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: 1674562
Sex: F
Age: 50
State: NY

Vax Date: 08/21/2021
Onset Date: 08/21/2021
Rec V Date: 09/04/2021
Hospital:

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

Lab Data: EKG and doctor's exam -- 9/1

Allergies: penicillin

Symptom List: Dysphagia, Epiglottitis

Symptoms: Immediate: intense fatigue, inability to move arm, lymph nodes massively swollen under both arms, under the left arm to the point that it was cutting off some sensation in the nerve running down my arm for 3 days Beginning 8/24: chest pressure, racing heart, feeling of shortness of breath; immense fatigue As of this report (9/4): Chest tightness/pressure, racing heart and fatigue continuing. Lymph nodes under both arms still massively swollen. I also noticed that I am bruising easily and for no reason. A day or two after the vaccine I noticed a huge bruise on my leg that I couldn't pinpoint a reason for. Two days ago this occurred on multiple places on my right arm, also for absolutely no reason and this has never happened before.

Other Meds: occasional allergy medicine

Current Illness: none

ID: 1674563
Sex: F
Age: 54
State: OR

Vax Date: 02/07/2020
Onset Date: 03/10/2020
Rec V Date: 09/04/2021
Hospital:

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

Lab Data: Blood tests, Pelvic ultrasound, regular ultrasound, scraping of the uterus to test for cancer, followed by a DNC.

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: I had not had a period in over two years, I began spotting which turned into heavy bleeding with golf ball size blood clots. This lasted for 8 weeks. I was seen by my OBGYN which then began a series of tests including a DNC, there was no know cause found.

Other Meds: Zoloft

Current Illness: None

ID: 1674564
Sex: F
Age: 64
State: CA

Vax Date: 08/16/2021
Onset Date: 09/03/2021
Rec V Date: 09/04/2021
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: PLT 128, Neutrophils 79%, Lymphs 14 %, Lipase 104, CRP 2.8, CXR shows airspace opacities in the right lung, O2 SATs 91% on RA, SARS-COV-2 tested positive.

Allergies: NKDA

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

Symptoms: Confusion, disorientation; patient was getting ready to leave her home but did not know what day is is or where she was going. Also reports feeling tired and having chills. Noted to have hypoxia here in ER.

Other Meds:

Current Illness: None identified

ID: 1674565
Sex: F
Age: 38
State: WI

Vax Date: 03/09/2021
Onset Date: 06/20/2021
Rec V Date: 09/04/2021
Hospital:

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

Lab Data: MRI, CT Scan, EEG, Tilt Table Test

Allergies: Amoxicillin; penicillin

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: I had an incidence of Syncopal episode. In May of 2021 I was at work and I was very dizzy, pale and weak. I visited my doctor and after testing they couldn't find anything wrong. I have seen a Cardiologist and Neurologist. All tests were negative. I have had several more episodes on 06/07/2021 and 06/19/2021. There has not been any explanation.

Other Meds: N/A

Current Illness: N/A

ID: 1674566
Sex: F
Age: 45
State: PR

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/04/2021
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: Aspirin Seafood

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

Symptoms: Within 12 hours of receiving the second dose I started with severe joint pain, intolerance to cold and increased pre-existing tinnitus.

Other Meds: Metropolol 25 mg Xyzal 5 mg L-Carnitine 1000mg

Current Illness: Tachycardias Asthma Allergies Carnitine Deficiency with Hypoglycemia

ID: 1674567
Sex: F
Age: 39
State: PA

Vax Date: 08/16/2021
Onset Date: 08/31/2021
Rec V Date: 09/04/2021
Hospital: Y

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: Chest CT, Venous Doppler

Allergies: Eggplant allergy that causes hives, eye swelling, and anaphylaxis.

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

Symptoms: My 1st dose if the Moderna brand Covid-19 vaccine was administered on the evening of Monday 8/16/2021. I received this vaccine in compliance with my employers mandatory vaccine policy. I experienced fever chills and extreme fatigue immediately after. The next day on 8/17/2021 I had severe flu symptoms including dizziness, shortness of breath, fatigue, fever, chills, nausea, and headache. These symptoms persisted until 8/23/2021. On 8/24/2021 I began to experience severe headaches, shortness of breath and diarrhea until 8/29/2021. On 8/30/2021 I was still experiencing shortness of breath. On 8/31/20201 I began to feel pain and a bulge in my right calf. These symptoms persisted until I arrived in the emergency room on Thursday 9/2/20201 when the right calf pain increased and I then started to feel and an ache in my lungs and chest pain. DVT was found in my right leg and multiple Pulmonary Emboli in my Right lung. I was admitted overnight. Today I am being discharged from Hospital. The pain from the DVT and the PE is still present.

