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: 1689939
Sex: M
Age: 70
State: AR

Vax Date: 03/15/2021
Onset Date: 03/17/2021
Rec V Date: 09/10/2021
Hospital:

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

Lab Data: none

Allergies: to many to list here, was not near anything I am allergic too

Symptom List: Dysphagia, Epiglottitis

Symptoms: After First Injection, the next day I was fine The 2nd Day I had Diarrhea for 24 hours.

Other Meds: Regular BP meds

Current Illness: none

ID: 1689940
Sex: F
Age: 28
State: IL

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/10/2021
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: Pfizer vaccine was reconstituted with Moderna vaccine that was sitting right next to it, instead of the sodium chloride

Other Meds:

Current Illness:

ID: 1689941
Sex: F
Age: 13
State: WA

Vax Date: 08/16/2021
Onset Date: 09/08/2021
Rec V Date: 09/10/2021
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: penicillins

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

Symptoms: Patient presented with isolated left facial nerve palsy (Bell's Palsy) 24 days after receiving Pfizer/BioNTech Covid-19 vaccine. No other trigger identified. Unclear whether related. Started on prednisone taper.

Other Meds: cetirizine 10 mg Albuterol 90 mcg/actuation Flonase 110 mcg

Current Illness: none

ID: 1689942
Sex: F
Age: 32
State: CA

Vax Date: 03/12/2021
Onset Date: 03/23/2021
Rec V Date: 09/10/2021
Hospital:

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

Lab Data: Blood tests, August 12th, new doctor's office, low on iron.

Allergies: No.

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: I started with having irregular cycles which I have never had before. They started around 2 weeks after the vaccine and then throughout the next few months, they repeated as irregular, much longer than usual and irregular mid-cycle bleeding. There is no explanation as to why it was happening. Doctor said she had seen other women with irregular symptoms after the COVID vaccine. They symptoms have persisted. It's a little better, I do not experience any bleeding outside of the normal cycle bleeding but the dates are still irregular. I have change in health plans and there is a new doctor that is going to do a pelvic ultrasound (September 21st) to see if there is anything wrong there. My new doctor said that because of the irregular bleeding, I was a little low on iron. I was told to take a multi-vitamin with iron. I was almost anemic but not quite.

Other Meds:

Current Illness: No.

ID: 1689943
Sex: F
Age: 26
State: RI

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

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

Lab Data:

Allergies: Latex Sensitivity

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

Symptoms: Symptoms after vaccination: whole body itchy, tongue and throat scratchy, hives, nauseous and light headed/anxious. Blood pressure: 159/96 and heart rate:156. Took Benadryl before administration. Rescue was called. IV started and given more Benadryl. Taken to emergency room and placed in the critical care observation room. Given more Benadryl, Famotidine, Solumedrol, Zofran and Normal Saline. Observed for 3 hours. Sent home with epi pen. Took Benadryl 2 more times that night. Next day still taking Benadryl because when it starts wearing off itchy symptoms return. Feeling light headed, scratchy throat, anxious and itchy still the next day (9/10/2021). Following up with Primary Doctor on 9/13/2021.

Other Meds: Junel-birth control

Current Illness:

ID: 1689944
Sex: M
Age: 70
State: AR

Vax Date: 04/12/2021
Onset Date: 04/14/2021
Rec V Date: 09/10/2021
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: None

Allergies:

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

Symptoms: Day of Injection and day after no Problem, 2nd Day after, I have Diarrhea for the next 5 days.

Other Meds:

Current Illness:

ID: 1689945
Sex: F
Age: 63
State: MD

Vax Date: 08/02/2021
Onset Date: 08/03/2021
Rec V Date: 09/10/2021
Hospital:

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

Lab Data: CT of head was negative

Allergies: none

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: I had received my Pfizer Covid vaccine on 8/2/21, between 10 am - 2:00 pm. Myalgias started around 8 pm. I took Trazadone 50 mg at about 9 pm, at which time I went to bed. ( I had taken Trazadone previously and had not had any adverse reactions.) I woke up in the middle of the night to go to the bathroom, as usual. During the night, I had myalgias and night sweats. At about 7 am, I awoke, had significant myalgias, was a bit dizzy, so I sat up and waited a couple of minutes before getting up. I got up, walked about 10 steps to the bathroom, used the toilet and went to the sink. I felt very dizzy and next thing I knew, I had passed out, hit my head on the tile floor. When I came to, I was extremely dizzy. My husband helped me to bed, I took Tylenol, had ice on my head. I take ASA 81 mg every other day, so my head continued to bleed for 4 hrs. I went to the local Medical Center Emerg department for evaluation and CT. The 1st week after my fall I was very fatigued and slept 10-12 hrs at night with 1-2 naps during the day. (This was a stark contrast to my usual 6-7 hrs/ night, with no naps.) I continued to be dizzy at times, lightheaded and sometimes queezy. I was unable to read much at all, could not tolerate noise or viewing a screen. I started PT on 9/2/21 and the rehab therapist diagnosed me as having a nerve inflammation (neuritis) affecting my vestibular system. I am improving continually.

Other Meds: Taken at about 7:00 pm on 8/2/21: Rosuvastatin 10 mg , Ezetimibe 10 mg, Co Q10 Trazadone 50 mg taken approximately 9:30 pm on 8/2/21

Current Illness: none

ID: 1689946
Sex: F
Age: 65
State: FL

Vax Date: 02/11/2021
Onset Date: 03/01/2021
Rec V Date: 09/10/2021
Hospital:

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

Lab Data: Blood work (all normal, COVID negative); Chest XRays (normal); EKGs (normal); CT scan (normal).

Allergies: Numerous

Symptom List: Pharyngeal swelling

Symptoms: Have developed long-hauler symptoms since getting second Moderna vaccine: heart palpitations, shortness of breath, nausea and inability to eat, exhaustion.

Other Meds: None.

Current Illness: None

ID: 1689947
Sex: M
Age: 87
State: IL

Vax Date: 02/12/2021
Onset Date: 08/04/2021
Rec V Date: 09/10/2021
Hospital: Y

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

Lab Data: 8/5/21 COVID-19: Positive 8/4/21 Chest xray: Negative 8/4/21 temp: 100.6

Allergies: None

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Came to ER on 8/4/21 with complaint of frequent falls and urinary incontinence x 1 week. Complained of generalized weakness and balance problems and sore throat. Fever of 100.8. COVID19 test came back positive. Was admitted for observation. On room air at 95%. Placed on azithromycin and mucinex

Other Meds: Diltiazem, gabapentin, olmesartan,

Current Illness:

ID: 1689948
Sex: F
Age: 42
State: GA

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

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient stated that she had the normal side effects. The sat following the vaccine she was having joint pain. Shed took Tylenol and they went away. On today She stated that the pain is worst it is in her joints. She stated that she can barely walk.

Other Meds: Spiriva wilce Seasoniq (Birth Control)

Current Illness:

ID: 1689949
Sex: F
Age: 62
State: IL

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

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

Lab Data: None - a side effects were minor in nature. Vitals taken by a nurse in the hospital on 9/9 and an ER tech at home on 9/10

Allergies: Epinephrine, naproxen sodium, and codeine (hyper sensitivity)

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

Symptoms: Paresthesia (numbness/tingling in left hand) Dizziness (minor, lasting about 15 minutes, BP 136/84, Pulse 64, Oxygen 98% after resting 5 minutes) Minor confusion (made many unusual but minor errors in regard to location and date during my evening shift) Second day - minor headache and tiredness, occasional chest pain, pulse 76

Other Meds: Vitamin C, Vitamin D3, Zinc, Quercetin, CoQ10, EGCg, Glutathione, Calcium, Magnesium, Turmeric, Resveratrol, Androphraphis, took 1 tylenol

Current Illness: None

ID: 1689950
Sex: F
Age: 54
State: IL

Vax Date: 03/11/2021
Onset Date: 03/12/2021
Rec V Date: 09/10/2021
Hospital:

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

Lab Data:

Allergies: sulfa, latex, potatoes, coconut, avocado, bananas, shea butter, rosemary, sage

Symptom List: Rash, Urticaria

Symptoms: About 5 pm the day of the vaccine (Friday) I was getting chills and achy. Two days later I was so weak I couldn't even walk up the stairs. By Monday I was feeling a little better, by Tuesday the headache went away.

