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: 1685617
Sex: F
Age: 59
State: OK

Vax Date: 03/06/2021
Onset Date: 03/14/2021
Rec V Date: 09/09/2021
Hospital:

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

Lab Data: June 9 Biopsy of left lower arm.

Allergies: Penicillin

Symptom List: Dysphagia, Epiglottitis

Symptoms: I received the first dose on March 6. On March 14 I developed a weal on my upper right arm. It started about the size of a quarter, but very quickly move to 2-3" in diameter, raised, and Itchy. It initially was treated with Doxycycline. I received the second dose on 3/27. about 2 weeks after that, the weal returned. This time it moved the length of my arm over the time of a week. This time it was treated with antihistamines. The weals continued around my body on and off, including the bottom of my feet.. I was able to get into a Dermatologist on June 9, who took a biopsy of my lower right arm. The results came back 2 weeks later that it was Chronic Urticaria. On July 3 I suddenly developed Angioedema of the lips, and ended up in ER. I was treated with intravenous Benadryl, famotidine, and prednisone, and put on famotadine and predisone for the next 2 weeks. While things went away for a while, the series of Hives started again, and 2 days after my feet swelled, I developed the Angioedema again and was back in ER. This has continued throughout the summer, and continues to the current day. I have had one more ER Visit on 8/28. I am currently on Zyrtec, Famotidine, montelkast, and Allegra to treat the hives.

Other Meds: Tegretol, Omeprozole, Olmestartin Menoxodil, Anastrozole, Xyzal.

Current Illness: None

ID: 1685618
Sex: F
Age: 29
State: TX

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

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

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: I started having abscesses on my thighs. I though it could of been a staph infection so my primary care physician got me a prescription for it. One of the abscesses got infected so I went to the ER. They said it could of been MRSA so they gave me a stronger antibiotic. I went to a dermatologist and also discovered an abscess in my armpit. I was given an even stronger antibiotic for it. The dermatologist ruled out that I had MRSA and diagnosed me last Friday with HS (hidradenitis suppurativa).

Other Meds:

Current Illness:

Date Died: 09/09/2021

ID: 1685619
Sex: F
Age: 86
State:

Vax Date: 04/15/2021
Onset Date: 08/18/2021
Rec V Date: 09/09/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: COVID-19 PCR positive on 8/18/21

Allergies: hydrocodone, oxycodone

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

Symptoms: 8/18/2021: admitted with COVID breakthrough Pt reports fully vaccinated in April 2021. Reports since Sunday having fatigue, diarrhea, mild cough, loss of taste/appetite, and exertional dyspnea. reported testing positive for COVID-19 on 8/16/21. 1st vaccine 3/8/2021 second 4/15/2021. Diagnosed with: COVID-19 pneumonia, acute hypoxic respiratory failure, viral enteritis 9/9/21: patient died.

Other Meds: Diltiazem, furosemide, glimepiride, levothyroxine, memantine, metoprolol, miralax, KCL, entresto, sertraline, simvastatin, timolol Malaete eye, travoprost eye, warfarin

Current Illness:

ID: 1685620
Sex: F
Age: 17
State: CA

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

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

Lab Data: n/a

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Parent requested Moderna for their 17 year old child and RN administered the Moderna vaccine at parents request, and forgot that pediatric patients under age 18 could only receive Pfizer vaccine. Called CDC hotline and they said to keep patient on the Moderna series and administer the 2nd vaccine and document it as "off label" given that the EUA for Moderna is not covered for patients less than 18 years of age. Patient observed for 30 minutes and did not have any reaction.

Other Meds:

Current Illness:

ID: 1685621
Sex: F
Age: 29
State: AZ

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

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

Lab Data: Non

Allergies: None

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

Symptoms: Full body itchy and raised rash that looks like hives from head to toe.

