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: 1693651
Sex: F
Age: 64
State: IN

Vax Date: 08/10/2021
Onset Date: 08/11/2021
Rec V Date: 09/12/2021
Hospital:

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

Lab Data: YOu did not give me enough time to fill all of this out. They are available if you want them.

Allergies: Zofran, Penicillin

Symptom List: Dysphagia, Epiglottitis

Symptoms: Adminstred at Day after vaccination, 8//11/21 hot flashes and headache developed. This headache did not go away. On 8/15/2021, started having dizzyness spells that would come and go randomly, whether sitting or standing. Headache was worsening. BP taken with an automatic cuff was 175/110. Thought it was an inaccurate reading. Repeated BP later with a different cuff. It was 168/ 93. Made an appointment to see provider. BP remained elevated in 160s-170s/ 80s- 110. Borrowed Labetalol from a friend and began taking that to try to controll BP until Dr. Appointment. Was taking 50mg BID. ON */20/21 felt worse. Headache worsened and more dizziness. Labetalol was not working well. Decided to go to ED at Hospital. BP upon admission was 192/93. The BP went as high as 243/117. I was treated with 4 antihypertensives to bring the BP down. I was sent home with a prescription for losartan 50 mg daily. It was not controlling my BP. I saw the cardiologist and am now taking losartan 100 with hctz 12.5. This seems to be working. I am still having the headache.

Other Meds: Fish oil supplement, Tylenol, Glucosamin Chondroitin, Allegra (OTC),

Current Illness: None

ID: 1693653
Sex: M
Age: 74
State: IN

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

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

Lab Data: N/A

Allergies: Naprosyn, possible egg allergy (issue with flu vaccine is past)

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient stated was feeling dizziness, lightheadedness, tiredness, tingling in fingers and toes. Patient was able to respond to verbal queues. Patient experienced these symptoms for approximately 10 minutes and then symptoms improved. Patient still complained of burning feeling in feet, however patient stated he thought it was due to his Baron Dupuytren's Disease. Patient felt he could get up to walk out however I encouraged patient to stay for observation. Approximately 25 minutes after shot patient begin to experience same symptoms however was complaining of chest tightness. Called 911. EMTs arrived and took over care of patient.

Other Meds: Atorvastatin, Atenolol

Current Illness: N/A

ID: 1693654
Sex: M
Age: 15
State: TX

Vax Date: 08/28/2021
Onset Date: 09/07/2021
Rec V Date: 09/12/2021
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: MRI on 9/12/2021 showed extensive anoxic damage to cortex, cerebellum, basal ganglia, brainstem

Allergies: None known

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

Symptoms: On 9/7/2021 at approximately 21:30 the patient experienced an out of hospital cardiac arrest while driving with a friend. He was resuscitated by EMS and transported to hospital. His tox screen was positive for cannabinoids. No cause could be found for this event. He suffered severe anoxic brain damage. Patient is still in hospital on life support at the time of this report. High chance of death. Almost certain to have permanent severe disability if he survives

Other Meds: None

Current Illness: None known

ID: 1693655
Sex: F
Age: 47
State: OR

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

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

Lab Data:

Allergies: penicillin

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Heart started racing within a couple of minutes of the vaccine. Felt flushed and tingly/prickly all over. Breathing was kind of quick, almost like a panic attack. Symptoms went away after a few minutes. *Have had something similar happen when administered the drug they give to do a CT scan. NOT a comfortable sensation!

Other Meds:

Current Illness: none

ID: 1693656
Sex: F
Age: 21
State: NM

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

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

Lab Data:

Allergies: na

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

Symptoms: Patient received covid shot, after a few hours the arm began to swell and itch. The patient went to an urgent care and was told that was a normal reaction to the shot. The arm continued to swell and itch and began to bruise. The bruise has lasted the entire month but has faded significantly. Primary care physician told patient the shot may have been given too low and to ask the pharmacist to give the booster 3 finger width below the shoulder.