Other Meds:

Current Illness:

ID: 1689951
Sex: F
Age: 39
State: WA

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/10/2021
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: pt reported immediate intense pain /burning on injection site and followed by tingling of tongue. she refused calling for aid or waiting around ; she said she has EpiPen on her person and husband in care that will drive her to er/urgent care.

Other Meds:

Current Illness:

ID: 1689952
Sex: M
Age: 60
State: MA

Vax Date: 07/22/2021
Onset Date: 07/23/2021
Rec V Date: 09/10/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Leg swelling. Joint pain. Eye pain. Headaches. More pronounced after second Pfizer shot which was on 8/16/2021 whose Lot# is EW0185.

Other Meds:

Current Illness:

ID: 1689953
Sex: F
Age: 29
State: WI

Vax Date: 03/06/2021
Onset Date: 08/04/2021
Rec V Date: 09/10/2021
Hospital:

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

Lab Data: COVID test August 4th 2021 ; negative on both the rapid and PCR

Allergies: codeine, dairy, eggs

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

Symptoms: Mouth felt like it was on fire, fatigue, throat was sore, migraine. It was allergies.. Relocated in Apfil. They gave me a shot in my arm for the pain, just said not to take anything OTC for 24 hours because the shot was like a 'little bit of everything'. Also gave me a steroid pack and antibiotics. I was worried about having COVID again or a virus or something. So, they gave me all of that just to be safe. I started taking Zyrtec, got a humidifier and took Mucinex for about 10 days and was good to go, it was definitely allergies.

Other Meds: Zoloft, Zofran, Hydroxine, Gabapentin, turmeric

Current Illness:

ID: 1689954
Sex: M
Age: 60
State: MD

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

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

Lab Data: Lumbar X-ray (9/10): Herniated disk of L5-S1

Allergies: - peanuts - Spanish peanuts - cashews - Hazelnuts/Filberts - peas - soybeans/tofu - cantaloupe - honeydew - banana - mango - guava - papaya

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

Symptoms: Pain radiating along the sciatic nerve running down right leg from the lower back throughout the day and night. Worst with standing and sitting.

Other Meds: Eliquis Allopurinol Prednisone Singular

Current Illness: Pancytopenia secondary to Imuran

ID: 1689955
Sex: F
Age: 71
State: CO

Vax Date: 02/02/2021
Onset Date: 07/18/2021
Rec V Date: 09/10/2021
Hospital:

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

Lab Data: Covid-19 Positive

Allergies: N/A

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

Symptoms: I had been outside all day and I was coughing. I was still coughing the next day and I felt unwell. I then started to have body aches and started to run a fever. I tested positive for Covid-19 and they identified the Delta Variant. I was given an antibody infusion the next day which was three days after the first symptoms. I felt really out of it for a week. I had no balance and my fever was coming and going. I felt like I had a foggy brain and I was extremely fatigued. It has been seven weeks and I still have some fatigue and I feel like I am hyperventilating sometimes. I can still breath deeply but it feels like my heart is beating fast. I have to stop and take a break for a few minutes. The cough was really bad for four weeks.

Other Meds: Simvastatin, Vitamins

Current Illness: N/A

ID: 1689956
Sex: F
Age: 31
State: CA

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

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

Lab Data: None

Allergies: No allergies to food or medication

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Warm heavy sensation to both feet, tingling to both calves, tingling to right and left hand

Other Meds: Zoloft 100mg and Mirapex 0.25mg

Current Illness: Depression and Restless Leg Syndrome

ID: 1689957
Sex: M
Age: 60
State: CO

Vax Date: 08/13/2021
Onset Date: 08/16/2021
Rec V Date: 09/10/2021
Hospital:

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: Patient recieved the vaccine and then had pain in the arm that was "excruciating" and wanted to go to the ER to have it seen but decided to wait until the following monday due to cost. He was given Colchicine as the Doctor thought it might be due to gout. The colchicine did not help at all. He came back to have it seen again a few days later by another physician and was told to continue on the colchicine and he did without relief. He came back again and recieved Diclofenac and Gabapentin for the pain that was from the top of the arm to the wrist and recieved a referal to a neurologist.