Other Meds: Turmeric Digestive advantage Probiotic Vitamin C Vitamin D Tylenol Niacinamide Balance

Current Illness: None

ID: 1685622
Sex: F
Age: 45
State: CA

Vax Date: 12/22/2020
Onset Date: 03/06/2021
Rec V Date: 09/09/2021
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: 3/9/21 - CBC, white blood cell differntial, alanine aminotransferase, non-fasting lipid panel, hemoglobin A1C, glucose, thyroid stimulating hormone (TSH), creatinin & calculated glomerular filtration rate 4/9/21 - potassium, surgical pathology 6/3/21 immunoglobulin G,A & M, hemoglobin A1C, antinuclear antibody patter, white blood cell differntial, CBC, tissue transglutaminase & deamidated gliadin peptide immunoglobulin A, 6/7/21 - creatinine & calculated glomerular filtration rate, creatinine kinase, cyclic citrullinated peptide immunoglobulin G, serum rheumatoid factor, lupus anticoagulant, beta 2 glycoprorein 1 antibody, cardiolipin antibody, C4 complement, C3 Complement, C reactive protein, protein electrophoresis interpretation, serum,Serum protein electrophoresis, Beta 2 glycoprotein 1 antibody screen,

Allergies: none

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

Symptoms: had rashes after 2nd dose in less than 2 months interval

Other Meds: Vitamin C

Current Illness: none

ID: 1685623
Sex: F
Age: 64
State: PA

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

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

Lab Data: I have been tested for Covid twice (negative); CBC done twice (WNL), chest x-rays (no significant findings); sed rate test - normal

Allergies: Chamomile tea

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Low grade fever and no other sx's besides fatigue and feeling feverish; started night of 4/3/21 and lasted 24 hours or so; fine the next day. Fever has recurred several times since then, always without any other sx's (occasionally headache). Fever has ranged from 99.1 to 102.0; my average temp is about 97.3 degrees. It seems that the frequency and duration of the fevers is worsening. It started out lasting only a day, but the last episode lasted for a week (PM fevers only that week)

Other Meds: Spironolactone, Omega 3 Fish oil, Ashwagandha supplement

Current Illness: None

ID: 1685624
Sex: F
Age: 50
State: FL

Vax Date: 02/08/2021
Onset Date: 06/10/2021
Rec V Date: 09/09/2021
Hospital:

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

Lab Data: Steroids were prescribed. Visit to doctor

Allergies: sulfa ,

Symptom List: Pharyngeal swelling

Symptoms: red rash started around bottom area .3 months later rash begin to spread to trunk . Stomach has hives

Other Meds: Kratom herbal

Current Illness: no

ID: 1685625
Sex: F
Age: 38
State: PA

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

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

Lab Data:

Allergies: Peanuts, bees

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Chest pain, shortness of breath, and numbness/tingling on right side. Chest pain is sometimes severe. Vision is a bit blurry on right side. Chest pain radiates to left side at times.

Other Meds:

Current Illness: None

ID: 1685626
Sex: F
Age: 47
State: VA

Vax Date: 08/07/2021
Onset Date: 08/10/2021
Rec V Date: 09/09/2021
Hospital:

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

Lab Data: X-ray; blood work; TCR.

Allergies: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: SORE THROAT, FATIGUE AND DIZINESS AND COUGHING. I went to the urgent care and they ran blood work and TCR and X-ray. The doctors said I had Covid ammonia and they gave me a couple of medicines and antibiotics. I was nauseaus and achy and the doctor told me that I can't take the second dose

Other Meds: LAXIUM; hydroxyzine; vitamin D; vitamin C; multivitamin

Current Illness: None

ID: 1685627
Sex: F
Age: 30
State: CO

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

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

Lab Data:

Allergies:

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

Symptoms: Pt presented to ED 1 day following vaccine with sudden onset midsternal chest pain

Other Meds:

Current Illness:

ID: 1685628
Sex: F
Age: 44
State: IA

Vax Date: 08/18/2021
Onset Date: 08/25/2021
Rec V Date: 09/09/2021
Hospital: Y

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

Lab Data: see above

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Patient had sudden shortness of breath. Ambulance documented severe hypoxia. ER did CT scan of chest which showed flash pulmonary edema. Admitted for two days in hospital. Echo showed EF 39%. Troponin mildly elevated. WBC elevated to 23,000. Diagnosis is myocarditis and cardiomyopathy due to COVID vaccine.

