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: 1683327
Sex: M
Age: 30
State: TX

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

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

Lab Data: N/A

Allergies: None

Symptom List: Dysphagia, Epiglottitis

Symptoms: Swelling and tingling of vaccinated arm, light headed, dizzy.

Other Meds: None

Current Illness: None

ID: 1683328
Sex: M
Age: 72
State: WA

Vax Date: 03/02/2021
Onset Date: 05/31/2021
Rec V Date: 09/08/2021
Hospital:

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

Lab Data: ER - CT scan or MRI on brain/head; blood pressure and other vitals. Did not find an event in the brain.

Allergies: Gadolinium - rash and others I can't remember right now

Symptom List: Anxiety, Dyspnoea

Symptoms: I blew my nose as I was walking through the kitchen and I heard something pop in my inner ear (left side). I called my wife to bring a chair to sit on. I thought it would go away but it didn't. I was sweating in the chest area and feeling a little nauseous. It was going on so long I called an ambulance and they took me to ER. At the Hospital ER they did a CT scan and said they couldn't find any event in my brain. I did not have a stroke. No treatment at the hospital - but the ambulance EMT's gave me something under my tongue which kind of cleared things up in a hurry. But because I was still sweating they took me to ER. They only gave me some medications (prescribed them) - Meclizine 25 mg - one tablet three times daily as needed for dizziness. I know it did something to my inner ear - but they were treating me for Vertigo but I think I it was just from blowing my nose too hard. They also prescribed Ondansetron ODT - 4 mg for nausea - I never took one of those. I didn't have need of those. Meclizine that I was taking - I am not taking it any longer - I almost feel like I became addicted to it. I haven't really needed it for awhile.

Other Meds: Amlodipine; lisinopril; ezetimibe; atorvastatin; montelukast; ELIQUIS; multi-vitamin; baby aspirin

Current Illness: No

ID: 1683329
Sex: F
Age: 27
State: NY

Vax Date: 09/06/2021
Onset Date: 09/07/2021
Rec V Date: 09/08/2021
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:

Allergies:

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

Symptoms: When i woke up at 6:30 a.m i felt dizzy, light headed and weak. When i went to brush my teeth i felt that i was going to faint and so i sat down. After sitting for 5 minutes in the bathroom i went back to my bedroom to lay down to sleep again. Once i woke up at around 8.a.m i had joint pain and a strong headache and lower back pain. This entire day i bedridden. The next day i felt great, i had no symptoms.

Other Meds:

Current Illness:

ID: 1683330
Sex: M
Age: 70
State: AR

Vax Date: 01/20/2021
Onset Date: 08/29/2021
Rec V Date: 09/08/2021
Hospital: Y

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

Lab Data: Coronavirus Testing: 8/28/2021: positive

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient admitted on 8/29/2021: Patient is a 70-year-old gentleman, who tested positive for COVID on Monday. He was treated with __________, has been at home and has been improving. He said his onset of symptoms were the middle of last week. This afternoon, he was walking when his right lower extremity became painful and then numb. He has no antecedent claudication. He came to the emergency room. A CTA was performed, which shows a thrombus in the popliteal artery. Patient discharged 9/1/2021: This is a 70-year-old gentleman, who is COVID positive that presented with acuteonset of right lower extremity pain, followed by numbness. He underwent CTA that showed acute popliteal artery thrombosis with limb-threatening ischemia. His foot was cool, pale, and beginning to become mottled with loss of sensation and movement and he also had absent Doppler signals below his groin. It was felt that he would require emergent thrombectomy. He was taken to the operating room on August 28th and underwent the above-stated procedure. A long portion of acute thrombus was removed from his popliteal artery and below and he was noted to have good back bleeding and positive Doppler signals at the end of the case. Postoperatively, he has done well. He has been placed on warfarin therapy and currently is therapeutic with an INR in the 2-3 range. We will alternate 7.5 and 5 mg of Coumadin daily. He is ambulating without difficulty. His pain is controlled and he is ready for discharge home.

Other Meds:

Current Illness:

ID: 1683331
Sex: F
Age: 50
State: FL

Vax Date: 09/07/2021
Onset Date: 09/08/2021
Rec V Date: 09/08/2021
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 erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Resting heart rate increased (130's) for a few hours, approximately 24 hours after the vaccine.