Other Meds: Liniopril and Omeprazole

Current Illness: none

ID: 1689958
Sex: F
Age: 70
State: NY

Vax Date: 03/15/2021
Onset Date: 06/10/2021
Rec V Date: 09/10/2021
Hospital:

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

Lab Data: July 11 - first MRI test - neurology. August 7 - second MRI test - orthopedist on spine

Allergies: none

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

Symptoms: Approximately 3 months later, I had extreme back head pain as if someone was beating me in the head with a hammer. It was almost paralyzing. So much pain that i could not do anything except sleep and not move. I finally went to the neurologist and had an MRI which showed i was diagnosed with occipital neuralgia which is inflamed nerves that travel to the skull. Never had so much pain in my life. The doctor was able to give me two injections in the back of my head to ease the pain. It did not work right away and at the same time the pain traveled to the right side of my neck with also practically crippled me. I could not turn my head at all. Went to an occupational therapist who took another MRi and said it could be a pinched nerve or arthritis. Never was so sick in my life. This condition required me to take pain medication which did not really help much. I spent most of the day crying in pain and not knowing what else to do. Then maybe two or three weeks later I woke up and all the pain disappeared. Have no idea what happened but I cannot say for sure if the Moderna shots had any impact of this since I have never been sick in my life. I have lead a pretty healthy life before.

Other Meds: paroxetine, simvastatin

Current Illness: none

ID: 1689959
Sex: F
Age: 50
State: AL

Vax Date: 08/23/2021
Onset Date: 08/26/2021
Rec V Date: 09/10/2021
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: MRI; Nerve conduction study; Blood test; EMG; Skin biopsy; Lumbar test; Antibody test.

Allergies: Macrobid; Wheat; Latex; Certain fruits & vegetables

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

Symptoms: Tingling & numbness of my legs and arms; Joint pain; Weakness from my calf, feet, wrists, and to my hands came back & it has continued to progress up to my thighs; Cold sensation; Rheumatoid Arthritis (recently diagnosed in June 2021) flared up; My symptoms have worsened after taking each dose.

Other Meds: None

Current Illness: N/A

ID: 1689960
Sex: M
Age: 36
State: MI

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

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

Lab Data:

Allergies: None

Symptom List: Unevaluable event

Symptoms: Brain cloudyness, Memory loss, Momths, ongoing.

Other Meds: None

Current Illness: None

ID: 1689961
Sex: M
Age: 12
State: OH

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/10/2021
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: n/a

Allergies: nkda

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

Symptoms: Syringe-Needle malfunction when technician performing vaccination (incomplete dose). Parent wanted us to consult with patient pediatrician first to consider an additional vaccination dose. Will be discussing with DR and utilize CDC and ACIP considerations, amount of dose was hard to estimate, likely >1/2 dose.

Other Meds: unknown

Current Illness: unknown

ID: 1689962
Sex: F
Age: 59
State: NJ

Vax Date: 08/20/2021
Onset Date: 08/20/2021
Rec V Date: 09/10/2021
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: Penicillin, Ciprofloxacin, Iodine

Symptom List: Injection site pain, Pain

Symptoms: Patient had a reaction on arm. Patient"s arm was red warm, raised and sore , symptom ongoing.

Other Meds: Novolin, Metoprolol, Levemir and Metformin

Current Illness: None

ID: 1689963
Sex: M
Age: 34
State: WI

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

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

Lab Data: None at this time. I am searching for a primary care physician so that I may get regular check-ups as well as get my heart checked out after experiencing palpitations.

Allergies: Cat and dog fur/hair. Melatonin.