Other Meds: N/A

Current Illness: N/A

ID: 1674568
Sex: F
Age: 31
State: IL

Vax Date: 08/28/2021
Onset Date: 09/02/2021
Rec V Date: 09/04/2021
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: No

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Diagnosed as an upper respiratory infection (low grade fever, chest congestion, trouble getting a very deep breath, sinus congestion).

Other Meds: I?m on a lot of medications? for rheumatoid arthritis/fibromyalgia/etc

Current Illness: No

ID: 1674569
Sex: F
Age: 39
State: NY

Vax Date: 08/31/2021
Onset Date: 09/01/2021
Rec V Date: 09/04/2021
Hospital:

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

Lab Data:

Allergies: Sulphas Vitamin E Concentrate

Symptom List: Pharyngeal swelling

Symptoms: Lymphadenopathy

Other Meds: ZInc Tumeric Omega-3 Biotin

Current Illness:

ID: 1674570
Sex: F
Age: 31
State:

Vax Date: 09/02/2021
Onset Date: 09/03/2021
Rec V Date: 09/04/2021
Hospital:

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

Lab Data:

Allergies: Eggs, sulfa, amoxycillin

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Racking chills, fever, head and neck ache: 10 hours post-vaccine to 18 hours post-vaccine Body aches, fever, dizziness, difficulty rising: 12 hours post-vaccine to 24 hours post-vaccine. Flickering vision/appearance of flashing lights and acute joint pain: 30 hours post-vaccine

Other Meds: Culturelle probiotic Lo-loestrin FE (birth control)

Current Illness: None

ID: 1674571
Sex: F
Age: 52
State: TX

Vax Date: 08/01/2021
Onset Date: 09/02/2021
Rec V Date: 09/04/2021
Hospital:

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

Lab Data: 9/3/21 saw eye doctor no infection in eyes Told to take Benadryl and to use allergy drops and artificial tears/lubricant drops

Allergies: Na

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Itchy eyes red swollen eye lids and swollen around eyes and face . Skin is red and splotchy. Condition is with both eyes.

Other Meds: Escitalopram Pantraprazole Hydrocychliroquine Gabapentin Levothyroxine

Current Illness: Na

ID: 1674572
Sex: F
Age: 28
State: NM

Vax Date: 09/02/2021
Onset Date: 09/02/2021
Rec V Date: 09/04/2021
Hospital:

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

Lab Data:

Allergies: Tramadol, some nausea medications

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

Symptoms: Racing heart, shortness of breath, dizziness, fainting/black out

Other Meds: Birth control (pill)

Current Illness: None

ID: 1674573
Sex: F
Age: 51
State: NC

Vax Date: 08/13/2021
Onset Date: 08/14/2021
Rec V Date: 09/04/2021
Hospital:

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

Lab Data: N/A

Allergies: N/A

Symptom List: Rash, Urticaria

Symptoms: Post Menopausal bleeding from date of injection to present (over 3 weeks); migraine; body aches; lethargy

Other Meds: Levothroxine; Lexapro; Vitamin D3 , Vitamin B12, Tylenol

Current Illness: N/A

ID: 1674574
Sex: F
Age: 65
State: IL

Vax Date: 02/22/2021
Onset Date: 02/22/2021
Rec V Date: 09/04/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Headache, Vomiting, Muscle Ache, Fatigue

Other Meds: Fluoxetine 60 mg daily Ibuprofin 150 mg daily Centrum Calcium 600 mg + D3daily D3 1000 mg daily Prolia 60 mg Injection every 6 mos Probiotic Clobetasol a .05% as needed

Current Illness:

ID: 1674575
Sex: F
Age: 75
State: AL

Vax Date: 02/27/2021
Onset Date: 05/18/2021
Rec V Date: 09/04/2021
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: EGD diagnosed ulcers 05/18/2021