Other Meds: Bupropion

Current Illness: none

ID: 1683332
Sex: F
Age: 39
State: GA

Vax Date: 05/15/2021
Onset Date: 08/25/2021
Rec V Date: 09/08/2021
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: Positive pcr on 08/29

Allergies: Ciprofloxacyn

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

Symptoms: Got covid

Other Meds:

Current Illness:

ID: 1683333
Sex: M
Age: 55
State: NJ

Vax Date: 08/24/2021
Onset Date: 08/26/2021
Rec V Date: 09/08/2021
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: cefadrixal/duricef Sometimes when i eat garlic meat or onions ill break out in hives from waist down until it gets processed in my system.

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: The first one i was itchy that night that was it. The second one three days later getting these little twinges of chest pain every now and then. They seem to be fading away now, but still once in awhile. Never sought treatment

Other Meds: none

Current Illness: none

ID: 1683334
Sex: F
Age: 52
State: ID

Vax Date: 01/27/2021
Onset Date: 07/31/2021
Rec V Date: 09/08/2021
Hospital:

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

Lab Data: 8/1/2021 visual inspection by provider to confirm shingles.

Allergies: none

Symptom List: Pharyngeal swelling

Symptoms: Received 2-dose Modena COVID-19 vaccine on 12/30/2020 & 1/27/2021 (same lot and hospital administration). Developed shingles on 7/31/2021 at age of 52. Morning of 8/1/2021, evaluated within 12 hours of onset. Given prescription for Valtrex 1000mg twice daily for 7 days. Given Gabapentin pills and lidocaine cream for nerve pain. Rash spread to cover 4" swatch from middle of back/spine to middle of front/midline just under shoulder and armpit. Rash resolved after 7-10 days. Nerve pain continued. Refilled lidocaine cream on 8/23/2021. Nerve pain still continues now 6 weeks after diagnosis.

Other Meds: Premarin, Flonase, Claritin

Current Illness: none

ID: 1683335
Sex: M
Age: 77
State: AL

Vax Date: 03/23/2021
Onset Date: 04/01/2021
Rec V Date: 09/08/2021
Hospital:

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

Lab Data: Er visit labs normal CT scan of head normal. Visit to neurology.

Allergies: None

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Started with balance problem falling cognitive decline

Other Meds: Simvastatin, effient, zoloft, vit d, vit b12

Current Illness: None

ID: 1683336
Sex: M
Age: 11
State: MT

Vax Date: 09/08/2021
Onset Date: 09/08/2021
Rec V Date: 09/08/2021
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: Unknown

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Pt presented to clinic for 1st dose of Pfizer Covid-19 vaccination. Pt and Mother stated pt's birth date was 9/2/2009 and received a 1st dose of Pfizer covid-19 vaccine. Upon entering data into state registry, we discovered pt's birthdate is 9/20/2009. Mother confirmed birthdate was 9/20/2009 and stated she had lied on the paperwork. She was informed that her child will not receive a second dose until child was 12 years old.

Other Meds: Unknown

Current Illness: Unknown

ID: 1683337
Sex: F
Age: 51
State: MN

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

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

Lab Data:

Allergies: Allergies Nucala [Mepolizumab] Anaphylaxis High 11/25/2020 Amoxicillin Other (see comments) Not Specified 5/19/2004 unknown Aspirin Other (see comments) Not Specified 5/19/2004 Azithromycin Other (see comments) Not Specified 2/18/2005 Bee Sting [Bee Venom Protein (Honey Bee)] Anaphylaxis Not Specified 5/19/2004 Cat Dander Other (see comments) Not Specified 11/26/2019 itching Erythromycin Base Other (see comments) Not Specified 5/19/2004 Levofloxacin Other (see comments) Not Specified 5/19/2004 Mold Hives Not Specified 3/7/2017 Monosodium Glutamate Hives Not Specified 3/7/2017 Penicillins Other (see comments) Not Specified 5/19/2004 Polysorbate 80 Anaphylaxis Not Specified 4/15/2021 Red Dye Hives Not Specified 3/7/2017 Sodium Phosphate,dibasic Heptahydrate Anaphylaxis Not Specified 4/15/2021 Sucrose Anaphyla

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

Symptoms: Patient received Pfizer vaccine after allergy testing and was cleared to receive vaccine. Approximately 30 minutes after dose given she started wheezing, having difficulty breathing, and had satts of 70%. She was given Epinephrine. Benadryl, and IV was started and she was given steroids. She was then transported to the ER.