Other Meds: na

Current Illness: na

ID: 1693657
Sex: F
Age: 43
State: CO

Vax Date: 09/01/2021
Onset Date: 09/04/2021
Rec V Date: 09/12/2021
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: Covid test 9/10/21

Allergies: Sulfa, codeine, pneumonia vaccine and the cold

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

Symptoms: Continuing shortness of breath and headache.

Other Meds: NA

Current Illness: None

ID: 1693658
Sex: M
Age: 34
State: FL

Vax Date: 08/27/2021
Onset Date: 08/27/2021
Rec V Date: 09/12/2021
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: Pyrexia, White blood cell count decreased

Symptoms: 5 minutes after receiving the vaccine the patient fell to the ground and went in an out of consciousness for a few moments at a time. EMS was called and arrived shortly after the patient fell. EMS examined the patient and (per the patient) he walked home without issue afterwards.

Other Meds: Vyvanse 50 mg, lamotrigine 150 mg, and duloxetine 60 mg

Current Illness:

ID: 1693659
Sex: F
Age: 66
State: MI

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

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: CHILLS AND LOW GRADE FEVER OF 99.4, TOOK IBUPROFEN AS DIRECTED

Other Meds:

Current Illness:

ID: 1693660
Sex: F
Age: 71
State: AZ

Vax Date: 03/10/2021
Onset Date: 08/11/2021
Rec V Date: 09/12/2021
Hospital:

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

Lab Data: covid 19 positive

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: I started with a scratchy throat with a cough, not a very productive cough. I lost my taste and smell and I still don't have that back. I was really achy and fatigued. I still get tired easily . I went to Urgent Care for test it was positive and the next day on Sunday the 15th they scheduled me for an infusion. I started feeling better after the infusion.

Other Meds: one a day womens vitamin, preservision, tylenol, naproxen, Pantoprazole 40 mg once day , imdur 90 mg once daily , Lasix 40 mg once daily, crestor 10 mg 4 times a week , Norvasc 10 mg once daily , potassium NEQ once daily, Coreg 25 mg twice

Current Illness:

ID: 1693661
Sex: F
Age: 56
State:

Vax Date: 09/12/2021
Onset Date: 09/12/2021
Rec V Date: 09/12/2021
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 became clammy, nauseated, and vomited after receiving vaccine.

Other Meds:

Current Illness:

ID: 1693662
Sex: F
Age: 75
State: OR

Vax Date: 09/02/2021
Onset Date: 09/03/2021
Rec V Date: 09/12/2021
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: Red rash that covered the front of my upper arm from elbow to shouldar. Arm swelled to nearly twice normal size. Low grade fever for 2 days. Redness and swelling lasted 7 days. Feeling exhausted. Heart tachycardia up to 139 bpm. Had the same reaction to the first shot on 6/3/2021. Saw MD for the reaction to first shot but not to this second one as it was the same. Used cold compress and rest and fluids for 1 week.

Other Meds:

Current Illness: none

ID: 1693663
Sex: F
Age: 40
State: VA

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

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

Lab Data: NA

Allergies: gluten, dairy, multiple chemical sensitivities

Symptom List: Rash, Urticaria

Symptoms: Internal tremors lasting about 10 minutes that come and go without fever, weakness, nausea. The internal tremors are the most severe symptom.

Other Meds: Adderall XR

Current Illness: None

ID: 1693664
Sex: F
Age: 40
State: CA

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 09/12/2021
Hospital: Y

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

Lab Data: Labs, MRI, CT, EEG, Ultrasounds of heart and carotid arteries.

Allergies: Codeine, Penicillin, Cocamidopropyl Betaine, Thimerosal, Amidoamine and Fragrance.

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

Symptoms: Seizure activity, blurred vision, numb finger tips and toes, hives, itchy skin, bumps.