Other Meds:

Current Illness:

ID: 1685629
Sex: F
Age: 75
State: FL

Vax Date: 04/01/2021
Onset Date: 08/12/2021
Rec V Date: 09/09/2021
Hospital: Y

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

Lab Data: COVID PCR 8/19/2021

Allergies: NKDA

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

Symptoms: 8/20/21: Admitted to hospital c/o generalized weakness over the last week. found to be COVID positive on 8/19/21. Diagnosed with: sepsis, hypoxia, acute COVID-19. Note: patient vaccinated with Pfizer COVID-19 vaccine on 3/11/21 and 4/1/21. 8/24/21: Discharged

Other Meds: Insulin, calcitril, clonidine, dorzolamide-timolol opthalmic solution, furosemide, hydralazine, latanoprost ophthalmic, metoprolol, pravastatin

Current Illness: ESRD on peritoneal dialysis

ID: 1685630
Sex: F
Age: 77
State: FL

Vax Date: 04/10/2021
Onset Date: 08/27/2021
Rec V Date: 09/09/2021
Hospital: Y

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

Lab Data: COVID PCR test performed on 8/27/21 and came back positive,

Allergies:

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

Symptoms: Patient presented to hospital with complaints of hypoxia, SOB, no appetite, increased weakness

Other Meds:

Current Illness:

ID: 1685631
Sex: F
Age: 43
State: WA

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

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

Symptoms: This report is for a failed administration of the vaccine. The person administering had a faulty needle/ syringe and the vaccine ended up all over my arm and the arm rest in the care. I stated it was spread out all over my arm and car and she said it was a nerve reaction. It was not. I know what a nerve reaction is. I spoke to my doctor and no one knows if I was vaccinated. This is an issue because I cannot get another vaccine because technically I was vaccinated, even though my car was vaccinated. I have pictures to show this issue and a witness in the car with me whom had a successful vaccine. No pharmacy can administer a vaccine to me because the CDC guidelines state if you are vaccinated you cannot get another nor can you switch to Pfizer or Moderna. I would like to get a Pfizer or Moderna vaccine as I am a woman in the age group with birth control that has high risk.

Other Meds: This report is for a failed administration of the vaccine. The person administering had a faulty needle/ syringe and the vaccine ended up all over my arm and the arm rest in the care. I stated it was spread out all over my arm and car and

Current Illness: None

ID: 1685632
Sex: F
Age: 56
State:

Vax Date: 09/09/2021
Onset Date: 09/09/2021
Rec V Date: 09/09/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Within 10-15 minutes after receiving Pfizer Covid Vaccination patient experienced shakiness, dizziness, difficulty breathing, wheezing, coughing, throat tightness and difficulty swallowing. Pt was given a dose of epinephrine 0.3mg and immediately patient felt her throat tightness/difficulty swallowing improve but still had shakes, wheezing, and coughing. Emergency personnel arrived and took care of patient and patient eventually went home.

Other Meds:

Current Illness:

ID: 1685633
Sex: M
Age: 62
State: NY

Vax Date: 05/01/2021
Onset Date: 05/29/2021
Rec V Date: 09/09/2021
Hospital:

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

Lab Data: 7/6/2021,Cardiologist check,Bach on medication for Tachycardia and Arythmia. Several checks since,

Allergies: None

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

Symptoms: About 6 hours post injection felt a couple incidents of tachycardia and notable arythmia.Had been symptom free for 8 months.within 3 weeks,resting pulse of 135 plus was the norm.Despite my history,it seemed that something triggered it.Covering my bases.

Other Meds: Metformin,Allopurinol,Lisonipril,Torsemide,Glimperide,Invokana,Simvastatin,Warfarin Sodium.

Current Illness: None observed

ID: 1685634
Sex: F
Age: 16
State: NC

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

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

Lab Data:

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Vaccine was mixed on 9/7/21 at 1650. This patient received this dose on 9/8 at 1015, The vial was "expired" past its 6-hour mix window. Patient was monitored for 15 minutes per protocol, but error was not realized until after patient was home. We attempted to contact patient to notify of event but have not been able to reach them. we will try again.