Other Meds: Levofloxacin Other (see comments) Not Specified 5/19/2004 Mold Hives Not Specified 3/7/2017 Monosodium Glutamate Hives Not Specified 3/7/2017 Penicillins

Current Illness:

ID: 1683338
Sex: F
Age: 12
State: MN

Vax Date: 08/27/2021
Onset Date: 09/04/2021
Rec V Date: 09/08/2021
Hospital:

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

Lab Data: none

Allergies: none

Symptom List: Rash, Urticaria

Symptoms: Full body rash.

Other Meds: Claritin

Current Illness: none

ID: 1683339
Sex: M
Age: 69
State: CO

Vax Date: 03/05/2021
Onset Date: 05/17/2021
Rec V Date: 09/08/2021
Hospital:

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

Lab Data: August 4, 2021, Right shoulder MRI

Allergies: Egg Plant

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

Symptoms: In May of 2021 I suddenly developed a sore right shoulder and upper arm, this progressively got worse. The issue appeared coincident with a common cold that I contracted while in out of town at my mother's funeral. My PCP referred me to Spine clinic, believing I may have a spinal issue, however an MRI of my thoracic spine was OK. As the pain progressed in my right shoulder/upper arm, I was losing range of motion and the pain was getting worse. I was given Meloxicam 15mg to alleviate swelling, and referred to physical therapy. My therapist noted that my range of motion limitations were not consistent with his experience with rotator cuff impingements, which is what I had been diagnosed with by Spine Clinic. Subsequent visits at Spine clinic have resulted in an ultrasound of my right shoulder and an MRI. I then received a cortisone shot in my right shoulder about 4 weeks ago, and am for the moment pain free. I am still in PT. I have not yet talked to my PCP, I see her on September 30 for my annual physical. I contacted her today to tell her about my submission of this form. I submitted information regarding my rotator cuff impingement diagnosis in a vSafe report on Sunday 9/5 and was contacted by a CDC medical person on Tuesday 9/7 by phone, and asked to complete this online form.

Other Meds: Omeprazole. 20mg Simvastatin 5mg Lisinopril 2.5mg Tamsulosin HydroChloride .4mg Allegra 180mg Vitamin B12 1000mg Vitamin D3 2000mg

Current Illness: None

ID: 1683341
Sex: M
Age: 54
State: MI

Vax Date: 09/07/2021
Onset Date: 09/07/2021
Rec V Date: 09/08/2021
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: None

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

Symptoms: Hypotension tachycardia numb arms and hands loss of function of arm and hand TIA severe cold and shaking rigors extreme muscle aches resulting in being bedridden for 24 hours color of hands change to white with painful cold confusion and inability to focus or concentrate lethargic and inability to move

Other Meds: None

Current Illness: None

ID: 1683342
Sex: F
Age: 59
State: WA

Vax Date: 09/05/2021
Onset Date: 09/08/2021
Rec V Date: 09/08/2021
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: Morphine, nickel, dye from 30 yr old CD scan.

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

Symptoms: 09/06 took Tylenol after the vaccine 09/07 Am. Increased temp., 99.9 I took Tylenol again. By about 12:00 the cough started I started to feel achy in my arms and legs. By about 6:00 Pm the chills started but went away after I went to bed. Slept through the night when I woke up my temp was 100.2 my usual temperature is 97.4 ish. The aches started non stop I slept all day 3:37 and I took Tylenol half hour ago still high temp. I take GALYNIA for my MS .

Other Meds: I take to many medications to list I have a full list with pharmacy or I can send you copies of my list.

Current Illness: Multiple Sclerosis

ID: 1683343
Sex: F
Age: 17
State: MO

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

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

Lab Data: N/A

Allergies: None

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

Symptoms: "The day after the 2nd dose, I began feeling sick and was experiencing emotional problems. I had a headache and nausea. I began having bad thoughts, with thoughts of self-harm and feeling that I wanted to die. I was very tearful, felt very spacy and dissociated, and had difficulty standing."

Other Meds: Lo-Loestrin FE 1 mg - 10 mcg tablet: 1 tablet once daily

Current Illness: None

ID: 1683344
Sex: F
Age: 42
State: CA

Vax Date: 08/22/2021
Onset Date: 09/08/2021
Rec V Date: 09/08/2021
Hospital:

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

Lab Data: None

Allergies: None

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

Symptoms: Busted blood vessel in lower left eye. There is a bright red spot under pupil.

