: We gave patient Pfizer Covid 19 1st shot at 4:00pm on 8/31/21. Patient has history of vertigo and anxiety. After 5 minutes, at 4:45pm, pt started to feel lightheadedness and so we helped her to lay down and elevate her feet. Patient recovered after 15minutes but we had her stay in store to monitor until patient is totally recovered at 4:38pm.

Other Meds: N/A

Current Illness: Anxiety, Veritgo

ID: 1659496
Sex: M
Age: 11
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: 025J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: No known drug allergies

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

Symptoms: Patient and father came to pharmacy for second dose of pfizer vaccine. Noted date of birth on consent form. Noted date of birth on vaccine card was different. Pharmacist confirmed verbally with the patient and father that the date of birth was as listed on vaccine card before giving vaccine and that the patient was 12 years old. Upon billing insurance there was a mismatch DOB and insurance was called. Insurance confirmed patient's correct DOB is different making him only 11 years old and not eligible for vaccination at this time. Patient was okay after vaccination.

Other Meds: Unknown

Current Illness: No known illnesses

ID: 1659497
Sex: F
Age: 58
State: WA

Vax Date: 06/25/2021
Onset Date: 08/01/2021
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:

Allergies: Foods: preservatives, sulfites, nightshades, Not sure of what all but many things so live a very clean diet and topical products are organic and close to their natural state as possible. If I go to a restaurant usually have a reaction but am not sure what to. So I don't I just cook good organic basic meals

Symptom List: Vomiting

Symptoms: Significant increase in heart palpitations, arrhythmias, and strong beat. Gray-outs when exerting, like hiking in mountains. Shortness of breath has increased. Started a week or two after the second vaccination

Other Meds: Vit D3 Cal-Mag Multi

Current Illness:

ID: 1659498
Sex: M
Age: 44
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: SYR
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Sore arm tightness and shoulder socket, numbness/ pins & needles in left arm

Other Meds: Effexor

Current Illness:

ID: 1659499
Sex: F
Age: 29
State: CA

Vax Date: 08/27/2021
Onset Date: 08/31/2021
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:

Allergies:

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

Symptoms: RASH

Other Meds:

Current Illness:

ID: 1659500
Sex: F
Age: 41
State: WA

Vax Date: 04/22/2021
Onset Date: 04/23/2021
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: Stool lab work for parasites and bacteria (6/21) - NEGATIVE Celiac Panel bloodwork (7/21) - NEGATIVE Colonoscopy (8/19/21) - showed inflammation that is typical of Ulcerative Proctitis

Allergies: Tree Nuts

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Prior to vaccination, I had occasional bouts of minor gas, usually after eating a food that I am sensitive to, like dairy. However, within a day or so after each of the Moderna vaccines, I experienced rectal bleeding and increasing bouts of gas and abdominal pain, eventually being diagnosed with Ulcerative Proctitis in August 2021. I received my first Moderna vaccine on 4/22/21. On 4/23, I noticed slight red/pink blood when wiping after a bowel movement. On 4/24, I experienced sudden, strong stomach pain/achy bowels and started passing mucus. On 4/25, I again noticed slight red/pink blood when wiping after bowel movement. For the next few weeks after that, I had occasional (sometimes daily) gas and stomach pain, often after eating foods that are staples in my diet that previously had not caused issues, but no more bleeding. On 5/20/21, I received my 2nd Moderna vaccine, and became very ill with the typical symptoms of fever, headache, body aches, etc. On 5/23, I was starting to feel better, but again noticed red/pink blood when wiping after a bowel movement. The bleeding continued 5/25, 5/26, 5/28, and onward. The bleeding, gas and occasional abdominal pain continued to get worse over the following weeks. I visited with my PCP and a Gastroenterologist. In July, I began the low FODMAP diet, which helped reduce the symptoms, but did not resolve them completely. In August, a colonoscopy showed inflammation typical of Ulcerative Proctitis. Symptoms have intensified following the colonoscopy. I have been prescribed Mesalazine suppositories.

Other Meds: Multivitamin, Vit D 2000IU , Vit C 1000mg, Zinc 30 mg, Quercetin 500mg, Potassium 90mg, Magnesium 150mg, Omega 3s 700mg, Probiotic, B12 & folate 1000 mcg,

Current Illness: Major gas and abdominal pain on 3/26 after eating dairy, with only occasional, minor gas following.

ID: 1659501
Sex: F
Age: 19
State: FL

Vax Date: 08/23/2021
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: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None

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

Symptoms: Itchy/painful large welt and knot under skin at injection site 1 week post injection

Other Meds: Ibuprofen

Current Illness: None

ID: 1659502
Sex: M
Age: 0
State:

Vax Date: 08/28/2021
Onset Date: 08/28/2021
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:

Allergies:

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

Symptoms: Patient felt lightheaded immediately after shot. Continued to sit. Feet was propped up and after cool pad and water began to feel better and was able to walk out of the store with assistance.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am