Allergies: penicillin, niacin, doxycyline, dexilant, Contact allergies --bacitracin, neomycin sulfate, glutaral

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

Symptoms: ulcers no symptoms other that those for GERD

Other Meds: synthroid, telmisartan, praluent, vascepa, coq10, vitamin d3, cucurmin 95, vsl#3 probiotic, famotidine, novalog flexpen insulin (as needed)

Current Illness: hypothyroid, high blood pressure, high cholesterol/triglycerides, type 2 diabetes, mild chronic gastritis

ID: 1674576
Sex: F
Age: 36
State: TX

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 09/04/2021
Hospital:

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

Lab Data: Blood drawn 11:00 am 9/4/21 no results yet.

Allergies: MMR vaccine, spinach

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

Symptoms: Vaccine administered in left arm at 6pm 8/31/21. At 8pm I began to experience severe bloating that wouldn?t stop. It felt like someone took a bike pump to my entire digestive system. Even if gas was released I immediately blew up again. This lasted until 6am 9/1/21. My digestive system still seems slightly off but the severe bloating is gone. Beginning about 7-8am 9/1/21 my left eye started to twitch constantly, I felt nauseous and my neck ached.This lasted until the morning of 9/3/21. In the midst of the eye twitching I was also having occasionally twitching of my left quad on my leg. As of 9/4/21 the majority of my symptoms have subsided other than still feeling a little bloated and not much of an appetite. I visited my PCP this morning for a blood draw.

Other Meds: Plavix 75 mg, Aspirin 325 mg, Slynd 4mg, Spironolactone 100 mg, multivitamin

Current Illness: NA

ID: 1674577
Sex: F
Age: 61
State: NC

Vax Date: 09/02/2021
Onset Date: 09/03/2021
Rec V Date: 09/04/2021
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: Levaquin, penicillin

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

Symptoms: Swollen, hard, red, warm bump 2.5 inches long and 1 inch wide on arm?not at injection site, but starting 1 inch lower on the arm and extending down

Other Meds:

Current Illness: Cough, fatigue, swollen glands; cold sore

ID: 1674578
Sex: F
Age: 61
State: FL

Vax Date: 09/02/2021
Onset Date: 09/03/2021
Rec V Date: 09/04/2021
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: Contrast Iodine Dye, Shellfish, MSG, Dairy, Chicken Eggs, All chemical odors; Perfumes/Fragrances/Scented Products/Pesticides/Cleaning products/Bleach/Ammonia and Smoke, Folic Acid food/drink additive, Food colorings, Yeast, Legumes, Tomatoes, Peppers, White Potatoes, Eggplant, Bananas, Avocado, Chocolate, Beef, Pork, Natural Flavor additives, Citrus.

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

Symptoms: Severely and ongoing swollen and painful armpit radiating down left arm and left breast and up left side of neck and shoulder.

Other Meds: Low Dose Naltrexone, Acyclovir, Famotidine, Prilosec,

Current Illness: Herpes Simplex Virus outbreak. Ehlers-Danlos Syndrome, Mast Cell Activation Disease, Raynaud's Disease, Dry Eye Disease, Allergic Rhinitis, CCI, Asthma, Aspergillosis infection, IBS, Gut Dysmotility, Acid Reflux, Dysautonomia, Tinnitus, Skin Cancer, Guttate Psoriasis, Tricuspid Valve Regurgitation, Palpitations, Edema, Torn Left Miniscus

ID: 1674579
Sex: F
Age: 38
State: MN

Vax Date: 01/27/2021
Onset Date: 09/04/2021
Rec V Date: 09/04/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: breakthrough case on 9/4/21

Other Meds:

Current Illness:

ID: 1674580
Sex: F
Age: 37
State: MD

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/04/2021
Hospital:

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

Lab Data: Patient visited her allergist nearby , allergist advised her to see ER, Patient had taken 2 Benadryl and felt bit better after few hours, but felt symptoms coming back next day morning, that's when she reported to Pharmacist

Allergies: yes know allergic reaction to allergy shots and few other things as per patient, - none listed in IMZ form

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: patient described as " Heart rate, felt like racing HR, anaphylaxis, tongue swelling, Felt like passing out"

Other Meds: not known

Current Illness: not known

ID: 1674581
Sex: F
Age: 51
State: IL

Vax Date: 07/12/2021
Onset Date: 07/23/2021
Rec V Date: 09/04/2021
Hospital:

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

Lab Data: Venous Doppler

Allergies: none

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

Symptoms: About a week after the first dose of the Moderna vaccine, I started getting headaches. After two weeks my right leg started cramping. I didn't think it was anything to worry about at the time. After the third week, I started to get worsening headaches that were like a sinus infection, runny nose, and a sore throat. Thought it could be allergies. When my second dose was due, I was told to wait until symptoms improve before getting the 2 nd vaccination. I continued to get leg cramping that radiated up into my back of my right leg. Since then the cramping in my leg has come and gone and I continue to have headaches. I wake in the middle of the night with cramps and numbness in my right lower extremity that comes and goes and I cannot sleep well due to the pain. I get occasional shortness of breath and it feels like I can't catch my breath every once an a while. Plan to go to see a physician today.

Other Meds: none

Current Illness: none

ID: 1674582
Sex: F
Age: 50
State: MA

Vax Date: 05/01/2021
Onset Date: 09/02/2021
Rec V Date: 09/04/2021
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: Yes with antibiotics when I get CDiff

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

Symptoms: I received the shot at 6 PM my back was a little itchy when I went to bed I woke up at 6 AM and was covered from my chest to my feet as the day went on it got a little worse all the way to my fingertips toes palms of my hands. I went to see my primary care physician they took pictures and were reporting it as well they said they have never seen such a reaction from a vaccine. I also have been very sick and dad been diagnosed with more illnesses since March when I received my first dose on March 9 Then contracted the virus around the 20th and then received shot number two on April 9 again I have been in and out of the hospital and very sick ever cents which is why being on prednisone for the last few months and the diagnosis of Primary Sjogrens My primary care sent me to get the third shot ASAP

Other Meds:

Current Illness: Sjogrens & shingles I have been very sick since March when I receive my first vaccine then contacted covid 2 weeks later then 2nd vaccine 2 weeks after

ID: 1674583
Sex: F
Age: 45
State: LA

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

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

Lab Data: CT, blood work

Allergies: Penicillin; MRI contrast

Symptom List: Unevaluable event

Symptoms: I had tingling after two hours of the vaccination and it stayed up late for two days and then I took Claritin. a couple of days later I had muscle numbness and tingling again and twitchiness in my muscle and lost complete sensation from my arm to my finger. I went to the emergency room and they said i had a reaction to the shot. Few days later I contacted my doctor and they said it will do away because of the vaccination but I had diarrhea and continued for 7 days. My blood pressure was really high and for my blood work everything was normal except the potassium. The doctors sent me to neurologist and they said everything was clear. I am physically ill. I have lost a lot of weight. Sometimes my left hand is suddenly swollen.

Other Meds: None

Current Illness: None

ID: 1674584
Sex: M
Age: 20
State: TN

Vax Date: 08/23/2021
Onset Date: 09/02/2021
Rec V Date: 09/04/2021
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: Ambulance called taken to hospital then by car, ctscan, chest xray, ekg, lab work, all ran come back possible blood clot by dtimer blood work but then confirmed no blood clot by CTSCAN. No apparent reason for episode by dr.

Allergies:

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

Symptoms: Uncontrollably shaking, fever, heart racing, chest hurting, stomach aching, about passed out, clammy, pale.

Other Meds: Vitamin B, C

Current Illness:

ID: 1674585
Sex: F
Age: 57
State: MS

Vax Date: 08/11/2021
Onset Date: 08/11/2021
Rec V Date: 09/04/2021
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: Penicillin, keflex

Symptom List: Injection site pain, Pain

Symptoms: Sore throat, ulcers through mouth and tongue

Other Meds: Synthroid, cytomel , estratest, bupropion, ezetimbe, zinc, b3, emergenC, elderberry

Current Illness: Summer Cold

ID: 1674586
Sex: M
Age: 44
State: WI

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 09/04/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Severe red eyeball and face swelling. Headache, body aches and fever. Lasted 36 hours

Other Meds: None

Current Illness: None

ID: 1674587
Sex: F
Age: 73
State: CA

Vax Date: 09/01/2021
Onset Date: 09/02/2021
Rec V Date: 09/04/2021
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: None

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

Symptoms: My left arm at area of shot became rock hard and swollen also reddened. Today, three days after shot, the redness has spread, it is still hard, swollen and itches a little.