Other Meds: Vita-fusion multi vitamin for women

Current Illness: None

ID: 1683345
Sex: M
Age: 14
State: WI

Vax Date: 09/03/2021
Onset Date: 09/06/2021
Rec V Date: 09/08/2021
Hospital: Y

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

Lab Data: EKGs, Echo, ultrasound heart, bloodwork

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 09/04/21 9:00am fever aches headache 09/05/21 dull headache and fatigue most of day 09/06/21 5:00 am chest pains few hours while laying 09/07/21 3:30 am chest pain radiating to both arms while laying 09/07/21 8am called physician 10am ER 09/07/21 6pm transferred to hospital - myocarditis: high cardiac markers 09/07-08/21 Echo, enormal

Other Meds: None

Current Illness: None

ID: 1683346
Sex: F
Age: 37
State: CA

Vax Date: 04/07/2021
Onset Date: 04/09/2021
Rec V Date: 09/08/2021
Hospital:

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

Lab Data: Doctor refused to consider the vaccine could be the cause and did not have any tests done. Gave me antibiotic eye cream and nothing for the body rash. The rash lasted for about 4 months. The eye healed completely within one month.

Allergies: No

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Rash on entire body. The worst areas being the armpits. Left eye swollen shut with lots of discharge but both eyes irritated.

Other Meds: No

Current Illness: No

ID: 1683347
Sex: F
Age: 12
State: FL

Vax Date: 09/02/2021
Onset Date: 09/06/2021
Rec V Date: 09/08/2021
Hospital:

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

Lab Data: Rapid strep test negative in ER.

Allergies: None

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

Symptoms: Developed urticaria to entire body on 9/5/21. Given Allegra by mother. Taken to ER on 9/6/21 due to sensation of tightness in throat, given Benadryl and Prednisone. Taken back to ER on 9/7/21 for recurrence of symptoms, prescribed 5 days of prednisone and Epipen, but was not given epinephrine. Described some lip swelling during the event along with urticaria. No vomiting or respiratory symptoms apart from sensation in throat.

Other Meds: None

Current Illness: COVID diagnosed 8/6/2021

ID: 1683348
Sex: F
Age: 76
State: FL

Vax Date: 08/09/2021
Onset Date: 08/13/2021
Rec V Date: 09/08/2021
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: None known

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

Symptoms: Four days after the first dose, she started feeling a pinch or prick type of pain in her heart/chest area that radiated out and slowly dissipated. It would last a few minutes and happen without a specific interval several times a day for about four days. After that, it didn?t happen again. We wanted to go to urgent care, but at the end didn?t go.

Other Meds: Vitamin C, B, Glucosamine, Omega 3

Current Illness: None

ID: 1683349
Sex: F
Age: 39
State: MA

Vax Date: 04/10/2021
Onset Date: 09/07/2021
Rec V Date: 09/08/2021
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: None

Symptom List: Unevaluable event

Symptoms: Injection site pain and inflammation on 7-8 September 2021, four months after receiving second dose of vaccine. Had very mild pain during first injection that lasted less than 5 minutes and no pain with second injection. Woke up from sleep on 7 September with similar pain as experienced after first injection but much stronger, accompanied with swelling. Pain increased with movement of arm and movement was limited. Responds well to ibuprofen and but has persisted for two days and required frequent re-dosing of ibuprofen. Severe enough to impact daily activities but not severe enough to seek further medical attention.

Other Meds: Bupriopion XL 300 mg once daily, famotidine 40 mg once daily, hormonal birth control (Levono-E Estradiol 0.15-0.03-0.01tablets)

Current Illness: none

Date Died: 08/26/2021

ID: 1683350
Sex: M
Age: 70
State: TX

Vax Date: 02/23/2021
Onset Date: 08/17/2021
Rec V Date: 09/08/2021
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: COVID Positive test 0n 8/11/2021 @ 2120 using PCR or equivalent.