Symptom List: Injection site pain, Menorrhagia

Symptoms: Extreme dizziness occurred immediately after the injection. As the dizziness increased my heart started pounding as hard as it could. I began to taste blood in the back of my throat when swallowing saliva. Dizziness kept increasing until the point the I nearly fainted. Breathing became extremely labored. I felt feelings of impending doom. I thought we were going to have to call an ambulance. It felt like I was dying. The episode lasted about 5 minutes, and was the worse 5 minutes of my entire life. Overnight I had the worst chills I have ever experienced. I also had a fever, but the chills were awful and worse than the fever. The next day I was experiencing tachycardia with a pulse of 120 bpm, my normal is around 60 bpm; I was also experiencing heart palpitations and skipped heart beats (I have never felt this before). On the third day I was mostly feeling weak, but still experiencing tachycardia and skipping heart beats/palpitations. By the fourth day I felt somewhat more normal again.

Other Meds: None.

Current Illness: None.

ID: 1689964
Sex: F
Age: 29
State: TN

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

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

Lab Data: N/a. Doctor called in valtrex and pharmacy said to report side effects

Allergies: Seasonal

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

Symptoms: Very sick and running a fever, couldn?t move, stay awake, was nauseous, and weak next day around lunch and lasted for over 24 hours. I was better the next day, but got 2 cold sores on chin. My cold sore seemed infected and had pus in it. I began getting more and more cold sores each day and by a week since the vaccine 9/9, had more than 10 on nose in nose, all over mouth, between nose and mouth and going down to chin. My lymph node under my chin became hard, hot, firm, and round, in size similar to an adult spoon and has not gone away. Teeth are constantly sensitive and hurt when I breath, jaw and mouth are in constant pain too. Around neck and ear mild pain with strange giant zits like I have never had before. Continuous headache, mouth tingling and itching and swelling

Other Meds: Nasal spray and zyrtec

Current Illness: None

ID: 1689965
Sex: M
Age: 44
State:

Vax Date: 09/07/2021
Onset Date: 09/08/2021
Rec V Date: 09/10/2021
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: Patient is reporting pain and swelling at the axilla area. Could be related to swollen lymph nodes.

Other Meds:

Current Illness:

ID: 1689968
Sex: F
Age: 31
State: FL

Vax Date: 09/08/2021
Onset Date: 09/10/2021
Rec V Date: 09/10/2021
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: Latex

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Chest tightening and redness around arm the size of a half dollar. Very hot to touch and painful.

Other Meds: None

Current Illness: None

ID: 1689969
Sex: F
Age: 41
State: AL

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/10/2021
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: Muscle weakness, weak shaky joints, confusion, diarrhea, extreme chills, headache, brain fog, numbness, tingling, fatigue

Other Meds:

Current Illness:

ID: 1689970
Sex: M
Age: 62
State: MA

Vax Date: 08/24/2021
Onset Date: 09/10/2021
Rec V Date: 09/10/2021
Hospital:

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

Lab Data: none

Allergies:

Symptom List: Nausea

Symptoms: Patient came in on 09/10 /21 and described an excruciating pain through entire right arm lasting for about 2 weeks which did resolved by the time of reporting it to pharmacy.

Other Meds:

Current Illness:

ID: 1689971
Sex: M
Age: 11
State: WA

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 09/10/2021
Hospital:

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

Lab Data: Unknown

Allergies: unknown

Symptom List: Injection site pain

Symptoms: Received Pfizer vaccine at age 11 years and 1 month. No adverse reactions reported.

Other Meds: Unknown

Current Illness: unknown

ID: 1689972
Sex: M
Age: 12
State: AR

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/10/2021
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 briefly fainted after vaccine

Other Meds:

Current Illness:

ID: 1689973
Sex: F
Age: 57
State: IN

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/10/2021
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: none

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

Symptoms: The patient came to the pharmacy to receive her second COVID vaccine (Pfizer). She did not have her card with her and she thought she was due for her second shot. We administered the vaccine. We later discovered that she was not due for her second dose until September 14th. The patient has not had any adverse effects from receiving the vaccine early.

Other Meds:

Current Illness:

ID: 1689974
Sex: F
Age: 13
State: OH

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/10/2021
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: Tremor

Symptoms: COVID -19 VACCINATION MODERNA WAS GIVEN TO A 13 YEAR OLD.