Other Meds: Metformin 500mg (4 a day) Glipizide 10mg (2 x a day) Januvia 100mg Bupropion XL 300mg Benazepril 20mg Pantoprazole 40mg Atorvastatin 20mg Levothyroxine 0.05 mg Anastrozole 1 mg Aspirin 81mg every other night Vitamin D3 5000IU

Current Illness: None

ID: 1674588
Sex: F
Age: 43
State: CA

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 09/04/2021
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: Erratic heart rate two weeks after 1st Pfizer vaccine, lasted for two weeks. This was followed by additional two weeks of constant stabbing headache, and after that passed, four weeks of extreme fatigue. Recovery from first Pfizer took six weeks. Same heart rate issues but more severe after second Pfizer dose. Lasted eight weeks this time

Other Meds:

Current Illness:

ID: 1674589
Sex: F
Age: 12
State: CA

Vax Date: 06/10/2021
Onset Date: 06/21/2021
Rec V Date: 09/04/2021
Hospital:

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

Lab Data:

Allergies: no

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Irregular heartbeat, tics

Other Meds: no

Current Illness: no

ID: 1674590
Sex: F
Age: 30
State: VT

Vax Date: 08/20/2021
Onset Date: 08/21/2021
Rec V Date: 09/04/2021
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

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

Symptoms: Extremely sore arm for 3 days. Vaginal bleeding (one week before expected cycle), bright red, heavy bleeding for 7 days, then some spoting for 2 days. Normal period has 2-3 days of red, then some brown spotting for 3-4 days.

Other Meds: Postnatal vitamin, sunflower Lecithin, Sulfurzyme (magnesium)

Current Illness: None

ID: 1674591
Sex: F
Age: 48
State: WA

Vax Date: 07/10/2021
Onset Date: 07/13/2021
Rec V Date: 09/04/2021
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: Nausea

Symptoms: Sore arm Lymph nodes sore

Other Meds: None

Current Illness: None

ID: 1674592
Sex: M
Age: 31
State: MI

Vax Date: 07/24/2021
Onset Date: 07/24/2021
Rec V Date: 09/04/2021
Hospital:

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

Lab Data: Please contact dr for all the information

Allergies: No

Symptom List: Injection site pain

Symptoms: Right after dose I had string of pain from my right shoulder all the way down to my hand for the first 3-5 minutes. I then felt my right ear feel like it was on fire for about 3-5 minutes. About 30-60 minutes later I felt like I had a small lump in my throat. The lump didn?t bother me at first but in next several day it got bigger and bigger until I went in to urgent care 2 days later on July 26. The lump my throat did start decrease but took until Aug. 28 to finally be completely gone

Other Meds: No

Current Illness: No

ID: 1674593
Sex: F
Age: 47
State: IL

Vax Date: 09/01/2021
Onset Date: 09/03/2021
Rec V Date: 09/04/2021
Hospital:

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

Lab Data: N/A

Allergies: N/A

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

Symptoms: Developed reddish spots on my forehead and few on my face, they are flat and do not itch. Had a low fever . Very achy and lethargic

Other Meds: Zoloft Buspar Synthroid Bupropion

Current Illness: Felt feverish and achy for 2 days

ID: 1674594
Sex: F
Age: 37
State: MD

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/04/2021
Hospital:

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

Lab Data: N/A

Allergies: Cats, dogs, trees, grass, dust, mold

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

Symptoms: Between 45-60 minutes after the dose my heart began to race, vision was blurred, I was dizzy and felt light headed. I then began to tremble. I took 50mcg of Benadryl at the onset of tongue tingling. I have a history of biphasic anaphylaxis from allergy shots and carry an epipen. I had another reaction this morning (9/4). Heart racing, dizzy, again with the Benadryl symptoms have subsided.