Other Meds: Covid-19 Pfizer vaccines

Current Illness: none

ID: 1685635
Sex: F
Age: 30
State: AZ

Vax Date: 07/23/2021
Onset Date: 09/03/2021
Rec V Date: 09/09/2021
Hospital: Y

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

Lab Data:

Allergies: Penicillin

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Mother was 37 weeks for her first COVID vaccination and was 40 weeks for her second vaccination. The neonate was born with no complications at birth. The neonate began to develop severe sweating episodes while breast feeding and 3 weeks post-birth was diagnosed with Congestive Heart Failure with reduced LV function with an EF of 37%. The neonate was admitted to the pediatric ICU for critical care management of her CHF. She was placed on IV milrinone and IV Lasix. After two days she was transitioned to oral Enalapril and oral Lasix. She was subsequently discharged to home in stable condition with oral Enalapril and Lasix.

Other Meds: Prenatal vitamen

Current Illness: None

ID: 1685636
Sex: F
Age: 57
State: NY

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

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

Lab Data:

Allergies: Antibiotics Sulfa

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

Symptoms: I started with a fever and tired and sore throat. It went away with in a week. 2 weeks later I had a lump in my right under arm. I saw my oncologist, he felt it was vaccine related. The next day I had my breast swelled and painful and my areola had a sore on it. It took 3 ? 4 days to go away. It was very painful. 3-4 weeks I had a lump under my left arm, and it was bigger than the previous one. I sent a text to my PCP because I was unsure about the second vaccine. He recommended to get it. I am still unsure though.

Other Meds:

Current Illness:

ID: 1685637
Sex: F
Age: 50
State: VA

Vax Date: 09/08/2021
Onset Date: 09/08/2021
Rec V Date: 09/09/2021
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: Medical allegen panel ran on 9/9/21 to see if any reaction on eggs. Panel results will not be back for 3 to 5 days.

Allergies: None aware of my whole life.

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

Symptoms: I felt something go down the left side of my body once injected. A few hours later hives (small bumps red, itchy) 4 to 5 hours after vaccine administered hives on legs, back of knees, arms, shoulders, back, one on forehead, neck back.

Other Meds: Vit D3, Vit C, zinc, Tylenol 500 mg

Current Illness: Covid-19 end of June or early July.

ID: 1685638
Sex: F
Age: 39
State: FL

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

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

Lab Data:

Allergies: 0

Symptom List: Unevaluable event

Symptoms: Heart palpitations

Other Meds: 0

Current Illness: None

ID: 1685639
Sex: F
Age: 14
State: CA

Vax Date: 09/09/2021
Onset Date: 09/09/2021
Rec V Date: 09/09/2021
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: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: Moderna vaccine given to 14 yo old patient per parent request. The RN mistakenly administered the Moderna vaccine to the pediatric patient. Per CDC hotline, submit VAERS report and schedule patient for 2nd Moderna vaccine and document as "off label" administration given that the EUA does not include less than 18 yo for Moderna. Patient observed for 30 minutes and did not have a reaction to Moderna.

Other Meds:

Current Illness:

ID: 1685640
Sex: F
Age: 13
State: MO

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

Symptom List: Injection site pain, Pain

Symptoms: Patient runs cross country. On Saturday, after a 2 mile run, her lips were blue, face was pale and she had difficulty breathing and recovering from her run. She began having a cough with light exertion that is still persistent. Tuesday, while in PE at school, she reported black dots in the corners of her vision that slowly got larger. She thought she was going to pass out. During this Tuesday episode, she reported vision changes including faces glowing bright white and flickers swirling around her vision. We have kept her from running since Tuesday.

Other Meds: None, multivitamin

Current Illness: None

ID: 1685641
Sex: F
Age: 51
State: OK

Vax Date: 08/13/2021
Onset Date: 08/19/2021
Rec V Date: 09/09/2021
Hospital:

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

Lab Data: N/A

Allergies: N/A

Symptom List: Injection site pain, Menorrhagia

Symptoms: BREAKTHROUGH CASE : Covid + 08/19/2021

Other Meds: N/A

Current Illness: N/A

ID: 1685642
Sex: M
Age: 66
State: CA

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

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

Lab Data: Hospital - 5/17/2021 and 5/18/2021 - Pericarditis and artery blockages; Urgent Care - Negative result of COVID test on 8/13. PCR test on 8/17 - negative result for that COVID test.