Other Meds: none

Current Illness: none

ID: 1689975
Sex: F
Age: 59
State: CA

Vax Date: 06/24/2021
Onset Date: 07/26/2021
Rec V Date: 09/10/2021
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: Medication: codeine (constipation, pt has history of diverticulitis) Food: none

Symptom List: Erythema, Pruritus

Symptoms: Patient had initial onset of eczema in 2008. In the past, patient's eczema was generally limited to chest and back. Patient noted weeping eczema around one month after getting vaccine. Pt said it itched so much that eyes watered. There was oozing and bleeding, then scabbing. Patient first noted it on the arms. It quickly spread to rest of the body. Pt said that abdomen and posterior are less affected. Pt reported that this event has resulted in significant scarring that was not present in previous episodes of eczema. Patient has been managing it on her own due to experience with ineffective doctors in the past. For years, patient has been using eucalyptus lemon oil, coconut oil, teatree oil, peppermint oil, lavender to make her own lotions and spray. Patient started using the lotion and spray immediately after she noticed new eczema. Patient says that home remedies stop itching, but eczema is still present. Patient that she sometimes uses neosporin for sores on the back.

Other Meds: Prescription: acyclovir 200mg capsule, escitalopram 20mg tablet, cyclobenzaprine 5mg tablet, levothyroxine 100mcg tablet, phendimetrazine 35mg tablet OTC: Benadryl, multivitamin, B-complex vitamin, melatonin Other: marijuana edibles 30mg of

Current Illness: After reporting symptoms to video visit with doctor, patient was diagnosed with COVID on 02/08/2021.

ID: 1689976
Sex: F
Age: 43
State: OR

Vax Date: 03/16/2021
Onset Date: 04/13/2021
Rec V Date: 09/10/2021
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: Blood test on 6/4 showed estradiol <15 and progesterone <0.5.

Allergies: None

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

Symptoms: Menstrual periods changed following 1st and second dose of the Pfizer vaccine. 2nd dose was taken 4/6/2022, lot EW0150. Previous menstrual cycles were between 21-30 days. Following the vaccines, the cycle was 137 days and the resulting menstruation was very light compared to normal cycles.

Other Meds: Triamcinolone acetonide 0.1%

Current Illness: None

ID: 1689977
Sex: F
Age: 32
State: FL

Vax Date: 08/13/2021
Onset Date: 09/10/2021
Rec V Date: 09/10/2021
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: shellfish

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

Symptoms: patient reported sharp pain in the back of her neck that she states started with shot and has continued

Other Meds: none

Current Illness: unknown

ID: 1689978
Sex: F
Age: 34
State: MD

Vax Date: 09/09/2021
Onset Date: 09/10/2021
Rec V Date: 09/10/2021
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: Penicillin, gluten, goat cheese, morphine/viocidin/codeine, Bactrim

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Bell's Palsy. Also occurred with first dose but was not confirmed related to the vaccine until it happened the second time too.

Other Meds: Generic Nexium, vitamin D, fiber gummy, Zyrtec, daily vitamin, Culterelle, vitamin B

Current Illness: None

ID: 1689979
Sex: M
Age: 58
State: CA

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

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

Lab Data: MRI 09/04/2021

Allergies: Avocado

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

Symptoms: Neuropathy left shoulder and arm. Severe extreme pain.

Other Meds: None

Current Illness: None

ID: 1689980
Sex: F
Age: 10
State: AL

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/10/2021
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:

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

Symptoms: Patient that received the Pfizer, and it was discovered after the fact that the patient was only 10 years old. We checked in with patient multiple times while she was here to verify that she was feeling okay and explained that the vaccine is not recommended as of now for patients under 12 years old.

Other Meds:

Current Illness:

ID: 1689981
Sex: F
Age: 67
State: CA

Vax Date: 03/09/2021
Onset Date: 03/12/2021
Rec V Date: 09/10/2021
Hospital:

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

Lab Data:

Allergies: asparagus

Symptom List: Pain in extremity

Symptoms: With the first vaccine I developed a slightly phlegmy cough, the cough seemed to progress to a point to where I experienced a shortness of breath. It has become more intense, so bad that one night I woke up wheezing and gasping for air. I was sent to a respiratory therapist, I ended up with different kinds of inhalers. This is something that has just kept going even after the second vaccine.