Other Meds: Loratadine, Sertaline, Flonose, Monkulast, Probiotic, Womens daily mulitivitamin

Current Illness: None

ID: 1674595
Sex: F
Age: 20
State: WI

Vax Date: 07/26/2021
Onset Date: 08/17/2021
Rec V Date: 09/04/2021
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: Latex, amoxicillin,

Symptom List: Tremor

Symptoms: disseminated HSV1, symptoms started 8/17 with fever, HA. Developed CP, dysphagia, oral ulcers, dysuria. ER visits x 2 for symptom management, dehydration. Endoscopy with biopsy on 8/23/2021. Confirmed HSV1- started Acyclovir on 8/26/2021

Other Meds: albuterol, symbicort

Current Illness: none

ID: 1674596
Sex: M
Age: 55
State: DE

Vax Date: 04/19/2021
Onset Date: 05/03/2021
Rec V Date: 09/04/2021
Hospital:

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

Lab Data: Hearing loss measured in both ears.

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Tinnitus and Severe Case of Vertigo. Vertigo has subsided to mild case. But Tinnitus has persisted consistently and continuously since the second shot. Hearing has also been effected and I have been diagnosed wit mild hearing loss in both ears.

Other Meds:

Current Illness:

ID: 1674597
Sex: M
Age: 35
State:

Vax Date: 08/13/2021
Onset Date: 09/01/2021
Rec V Date: 09/04/2021
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: Herpes simplex 1 eye infection

Other Meds:

Current Illness:

ID: 1674598
Sex: M
Age: 32
State: WY

Vax Date: 09/02/2021
Onset Date: 09/04/2021
Rec V Date: 09/04/2021
Hospital:

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

Lab Data: na

Allergies: shellfish allergy

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

Symptoms: Swollen, slightly painful armpit on right arm. Same arm as the injection site in shoulder.

Other Meds: na

Current Illness: common cold that started on August 13th.

ID: 1674599
Sex: M
Age: 15
State: CA

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/04/2021
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: ABOUT 10 MINUTES AFTER GETTING THE SECOND DOSE PATIENT FAINTED , BUT GAINED CONSCIOUSNESS IMMEDIATELY AND BLOOD PRESSURE WAS IN NORMAL RANGE.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1674600
Sex: M
Age: 37
State: TX

Vax Date: 08/20/2021
Onset Date: 08/20/2021
Rec V Date: 09/04/2021
Hospital:

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

Lab Data: Had CT scan at ER which was clear. No other tests done yet.

Allergies: Zithromax

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

Symptoms: Minutes after shot felt pain in back of left knee. Left arm felt "heavy". That night left arm felt "asleep" (numb/tingling). The following days the sensation travelled throughout left side of body. Muscle twitches occured spontaneously all over body. Left calf became tight. The pins and needles sensation has persisted for two weeks since. Also, first night woke up every 2 hours with vivid dreams and feeling hot. Every night since has been similar. Vision now seems slightly blurry.

Other Meds: Biktarvy, spironolactone, estradiol

Current Illness: Hiv-managed

ID: 1674601
Sex: F
Age: 79
State: AZ

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/04/2021
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: Ace inhibitors

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

Symptoms: This was the 3rd, Booster shot of Moderna. Fever of 103 for 12 hours; then fever of 100. Extreme headache, extreme pain at shot site; body aches, dizziness, chills, nausea, fatigue. All this lasted for 4 days (including day of shot). Day 4 profuse sweating, continued headaches, pain throughout body, fatigue. This reaction was far worse than the side effects of shot #2, which were typical - fatigue, some chills and discomfort, gone after 1 day.

Other Meds: Amlodipine, Losartan, Rosuvastatin, Vitamin D3

Current Illness: None

ID: 1674602
Sex: F
Age: 62
State: FL

Vax Date: 09/01/2021
Onset Date: 09/02/2021
Rec V Date: 09/04/2021
Hospital:

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

Lab Data: Vaginal Culture performed by OB/GYN twice with a diagnosis of overgrowth of vaginal bacteria and vaginal infection. First vaginal culture performed on April 7th, 2021 after second Covid Vaccine dose on March 31st, 2021. Second vaginal culture performed on September 3rd, 2021 after third Covid Vaccine dose on September 1st, 2021.

Allergies: Sulphur

Symptom List: Pain in extremity

Symptoms: Pelvic Pain, Green Discharge, Vaginal Infectiom - Treatment: Clindomycin Vaginal Insert Cream for 7 days as prescribed by OGYN. This is the second time that I have these symptoms and vaginal infection a day after receiving Pfizer Covid Vaccine dose. The first time was a day after receiving second dose and the second time was after receiving the third Pfizer Covid Vaccine dose.