Allergies: Sudafed; any decongestant; Prednisone - terrible withdrawal reaction to that, I think (they put me on it for the nasal polyps); latex

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

Symptoms: Reactions - no immediate reactions but at 05:00 that day - the pain at the injection site was 2. March 4th at 05:00 am - pain was an 8 on left arm. 99.4 was my fever - I was achy and very fatigued. At 08:00 am still the same as 05:00 am. 09:00 am still had temperature and I was achy but not as fatigue. 08:30 pm - pain at injection site was 2 and achy and very fatigued that night. I had a temp. 3/5/2021 - more normal with temperature and no aches or pains. 5/17/2021 ER and 5/18/2021 - at hospital for chest pain and temperature of 99. Diagnosed me with Pericarditis and three artery blockages. (They didn't officially admit me but just observed me within 24 hours). COVID symptoms: I went on August 11 around noon - all of a sudden felt sick - it was very low pressure which affects my sinuses and all. My taste went down for 5% for 2 seconds and then nothing after that - it's still like that; And then no sense of smell - and no that is between 0-5%; dull headache; congestion; runny nose and eye pain. I kept on eye at it at first. 8/16/2021 - Tasted 0 and smell - headache wasn't as bad; congestion had blood in the mucus (on the 17th, I had more blood in the mucus, too). But my eye doctor also had started me on Restasis - causing eye burning and I stopped it and the blood in mucus stopped. August 13th - called the doctor on 8/12/2021 - he gave me a prescription for a COVID test - and we scheduled a telehealth on 8/13 - and he said I could take the COVID test that day but they were closed by noon and I went to Urgent Care, that day - and I had results on Saturday. 14th, - negative results. I went to the Ear, Nose and Throat doctor on Thursday, August 26th. He diagnosed me -after doing a scan up the sinuses - moderate nasal polyps on the right side. He put me on Xhance Nasal Spray for polyps; Prednisone and Z pack; and he ordered a COVID antibodies blood test (SARS COV2 AB IGG Spike, semi QN) - result was greater than 20H - positive for antibodies. I had problems with the Prednisone - I finished the 9 day course of treatment on the 4th and I had withdrawal symptoms. While I was on it I had high anxiety. On Monday, I had wave of total body debilitating pain and couldn't lift my arms - for about 20 minutes. My condo has a water leak and I had to move to a hotel and that happened at the hotel. About 20 minutes later, the pain passed and went away. I went to ENT doctor today- polyps didn't change. So I go back next Thursday to discuss doing the Polyp surgery or doing a trial that would last 3 to 4 weeks. (They would inject something up there and it would release the polyps over a length of time). I will most likely get surgery. The pericarditis - unknown as far as if I'm recovered or not.

Other Meds: Silver (colloidal) - I probably stopped it for a few days before the vaccine

Current Illness: No

ID: 1685643
Sex: F
Age: 55
State: TX

Vax Date: 08/27/2021
Onset Date: 08/28/2021
Rec V Date: 09/09/2021
Hospital:

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

Lab Data: None

Allergies: Codeine; one strand of Penicillin

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: After the first vaccine I had all the symptoms. I ended up getting a UTI and sinus infection. I called the doctor's office for these symptoms. They did 2 Covid tests, I was positive for the PCR. It was almost 2 weeks since I had the vaccine. For the second dose I had a roaring sinus infection again. I called the doctor last Wednesday. They gave me Amoxycillin and oral steroids.

Other Meds: Vitamin C; vitamin D3; zinc; selenium; Atorvastatin; Lisinopril; Montelukast; Pantoprazole; Omeprazole; Zyrtec

Current Illness: After first vaccine I got Covid for the third time

Date Died: 02/22/2021

ID: 1685644
Sex: M
Age: 78
State: MA

Vax Date: 02/13/2021
Onset Date: 02/15/2021
Rec V Date: 09/09/2021
Hospital:

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

Lab Data: None

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: He received the vaccine on 2/13/21 by 2/15/21 he was not feeling himself didn?t really eat by 2/17/21 he couldn?t walk by 2/19/21 he was admitted to hospice and by 2/22/21 he passed away

Other Meds: Seroquel

Current Illness: Lewy Bodie dementia Lyden factor five

ID: 1685645
Sex: M
Age: 22
State: TN

Vax Date: 09/09/2021
Onset Date: 09/09/2021
Rec V Date: 09/09/2021
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: PENICILLIN --- CAUSED VOMITING YEARS AGO.