Allergies: Lisinopril (Swelling of lips)

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

Symptoms: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 2/25/2021 and 3/23/2021. Presented to the ED on 8/11/2021 for asymptomatic testing so he may resume dialysis. On 8/14/2021 patient returns to ED with a two day history of fatigue, nausea, vomiting, diarrhea, chills, body aches, and loss of taste and smell. Denies shortness of breath, headache or chest pain, Has O2 sats of 100%. Patient was discharged from ED with instructions to return if dyspnea occurs. On 8/17/2021 patient returns to ED with shortness of breath and sepsis secondary to infected dialysis catheter (MSSA bacteremia). Treated with dexamethasone, heparin prophylaxis dosing, zosyn, and vancomycin. Antibiotics were later changed to cefazolin once culture and sensitivity resulted. Patient also developed bleeding from catheter site. he eventually succumbed to multiple acute illnesses with multiorgan failure.

Other Meds: Atorvastatin 40 mg QD, Calcitriol 0.25 mcg QD, Calcium acetate 668 mg QD, Ferrous sulfate 1 tab Weekly, Glipizide 10 mg QD, Metoprolol 50 mg QD, Sodium bicarbonate 325 mg TID, Tamsulosin 0.4 mg QD,

Current Illness: Rhabdomyolysis (non-traumatic)

ID: 1683351
Sex: F
Age: 63
State: TX

Vax Date: 07/21/2018
Onset Date: 07/21/2018
Rec V Date: 09/08/2021
Hospital:

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

Lab Data: none

Allergies: Lamisil

Symptom List: Injection site pain, Pain

Symptoms: Extreme headache, body aches, nausea - unlike any I had ever experienced and that I can only describe as a chemical nausea meaning if I vomited, I don't think I would have felt any better. Chills which I assume were from fever because I felt cold but I did not check my temperature as I felt too bad. Injection site felt like someone had hit me in the arm with a baseball bat. Totally uncontrollable shaking of entire body which I would describe as having an epileptic fit while being awake.

Other Meds: Lipitor 10 mg, Ared 2 for eyes, Evista - 60 mg, Fish Oil, Vitamin C, Ashwaganda, CoQ10, B12 and Vit D.

Current Illness: none

ID: 1683352
Sex: F
Age: 47
State: AR

Vax Date: 01/05/2021
Onset Date: 08/31/2021
Rec V Date: 09/08/2021
Hospital: Y

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

Lab Data: Coronavirus Testing: 8/30/2021 - positive; 8/31/2021 - positive;

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Pt admitted on 8/31/2021: 48-year-old female presents to the emergency room with worsening shortness of breath fever and cough. Patient was diagnosed with COVID on 08/18/2021. Although she seems to be somewhat in denial of this. She had a positive test on that date. Tonight she presents and says she just has an upper respiratory infection. She is hypoxic on presentation. Her COVID swab is positive tonight. Chest x-ray is consistent COVID. She denies any diarrhea or GI symptoms. The patient has a history of a median sternotomy in February of 2017. This apparently was for a thymoma. She also has a history of lupus which apparently has not been treated since 2001. Patient has a generalized alopecia which I assume is an autoimmune alopecia. Patient states that she takes no medications regularly currently. Patient states that she received 2 doses of COVID vaccine although she does not specify which brand in February of this year. She has not had monoclonal antibody therapy with her current illness. Pt is a current patient at the facility.

Other Meds:

Current Illness:

ID: 1683353
Sex: M
Age: 14
State: NM

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

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

Symptoms: Patient is 14 years old and received a Moderna vaccine at a school based vaccination clinic. He reported no adverse reaction.

Other Meds:

Current Illness:

Date Died: 09/02/2021

ID: 1683354
Sex: M
Age: 48
State: TX

Vax Date: 05/29/2021
Onset Date: 08/11/2021
Rec V Date: 09/08/2021
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: Positive COVID-19 on 8/11/2021 using the Roche LIAT SARS Assay platform using PCR or equivalent nucleic acid amplification technology.

Allergies: Tide Detergent (Rash)

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 5/1/2021 and 5/29/2021. Presented to ED on 8/11/2021 with complaints of worsening symptoms over the past 10-11 days including generalized fatigue, body aches, weakness, decreased appetite, nausea, vomiting, diarrhea, dyspnea, and cough. Intubated 8/19. His course was complicated by L pneumothorax requiring Left chest tube placement X 2. He was given Decadron 10 d through 8/21. Completed course of Remdesevir 5 days. Course complicated by MSSA pneumonia and concern for fungal pneumonia. Was being treated with Ancef and Micafungin. However he rapidly declined on 9/2. The patient was with significant. hypotension and bradycardia, despite vasopressin and levophed gtts. Atropine x 1 given. Patient with full cardiac arrest at 1255 and CPR was initiated. Epinephrine 1mg given. 1257 pulse check revealed a pulse that progressed into vtach at 1259, shock x 1 at 200J with PEA and subsequent sinus tachycardia. 1303 patient again went into vtach and another shock x 1 at 200J given and amiodarone bolus of 150mg administered. Return of sinus tachycardia. ABG revealed acidosis and 3 amps of bicarb were administered. At that time the patient's family was called and the wife and daughter arrived at bedside. The family decided at that time to make the patient comfort care. He was taken off the ventilator and passed at 1350.