Other Meds: estroven

Current Illness: no

ID: 1689982
Sex: M
Age: 11
State: MS

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

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

Lab Data:

Allergies:

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

Symptoms: There were no adverse events but the vaccine was administered to the patient after the mother gave a DOB that made the patient 12 years of age. When they came for the second dose it was discovered that the patient was only 11 years old

Other Meds:

Current Illness:

ID: 1689983
Sex: F
Age: 27
State:

Vax Date: 08/30/2021
Onset Date: 08/30/2021
Rec V Date: 09/10/2021
Hospital:

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

Lab Data: on 9/9/2021 an non-stress test, ultrasound, and labs were all within normal limits.

Allergies: penicillin's

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

Symptoms: Patient had 1st dose of Pfizer Covid vaccine and on the same day the pt reported light spotting and cramping. These s/s were limited to only that evening of vaccination and resolved by the following day. Gestation age at time of vaccination =30w4d, EDD 11/05/2021.

Other Meds: ASA 81mg, calcium 500mg, magnesium 400mg, metformin 500mg, prenatal vitamin

Current Illness: gestational diabetes

ID: 1689984
Sex: F
Age: 36
State: CA

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/10/2021
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: Amoxicillin, sulfa drugs, pineapple, kiwi

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

Symptoms: RN Emergency Treatment Chief Complaint Patient presents with ? COVID-19 VACCINE BP 130/82 (BP Location: RA-RIGHT ARM, BP Patient Position: LYING, Cuff Size: Standard Adult) | Pulse 89 | Resp 20 | SpO2 100% Location of event Vaccine Center TRM Description of Event Patient came in today to receive second dose of Moderna. Patient did state she had fainted when she received her first dose at the pharmacy. As well as SOB that lasted shortly after receiving the vaccine. Patient does have allergies to amoxicillin, sulfa drugs, pineapple and kiwi. Patient does carry epi-pen for pineapple and albuterol for asthma. At 1515 patient's dad alerted RN that patient was not feeling well. RN assessed patient, placed 6L of O2 nasal cannula. Patient stated she was having a hard time breathing, and was experiencing chest pain. RN assessed vital signs, administered epinephrine to the right vastus lateralis at 1515. Patient stated very little improvement. Patient had albuterol inhaler, and patient had 2 puffs. Patient was moved to front of hospital, with little improvement in symptoms. EMS came and assessed patient and left at around 1538. Dr. was called and updated on patient. Interventions:Patient was assessed, monitored, Medications administered: Epinephrine 0.3mg auto injector; Lot:200909X Exp. 2/2022 Response to interventions and/or medications given:Little improvement Disposition:911 and Emergency Dept

Other Meds: Epinephrine auto-injector, Albuterol

Current Illness: Sickle cell anemia, Asthma

ID: 1689985
Sex: M
Age: 20
State: NJ

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/10/2021
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:

Symptom List: Vomiting

Symptoms: Patient felt like was going to pass out after receiving the Moderna vaccine but did not actually pass out. He was very light headed and then vomited. Patient says that he had passed out previously post vaccination on two occasions. After vomiting patient felt much better . He stated he had eaten 30 minutes prior to vaccination. He was awake and alert. He stayed 30 minutes after and then left with his mother.

Other Meds:

Current Illness:

ID: 1689986
Sex: F
Age: 71
State: CA

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/10/2021
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: gabapentin