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

Symptoms: VACCINE ERROR: PATIENT RECEIVED MODERNA COVID-19 VACCINE ON 08/09/2021 AND A NURSE INADVERTENTLY GAVE THE PFIZER COVID-19 VACCINE TODAY. NO ADVERSE REACTION WAS NOTED. THE PATIENT WAS INFORMED OF THE ERROR AND DENIED ANY COMPLAINTS.

Other Meds: UNKNOWN.

Current Illness: NONE.

ID: 1685646
Sex: M
Age: 61
State: IL

Vax Date: 03/05/2021
Onset Date: 06/23/2021
Rec V Date: 09/09/2021
Hospital:

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

Lab Data: Echocardiogram 07/19/2021; Cardiac CT 08/05/2021

Allergies: None

Symptom List: Nausea

Symptoms: Atrial Fibrillation diagnosed 06/23/2021; currently being treated medically ; cardioversion scheduled 10/26/2021

Other Meds: Hydrochlorothiazide, atenolol, baby aspirin, zinc tablet, fish oil, vitamin C, multi-vitamin supplement

Current Illness: None

ID: 1685647
Sex: F
Age: 24
State: MI

Vax Date: 12/29/2020
Onset Date: 08/01/2021
Rec V Date: 09/09/2021
Hospital:

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

Lab Data: A1c- 6.5%; POCT glucose random- 204 mg/dL; Glucose fasting- 130 mg/dL; Glutamic Acid Decarboxylase- 0.38 nmol/L; Islet antigen 2 antibody- 2.34 nmol/L

Allergies: Penicillins

Symptom List: Injection site pain

Symptoms: Type 1 Diabetes- discovered by repeat urogenital infections with glucose in urine. UTIs started in late July 2021 and diagnosis was early August 2021.

Other Meds: Blisovi 1/20 FE; Venlafaxine 150 mg; Cetirizine 10 mg; Cyclobenzaprine 5 mg

Current Illness:

Date Died: 09/01/2021

ID: 1685648
Sex: M
Age: 64
State: TX

Vax Date: 07/21/2021
Onset Date: 08/23/2021
Rec V Date: 09/09/2021
Hospital: Y

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

Lab Data: COVID Positive on 8/23/2021; INR 4.4 on 9/1/2021; platelets 14 on 8/29/2021; blood culture positive for enterobacter cloacae

Allergies: Ibuprofen, tramadol, methocarbamol

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

Symptoms: Pfizer-BioNTech COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Pfizer Vaccines on 5/24/2021 and 7/1/2021. Patient previously hospitalized for COVID-19 8/11/2021 to 8/15/2021 where he received remdesivir an. Presented to ED on 8/23/2021 with complaints of difficulty breathing. BiPAP was initiated in ED. Patient oxygenation continued to decompensate and eventually required mechanical ventilation. Patient developed seizures, shock, GI bleeding, DIC, and acute kidney failure requiring dialysis. Patient had enterobacter bacteremia. Patient received dexamethasone, ceftriaxone, cefepime, methylprednisolone, azithromycin, and vancomycin. After discussion with family, care was withdrawn on 9/1/2021 and patient expired at 1442.

Other Meds: albuterol 1-2 puffs 4 times daily as needed, atorvastatin, 40 mg daily, azelastine 1 drop both eyes twice daily as needed, bupropion 300 mg daily, cetirizine 10 mg daily, cinacalcet 30 mg daily, citalopram 40 mg daily, ergocalciferol 1250 m

Current Illness:

ID: 1685649
Sex: M
Age: 44
State:

Vax Date: 08/25/2021
Onset Date: 08/27/2021
Rec V Date: 09/09/2021
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: numbness on fingertips,

Other Meds:

Current Illness:

ID: 1685650
Sex: F
Age: 64
State: MD

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/09/2021
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: vicodin, methylprednisolone and boniva

Symptom List: Tremor

Symptoms: chills, fever 100.2, body aches, sore arm, red at injection site approx 3 " around, nauceous, weakness, severe headache, difficulty breathing, face swelled and was red like a rash. Called primary care doctor the said take benedryl and if not better go to urgent care. Took benedryl. Got worse with breathing so went to urgent care. They would give me steroids but I am allergic. Sent me to emergency room. Went to emergency room by the time I was seen at 10:30pm on 9/4 my breathing had eased and swelling in face had gone down. Doctor decided not to give epi pen or steroids and told me to return if I got worse.