Other Meds: Aspirin 81 mg QD, Clonazepam 0.5 mg BID prn, Insulin Aspart; 0-20 units TID, Insulin glargine 13 units QD, Magnesium Oxide 800 mg BID, Mirtazepine 15 mg QHS, Mycophenolate 720 mg BID, Ondansetron 4 mg Q8H prn, Prednisone 2.5 mg QD, Pantopro

Current Illness:

ID: 1683355
Sex: U
Age: 86
State: VA

Vax Date: 09/01/2021
Onset Date: 09/06/2021
Rec V Date: 09/08/2021
Hospital:

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

Lab Data: Hospital Visit 9/7/2021. No virus, no medical issues requiring emergency services

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Lethargy, confusion, overall sick felling

Other Meds: Thyroid medication

Current Illness: None

ID: 1683356
Sex: M
Age: 55
State: DC

Vax Date: 09/08/2021
Onset Date: 09/08/2021
Rec V Date: 09/08/2021
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: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: Patient received Moderna Vaccine on 04/13/2021 and received Janssen Vaccine today 09/08/2021.

Other Meds:

Current Illness:

Date Died: 08/29/2021

ID: 1683357
Sex: M
Age: 59
State: TX

Vax Date: 04/29/2021
Onset Date: 08/12/2021
Rec V Date: 09/08/2021
Hospital: Y

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

Lab Data: COVID Positive on 8/12/2021; chest x-ray: bilateral patchy airspace opacities concerning for multifocal pneumonia on 8/12/2021; serum creatinine 5.71 on 8/29/2021; urine culture positive for pseudomonas aeruginose on 8/26/2021, sputum culture postive for MRSA on 8/28/2021

Allergies: NSAIDs, sulfonamide

Symptom List: Nausea

Symptoms: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccines on 3/25/2021 and 4/29/2021. Presented to ED on 8/12/2021 with complaints of dyspnea for 1 week requiring oxygen. Patient was placed on oxygen and eventually required mechanical ventilation. Patient had septic shock and acute kidney injury. Medications administered: dexamethasone, ascorbic acid, ceftriaxone, azithromycin, micafungin, remdesivir, piperacillin/tazobactam, tocilizumab, prednisone, and vancomycin. Patient continued to decompensate and expired at 14:44 on 8/29/2021.

Other Meds: aripiprazole 5 mg daily, azelastine 2 sprays twice daily, aspirin 81 mg daily, buspar 30 mg twice daily cholecalciferol 2000 units daily, desvenlafaxine 100 mg daily, fenofibrate 145 mg daily, hydroxyzine 50 mg every 8 hours as needed for a

Current Illness:

ID: 1683358
Sex: F
Age: 55
State: NC

Vax Date: 09/04/2021
Onset Date: 09/07/2021
Rec V Date: 09/08/2021
Hospital:

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

Lab Data:

Allergies: DO NOT KNOW ALL OF THESE.

Symptom List: Injection site pain

Symptoms: PATIENT CAME TO THE PHAMACY CONCERNED ABOUT HER ARM BEING RED/SWOLLEN/SOFTBALL LIKE RASH NEAR HER INJECTION SITE.

Other Meds: DO NOT KNOW ALL OF THESE.

Current Illness: DO NOT KNOW ALL OF THESE.

ID: 1683359
Sex: M
Age: 17
State: NM

Vax Date: 08/20/2021
Onset Date: 08/20/2021
Rec V Date: 09/08/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Patient is 17 years old but received a Moderna COVID19 vaccine at a school based clinic.

Other Meds:

Current Illness:

ID: 1683360
Sex: F
Age: 23
State:

Vax Date: 04/15/2021
Onset Date: 05/10/2021
Rec V Date: 09/08/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: first period after the vaccine was later and heavier than normal

Other Meds:

Current Illness:

ID: 1683361
Sex: F
Age: 50
State: TX

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

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

Lab Data: n/a

Allergies: nkda

Symptom List: Tremor

Symptoms: Patient said that she was told by the doctor to come and get a Tetanus Shot, so we obliged. Then when she asked for a shot record, we realized she had the immunization 28 days prior.