Other Meds: Quetiapine, Hydrochlorothiazide, Atenolol, Levothyroxine, Eliquis, Xtampza, Hydrocodone, Saccharomyces Boulardii, Women's Daily Probiotic, Fish Oil, Apple Cider Vinegar

Current Illness:

ID: 1674603
Sex: F
Age: 37
State: CA

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/04/2021
Hospital:

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

Lab Data: NONE

Allergies: NKA

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

Symptoms: PT DID NOT INDICATE THAT IT WAS HER SECOND DOSE ON THE FORM. THE FIRST DOSE WAS ON 8/22/2021 SECOND DOSE WAS GIVEN TOO EARLY ON 9/3/2021. PT WAS CALLED FOR FOLLOW UP. NO ANSWER

Other Meds: UNKNOWN

Current Illness: NOT KNOWN

ID: 1674604
Sex: M
Age: 36
State: CA

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/04/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: I felt quite decent subsequent to the shot. Approximately 5-6 hours post shot, I began to feel freezing cold. I had a burning sensation in my penis which was not fun for about 1 hour. Afterwards, I started feeling very, very warm. My temperature went up to ~ 103.2. My body felt as though I had been beaten with a bat. My head was tender to touch, and it was painful while taking a shower. I had a strange taste in my mouth, seemingly, metallic. I slept horribly all last evening. I sweat all night, and I could not stay asleep for more than 2-3 hours at a time. I woke up with horrible chest pain (left side), and I thought that I was having a heart attack. I still have a fever, however, it has dissipated to ~ 100.4. I have never in my life felt like this, and I regret taking this vaccine 100%. This is the only thing in my life that I have ever regretted, so to say that I am happy would be a complete and utter falsification. I now have the worst headache that I have ever had, and quite honestly, feel like waking out into traffic? This was a disaster, and I?m very regretful.

Other Meds: 20mg Omeprazole daily

Current Illness: None

ID: 1674605
Sex: M
Age: 16
State: IA

Vax Date: 08/31/2021
Onset Date: 09/02/2021
Rec V Date: 09/04/2021
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:

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

Symptoms: right arm was sore the day after vaccine was given . 2 days later HA, fatigue, chills, Right arm was swollen and red.

Other Meds:

Current Illness:

ID: 1674606
Sex: M
Age: 66
State: PR

Vax Date: 04/06/2021
Onset Date: 05/01/2021
Rec V Date: 09/04/2021
Hospital:

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

Lab Data: No study was conducted. They used a special machine in the Doctor's office and indicated that it could be due acidity.

Allergies: Penicillin

Symptom List: Vomiting

Symptoms: At the end of May, he was presenting ulcers all over the inside of his mouth. They were treated as a reaction to a possible acidic. But I had never experienced an event like this or episodes of acidic to fully justify this strange appearance of lacerations. The same with everything and treatment lasted approximately until the end of June. I had this reaction for about 2 months.

Other Meds: Synthroid, Cardura, Lipitor, Plavix, Hydrochlorothiazide, Aspirin, Relafen, Pepcid, Omega 3, Neurontin, Vitamin C, Zinc, Probiotic

Current Illness: Cardiac, High Pressure, Thyroid

ID: 1674607
Sex: F
Age: 38
State: KY

Vax Date: 03/02/2021
Onset Date: 08/01/2021
Rec V Date: 09/04/2021
Hospital:

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

Lab Data: COVID-19 test performed on 8/2/21 after telemedicine visit with APRN in my GP?s office. Resulted late on 8/3/2021

Allergies: No know food/medication Environmental/Seasonal: pollen (trees, weeds, grass, etc), cats, horses, dust, molds

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Started with what I thought was a sinus infection- pain on one side of my face and congestion. Had serious chills and fatigue on Day 1 Fatigue, diarrhea, sinus pressure/congestion Days 2-4 Mild Chest tightening in addition to the symptoms mentioned above on days 4-9 (O2 saturation remained above 97), but ultimately went away and did not require intervention Mild Fatigue continued for ~2 weeks to to the point that I could not maintain my regular work out schedule

Other Meds: PCOS related: Metformin, ovasitol, vitamin D, vitamin B12 ADD: Adderall XR Allergies: Xyzol, Singulair, Flonase, allergy shots HBP: Lisinipril

Current Illness: None

ID: 1674608
Sex: F
Age: 61
State: CA

Vax Date: 08/26/2021
Onset Date: 08/29/2021
Rec V Date: 09/04/2021
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: no medical tests performed

Allergies: to medications or foods (allergic to bee stings)

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

Symptoms: Tinnitus in both ears, constant ringing. Began with constant whooshing sound, progressed to constant ringing in both ears within a couple days. It's been over a week.