Other Meds: Forteo, multivitamin, flaxseed oil, stool softner, baby aspirin twice a week, vitamin b2, probiotic, melatonin, magnesium and plant calcium with vitamin d3, k1 and k2.

Current Illness: recovering from concussion - injury February 2021

ID: 1685651
Sex: F
Age: 58
State: WA

Vax Date: 09/09/2021
Onset Date: 09/09/2021
Rec V Date: 09/09/2021
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: Erythema, Pruritus

Symptoms: About 15 minutes after injection patient complained of itching in her mouth and throat. 50mg Benadryl given.

Other Meds:

Current Illness:

ID: 1685652
Sex: M
Age: 66
State: MN

Vax Date: 03/02/2021
Onset Date: 09/07/2021
Rec V Date: 09/09/2021
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: trazodone

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

Symptoms: headache, cough, shortness of breath, body aches, ear pain, sinus congestion, nasal congestion, post nasal drainage starting on 9/7/21

Other Meds: Alprazolam; Metoprolol, Melatonin, Aspirin, Valcyclovir; Tadalafil, Zolpidem

Current Illness: none

ID: 1685653
Sex: F
Age: 47
State: NY

Vax Date: 09/01/2021
Onset Date: 09/02/2021
Rec V Date: 09/09/2021
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 just sort medical advise about the fevers being so high and the exagerated response from the auto immune disease i have. My doctor is a family friend and was concerned and monitored the immune response closely

Allergies: sulfa drugs

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

Symptoms: following morning i contacted my Doctor to do a telehealth because i have an Auto immune disease and i started to run extremely high fevers 102.8 -103.6. I had also noticed some memory issues after dose # 1 and they seemed to get worse with 2nd dose. couldnt recall my own telephone number. forgot the pin to my debit card would walk into a room and forget why misplace items keys, phone, medication bottles. had to set alarms in phone because i cant remember if i took my medication and had to count pills to see if i did or not. the fevers lasted 4 days and other then memory issues i feel normal. was also exposed to a patient at work on 09/06 that is now admitted at hospital with covid and she was fully vaccinated. i went and got tested yesterday and will retest again after 5 days from exposure

Other Meds: imatrex 100 mg prn, hydroxychloriqin 200 mg bid, benlysta 1 injection sq weekly, adderall 30 mg qd

Current Illness: MCTD

ID: 1685654
Sex: F
Age: 55
State: CA

Vax Date: 09/07/2021
Onset Date: 09/08/2021
Rec V Date: 09/09/2021
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: N/A

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Fever, body aches, sensitive skin, fatigue, sore arm

Other Meds: Lisinopril 10mg/day

Current Illness: None

ID: 1685655
Sex: M
Age: 47
State: TX

Vax Date: 07/29/2021
Onset Date: 08/01/2021
Rec V Date: 09/09/2021
Hospital:

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

Lab Data: EKG, 24hr Heart Monitor, multiple blood tests and multiple Dr. Consults with no findings or diagnosis. Have Cardiologist appt for Oct 7th.

Allergies: Penicillium

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

Symptoms: On going chest discomfort, shortness of breath, heart fluttering since the 4th day after 1st dose. When having an episode, while lying down, laying on either side seems to make it worse. After the initial 72hr episode, symptoms subsided for about 10days. Just prior to me scheduling 2nd shot, symptoms returned Friday Aug 27th and have remained. This is as of this report on 9/9/2021. No treatment besides keeping activities light, yard work and occasional walking on days with no issues. Have not worked out or ran since vaccine.