Other Meds: Janumet 50-100, Seroquel XL, Gabapentin, Cymbalta,

Current Illness: unknown

ID: 1683362
Sex: F
Age: 60
State: NY

Vax Date: 03/06/2021
Onset Date: 03/08/2021
Rec V Date: 09/08/2021
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: Formaldehyde.

Symptom List: Erythema, Pruritus

Symptoms: WITHIN 30 HOURS OF THE VACCINE I WOKE UP TO RINGING IN BOTH EARS (Tinnitus) AND HAVE BOUTS OF VERTIGO. IT HAS BEEN 6 MONTHS SINCE AND I STILL HAVE IT. :( I WENT FIRST TO DOCTOR, THEN ENT AND IT WAS CONFIRMED BUT NO CURE IS IN SITE. I MAY HAVE IT FOR THE REST OF MY LIFE. BTW MY ENT HAVE HAD SEVERAL OTHER CASES SIMILIAR TO MINE BUT DON'T FEEL THAT THEY NEED TO REPORT SINCE THEY DID NOT GET THE SHOT.

Other Meds: Venlafaxine.

Current Illness: NONE.

ID: 1683363
Sex: F
Age: 78
State: PA

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/08/2021
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: Statins benzodiazepines fosamax colestipol proton pump inhibitors niacin nateglinide steroid albuterol opioid sulfa penicillin

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

Symptoms: After she received a shot, she developed rash and swelling all over her body once she arrived home

Other Meds: No

Current Illness:

ID: 1683364
Sex: F
Age: 17
State: NM

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

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

Symptoms: Patient is 17 years old but received a Moderna vaccination at a school based immunization clinic.

Other Meds:

Current Illness:

ID: 1683365
Sex: F
Age: 67
State: WA

Vax Date: 03/04/2021
Onset Date: 08/10/2021
Rec V Date: 09/08/2021
Hospital:

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

Lab Data: Covid test

Allergies: Aspirin; penicillin; sulfa

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Covid.

Other Meds: Vitamin D

Current Illness: No

ID: 1683366
Sex: F
Age: 30
State: WI

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

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

Lab Data: none

Allergies: Midol

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

Symptoms: COVID 19-Pfizer was mixed with only 0.8ml of saline instead of 1.8ml. Pt was given 0.3ml of mixed vaccine

Other Meds: no known medications

Current Illness:

ID: 1683367
Sex: F
Age: 64
State: NY

Vax Date: 08/31/2021
Onset Date: 09/01/2021
Rec V Date: 09/08/2021
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: Gluten, soy

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

Symptoms: Swollen Lymph Node (two days after vaccine), swollen arm (next morning),fatigue (next day), sore throat (next day), headache (next morning), sharp back pain (next morning). Warm compress, Tylenol. Symptoms continue.

Other Meds: Humira, nexium, evoxac, carafate

Current Illness: none

ID: 1683368
Sex: F
Age: 35
State: CA

Vax Date: 09/08/2021
Onset Date: 09/08/2021
Rec V Date: 09/08/2021
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: Amoxicillin, Azithromycin, Diphenhydramine, Doxycycline, Eggs, Latex, Penicillins, Sulfa antibiotics

Symptom List: Pain in extremity

Symptoms: Patient had 2nd dose of COVID PFIZER vaccine at 0900, being monitored for 15 minutes, left the clinic without any adverse reactions. Patient returned the urgent care clinic around 1230 with swollen face, arms, vomited before arrived to the clinic, felt feverish, denied tightened on throat. Inserted peripheral IV on right antecubital, administered Solumedrol 40 mg, IV NS 1000 ml. Patient stated that she felt better after the treatment. Patient recalled that her throat felt heavy before solumedrol dose. Patient started complained of her throat feeling heavy and bothering her, administered EPI 0.5 mg IM. Monitored patient closely, VS taken every 30 mins. Called ambulance to transfer patient to ER for higher level of care

Other Meds: Unknown

Current Illness: Patient notified at the time of urgent care visit that she had reaction to 1st dose of Pfizer-flushing, numbness to right arm however did not report at the time prior to the second dose

ID: 1683369
Sex: F
Age: 47
State: MN

Vax Date: 08/09/2021
Onset Date: 08/11/2021
Rec V Date: 09/08/2021
Hospital:

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

Lab Data: I have not seen any doctor so far. I mainly just resting for now. I probably will see one sometime. After 2 weeks, I went to an urgent care clinic, but they suggest me go to ER. I am thinking to visit some cardiologist sometime.