Other Meds: Metformin 500 mg , Magnesium 200 mg, Zinc 15 mg, Vitamin C 60 mg, L-Carnitine 15 mg, B-12 500 IU, B-6 5 mg, Melatonin 3 mg, L-Theanine 50 mg, K2 90 mg, D3 125 mcg, Pre-Pro Biotics, Thyroid Support supplements

Current Illness: None

ID: 1674609
Sex: F
Age: 80
State: OR

Vax Date: 08/31/2021
Onset Date: 09/01/2021
Rec V Date: 09/04/2021
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

Allergies: none known

Symptom List: Injection site swelling, Limb discomfort

Symptoms: -fever (99.2); joint & muscle aches; headache; extreme fatigue; swollen, pink arm at injection site -2 days in bed with slight fever, aches, fatigue -used 400 mg of Advil each day for 4 days -4 days after injection major side effects have subsided; injection site still pink but not worse

Other Meds: Levothyroxine 75mcg daily daily: multi vitamin, Vit D (2000 IU), Vit C, Calcium citrate (600 mg), B-12 (500mcg), Omega-3 (1200 mg)

Current Illness: none

ID: 1674610
Sex: F
Age: 10
State: CA

Vax Date: 09/02/2021
Onset Date: 09/02/2021
Rec V Date: 09/04/2021
Hospital:

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

Lab Data: Seen at an ER Sept 3rd, I do not have any discharge notes at this time. Per Dad's report to me, she was given steroids and an Epi Pen prn. Vitals were stable in the ER, per Dad, and child remained with swelling and rash around the injection site, per Dad.

Allergies: Nonsteroidal Anti-inflammatory Compounds (NSAIDs); Severe Anaphylaxis Childhood; Penicillin; Severe Anaphylaxis Childhood; Gadolinium-Based Contrast Agent; Moderate Shortness of breath Childhood

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

Symptoms: Symptoms and event are per parents reports. Per Father's report: Dad reviewed with me that after leaving office, they stopped for ice cream, no symptoms noted. Dad not sure if symptoms or rash had started upon arrival to their home or after. After arriving, per Dad, patient said she was itchy, a hive was found and then hives began to increase. Dad was not aware of tongue/lip throat tingling or any other symptoms, denies SOB/cough/vomiting and denied lip/mouth/throat swelling and complaints from child. Mother took over at some point, he said he would need to check with her. In the a.m. of Friday, child still had itching and rash at injection site. Per mother's report, sent via email to me, this is her email: (I would like to note that this is indicative of possibly anaphylactic reaction, therefore could have been a life threatening event.) Patient had a reaction to her varicella vaccine last night within 20 minutes of leaving the office. She had severe hives, and some swelling and tingling in her mouth/throat/ears/nose. We gave her several doses of Benadryl over the next several hours and she was able to fall asleep around midnight. She is better this morning, still itchy, and has redness and swelling at the injection site that are more severe than she's had in the past. She is also complaining of a headache, such as she had with the last Varicella vaccine. As these reactions are going from mild to worse over the last months, especially with MMR and Varicella, we are going to make a report to VAERS and you will want to document the symptoms on her record. As the MMR and Varicella are complete, I'm not sure there is anything else we need to do and no follow up visit seems necessary unless you disagree. I just wanted to let you know.

Other Meds: None known

Current Illness: Central diabetes insipidus; Anxiety; Panic; Urinary incontinence; Mental Health Concerns; behavioral oddities and other emotional disturbance of uncertain etiology; diagnoses not known specifically to me

ID: 1674611
Sex: F
Age: 51
State: CA

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/04/2021
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: Fatigue, Myalgia, Headache, Shivering, fever so severe I had to take time off work. Also, at the injection site, a lot of pain swelling, and site was warm to the touch. Need to take Tylenol and NSAIDs foe pain relief.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am