Other Meds: OTC Ibuprophen or Tylenol, and OTC Claritin as needed. NOT DAILY

Current Illness: None

ID: 1685656
Sex: F
Age: 27
State: OK

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

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

Symptoms: BREAKTHROUGH CASE : Covid + 09/08/2021

Other Meds: Unknown

Current Illness: Unknown

ID: 1685657
Sex: F
Age: 35
State: VT

Vax Date: 09/01/2021
Onset Date: 09/09/2021
Rec V Date: 09/09/2021
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: Pain in extremity

Symptoms: Skin on back and neck hurts (feels sunburnt) Low fever 100? F Headache Chills Fatigue Arm soreness All still ongoing from 16 hours after vaccination until now (26 hours after vaccination)

Other Meds: None

Current Illness: None

ID: 1685658
Sex: F
Age: 62
State: NJ

Vax Date: 09/08/2021
Onset Date: 09/08/2021
Rec V Date: 09/09/2021
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: Penicillin, Tetracyline, Erythromycin, Sulfa drugs, Ceclor Pulvule, Avelox, Lomotil, Tequin, Ryanatan, Transderm Scop, Flomas, Entex LA, Anaprox, Sudafed, Allegra. Detrol LA, Nitrofuratin.

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

Symptoms: Headache, arm pain at site, dry eyes. Fever, chills, vomiting, fatigue, shakes, weak, dizzy. Stabbing pain in left arm pit.

Other Meds: Sertraline 50mg, Prilosec OTC, Calcium/Magnesium/Zinc, B-6, D-3.

Current Illness: None

ID: 1685659
Sex: F
Age: 54
State: WA

Vax Date: 09/09/2021
Onset Date: 09/09/2021
Rec V Date: 09/09/2021
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 complained of bilaterial face numbness after vaccine. 50 mg of Benadryl given.

Other Meds:

Current Illness:

ID: 1685660
Sex: F
Age: 76
State: CA

Vax Date: 03/04/2021
Onset Date: 07/14/2021
Rec V Date: 09/09/2021
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: I had a rash that started between my breasts. I was itchy and burning along my breastbone. It comes and goes, more in the evening. The doctor about it twice because it was not going away. She is having me go see a specialist for it.

Other Meds: Saltine

Current Illness:

ID: 1685661
Sex: F
Age: 4
State: GA

Vax Date: 08/27/2021
Onset Date: 08/27/2021
Rec V Date: 09/09/2021
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: no

Symptom List: Vomiting

Symptoms: 3 am fever 101 . Lost color nausea and vomiting. symptoms lasted 4 complete days .

Other Meds: flintstone complete vitamin

Current Illness: no

ID: 1685662
Sex: M
Age: 74
State: CO

Vax Date: 02/11/2021
Onset Date: 06/30/2021
Rec V Date: 09/09/2021
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: COVID vaccine 2nd dose on 2/11/21 Pt with COVID symptoms on 6/29/21 - testing COVID + on 7/1/21 Regeneron given on 7/6/21

Other Meds:

Current Illness:

ID: 1685663
Sex: F
Age: 33
State: CA

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 09/09/2021
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: I EXPERENCED MY THROAT STARTING TO SWELL SOON AFTER INJECTION AND A RASH STARTED TO DEVELOP FROM THROAT TO COLLAR BONES. I TAKEN BENADRYL TO RELEVE THE SYMPTOMS.

Other Meds:

Current Illness:

ID: 1685664
Sex: M
Age: 21
State: NM

Vax Date: 04/12/2021
Onset Date: 08/30/2021
Rec V Date: 09/09/2021
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: Aug 30, 2021@14:07 FLU A NEGATIVE, FLU B NEGATIVE, RSV NEGATIVE _COVID-19 POSITIVEA*

Allergies: Amoxicillin, Pedizole

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Felt Feverish, Chills, Lost Taste and Smell

Other Meds: None

Current Illness: None

ID: 1685665
Sex: F
Age: 23
State: KY

Vax Date: 06/11/2021
Onset Date: 09/07/2021
Rec V Date: 09/09/2021
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: PT VACCINATED USING MODERNA 5/14/2021 (045B21A) + 6/11/21 (025C21A). S/O BEGAN 9/3/21, TESTED + 9/7/21

Other Meds:

Current Illness:

ID: 1685666
Sex: M
Age: 61
State: MA

Vax Date: 06/16/2021
Onset Date: 06/21/2021
Rec V Date: 09/09/2021
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: None

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

Symptoms: High Pitch Constant Ringing in Ears.

Other Meds: None

Current Illness: None

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am