Allergies: Sulfa medicine

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

Symptoms: I took the first shot on 08/09021, then two days later, in the night, when I was sleeping, my heart started pounding very heavy and fast. I never had this kind of feeling before. I had fast heart rate for recent years, but the pounding feeling and the heaviness are something I never experienced before. The heavy pounding lasted for a day, then gradually become lighter. But the un-comfortable feeling is still hanging with my heart. I rested for a few weeks, I still do not feel my heart recovered to the state before I took the shot.

Other Meds: No

Current Illness: very large fabroids, fast heart rate (over 100/m)

ID: 1683370
Sex: F
Age: 15
State: NM

Vax Date: 08/20/2021
Onset Date: 08/20/2021
Rec V Date: 09/08/2021
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: Patient is 15 years old but received a Moderna vaccination at school based immunization clinic.

Other Meds:

Current Illness:

ID: 1683371
Sex: M
Age: 16
State: GA

Vax Date: 07/29/2021
Onset Date: 07/29/2021
Rec V Date: 09/08/2021
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: Moderna vaccine was given to a 16 year old male when it has not been approved to be administered to this age group.

Other Meds:

Current Illness:

ID: 1683372
Sex: M
Age: 28
State: TX

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

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

Lab Data: Unknown

Allergies: Unknown

Symptom List: Vomiting

Symptoms: Post administration, patient was shopping in grocery store and had syncope event, causing him to get light headed and fall back and hit his head.

Other Meds: Unknown.

Current Illness: Unknown

ID: 1683373
Sex: F
Age: 47
State: MN

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

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

Lab Data: None

Allergies: Latex, numerous contact allergies to perfumes, preservatives, etc

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Tickle at base of throat, ringing/ear pressure, mild headache, slight dizziness. Occurred about 5-10 min after. Didn't get worse so just waited. Dizziness resolved first after a few minutes. Tickle in throat resolved after about an hour. Ear pressure and headache lasted for the rest of day

Other Meds: Loratadine 10 mg

Current Illness: Slight cough, scratchy throat but COVID negative 2 weeks earlier

ID: 1683374
Sex: M
Age: 30
State: TX

Vax Date: 09/05/2021
Onset Date: 09/06/2021
Rec V Date: 09/08/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: My arm hurt for 1 day and then 2 days of eye lid swelling which dosent go away. Pain around swelling.

Other Meds: None

Current Illness: None

ID: 1683375
Sex: F
Age: 64
State: AZ

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 09/08/2021
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: Penicillin, Prednisone, Cortisone, Demerol, Zoloft, Ampicillin, Sulfa, all metals, iron

Symptom List: Injection site swelling, Limb discomfort

Symptoms: 1-hour post vaccination, heart rate increased to an unknown rate, feelings of throat closing, feeling of pounding in chest and headache, after 24 hours pt got rash that has lasted 2 weeks and is still present

Other Meds: Metoprolol ER 50 mg, ASA 81 mg, omeprazole

Current Illness: Type 2 diabetes, RA, Ehlers-Danlos syndrome,

ID: 1683445
Sex: F
Age: 12
State:

Vax Date: 07/29/2021
Onset Date: 07/29/2021
Rec V Date: 09/08/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Moderna vaccine was given to a 12 year old female when it has not been approved to be administered to this age group.

Other Meds:

Current Illness:

ID: 1683446
Sex: F
Age: 54
State: WA

Vax Date: 08/27/2021
Onset Date: 08/29/2021
Rec V Date: 09/08/2021
Hospital:

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

Lab Data: EKG ? normal result D-Dimer, Complete Blood Count, CRP Quant, Comprehensive Metabolic Panel and Troponin I ? all normal

Allergies: Sulpha and Amoxicillin antibiotics

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

Symptoms: Chest pain/chest wall pain two days after booster shot. EKG and blood work to check for heart issue and blood clots.

Other Meds: None (took a 2-week break from CellCept to get my booster) will remain off of it for two weeks after vaccine. This was my 3rd dose for immunocompromised individuals.

Current Illness: None

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am