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Client received the COVID vaccine (Janssen, lot # 206A21A, expiration 9/22) at 1:59. At 1415, RPh observed the patient standing at her seat in the observation area and asked her if she was ok. The client complained of dizziness and was escorted to a chair by RPh and RN. At that time, the client refused vital signs, snacks, juice, Benadryl, and to be seated in the zero gravity chair. The client was observed to be clammy, with normal skin color, and complained of "the world spinning" and nausea. She denied chest pain, headache, or shortness of breath. She was offered and accepted water. The client stated she has a history of epilepsy, fatty liver, kidney disease, hypertension, and high cholesterol. She stated that she is allergic to gabapentin and that she takes losartin but isn't sure what other medications she takes. The client appeared uncomfortable but was alert and oriented x4. At 1423, the client consented to having her vital signs assessed. At that time, her vital signs were as follows: blood pressure 130/88, heart rate 66, respiratory rate 14, O2 98%. At 1430, the client stated that her dizziness and nausea had resolved. At 1435, the client stated that her blurry vision had resolved and she no longer appeared to be clammy. At 1438, the client stood up and paced around the room. She stated that her dizziness had not resumed but that she "felt better" when standing. The client appeared to be anxious and uncomfortable but denied pain or shortness of breath. At 1443, the client complained of her nausea resuming and began to vomit in an emesis bag. After the episode of emesis, the client stated "I feel so much better now." The client denied any further nausea or dizziness. The client continued to drink water and sit comfortably in her chair. At 1445, the client's vital signs were as follows: blood pressure 128/76, respiratory rate 16, heart rate 72, O2 97%. Education provided regarding AMS activation and primary care follow up. The client denied any further questions and was escorted to her car by her husband, who drove her home.

Other Meds: losartan

Current Illness: see note

ID: 1689987
Sex: F
Age: 63
State: TX

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/10/2021
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: no known allergies

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

Symptoms: Patient was given flu shot and immediately after patients injection started to bleed a little more than normal. A few seconds later the injection site swelled up into a hard knot. Patient put ice on the injection site and the swelling went down a little.

Other Meds: lisinopril, rosuvastatin

Current Illness: no known illnesses

ID: 1689989
Sex: F
Age: 19
State: MO

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/10/2021
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: N/A

Allergies: N/A

Symptom List: Injection site swelling, Limb discomfort

Symptoms: PATIENT EXPERIENCED SLIGHT SYNCOPE, NAUSEA AND VOMITING AROUND 5 MINUTES AFTER INJECTION. PATIENT WAS GIVEN A WASTE BASKET, A WET PAPER TOWEL (FOR CLEANING OF THE MOUTH) AND A BOTTLE OF WATER AND WAS ASKED TO REMAIN IN THE VACCINATION BOOTH IN A CHAIR THAT HAD ARMS TO PREVENT FALLS AND POSSIBLE INJURY. PATIEN LEFT 15 MINUTES LATER UNDER OWN VOLITION WITH NO VISIBLE LASTING EFFECTS.

Other Meds: N/A

Current Illness: N/A

ID: 1689990
Sex: F
Age: 60
State: TN

Vax Date: 08/23/2021
Onset Date: 08/25/2021
Rec V Date: 09/10/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Injection site was hot, sore and swollen within 8 hours. I had fever between 101-102 until taking tylenol the next day. Most concerning was a maculopapular rash that appeared suddenly on my neck, upper chest, abdomen and back - it was red, raised and not pruritic. I took benadryl and it did not advance, but it took about 3 days to resolve. This was my third Moderna vaccine. Please note my second shot on 2/5/2021 resulted in fever up to 101 and sore, hot, swollen arm. I developed thrombophlebitis in my left great saphenous vein - symptoms began a few days after shot and persisted for weeks and later confirmed by ultrasound. No previous history of thrombophlebitis.

Other Meds: Methotrexate (halted for 2 weeks for vaccine administration), prednisone, folic acid, multivitamin

Current Illness:

ID: 1689991
Sex: F
Age: 54
State: GA

Vax Date: 09/07/2021
Onset Date: 09/08/2021
Rec V Date: 09/10/2021
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: 3:00 am 9-8-21 Pain swelling and fever at site of injection, along with body aches, headache and fever 99.9, began taking ibuprofen 200 mg x2 , took tepid bath to bring fever down. Same day after another round of ibuprofen still had all above symptoms after 2nd round of ibuprofen fever jumped to 103. Switched to Tylenol500 mg x2 more baths (Husband took a picture on 9-9-21) Swelling in arm bigger and site still feverish but head temperature coming back to normal. 9-10-21 mild headache at waking continued tylenol to ward of fever and ease headache and body aches arm still swollen but less red still have knot underneath injection site Husband took another picture of site of injection.

Other Meds: Lisinopril 20mg Levothyroxine 88mcg D3 25mcg

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am