Other Meds: No

Current Illness: No

ID: 1693665
Sex: F
Age: 22
State: NY

Vax Date: 09/11/2021
Onset Date: 09/11/2021
Rec V Date: 09/12/2021
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: None. clinical observation only. Sent covid testing.

Allergies: None

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

Symptoms: This is very mild. She came to ED for acute conjunctivitis left eye only with tearing. It began 2 hours after the vaccine. There is minimal erythema and tearing of the left eye. Will treat with topical antibiotic. I think its likely she has a coincidental concurrent viral conjunctivitis and this is not related to the vaccine, but timing is compelling for VAE. She has no other viral symptoms and she was perfectly well at time of vaccine administration.

Other Meds: None

Current Illness: None

ID: 1693666
Sex: F
Age: 67
State: TX

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

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

Lab Data: On the 2nd day I called my doctor to report symptoms. She was able to send me for Covid test at another office within the healthcare system.

Allergies: Phenergan

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

Symptoms: Regular temperature is 97.6 degrees F. Started w/a dizzy headache, followed by scratchy throat, then chills lasting 4-5 hours. This was followed by the next total 48 hours of: chills to sweats, fevers from 99.8 to 100.7, body aches, head and eyes hurt, head congestion, runny nose, heavy/deep sleep when fever dropped, severe brain fog-saw blackness, thirst, and lots of bathroom visits. Took 4-500 mg Tylenol every time fever went to 100, which was every 6 hours. On the 2nd day I called my doctor to report symptoms. She was able to send me for Covid test. Unfortunately the test site was 25 minutes away. It took me 45 minutes to drive there, as I did not have strength to watch traffic very well. Once I was administered the test, I sat in my car for 90 minutes sleeping to regain strength to drive back home.

Other Meds: Lipitor 80 mg daily Myrbetriq 25 mg daily Citalopram 20 mg daily Topiramate 50 mg daily Wixela 250/50 1 puff twice daily B12 1000 mcg D3 25 mcg C 1000 mg

Current Illness: None

ID: 1693667
Sex: M
Age: 49
State: SC

Vax Date: 08/26/2021
Onset Date: 09/10/2021
Rec V Date: 09/12/2021
Hospital:

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

Lab Data: UNKNOWN

Allergies: NKA

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

Symptoms: Patient came to the pharmacy expressing some concerns about muscle and nerve pain after receiving vaccine on 08/26/2021. Patient explains that he had the normal injection site pain and soreness but after that he started to experience nerve pain in this arms and back.

Other Meds:

Current Illness: unknown

ID: 1693668
Sex: M
Age: 23
State: FL

Vax Date: 08/23/2021
Onset Date: 08/23/2021
Rec V Date: 09/12/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient felt faint after receiving his vaccine. EMS was called since the patient stated he felt like he was "blacking out". EMS arrived shortly afterwards and examined the patient. The Patient mother arrived shortly afterwards and took the patient home after EMS examined him.

Other Meds:

Current Illness:

ID: 1693669
Sex: F
Age: 62
State: CO

Vax Date: 03/05/2021
Onset Date: 03/05/2021
Rec V Date: 09/12/2021
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:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Racing heart, heart palpitations, dizziness, nausea, rash on arm, swollen lymph nodes, difficulty speaking, symptoms beginning approximately 6 hours after dose and lasting up to 6 weeks. Arm and hand was numb and tingly right after getting vaccination

Other Meds:

Current Illness:

ID: 1693670
Sex: F
Age: 34
State: SC

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

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

Lab Data: NONE

Allergies: NONE

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: PT CAME IN ON 9/12/21 FOR A FLU SHOT BUT RECEIVED THE MODERNA COVID SHOT INSTEAD. THE PT SAID THAT THEY NEEDED THE SHOT FOR AN APPLICATION SUBMISSION FOR A FOSTER CHILD AND WOULD RETURN TO THE STORE WITHIN THE NEXT DAY OR SO FOR THE CORRECT VACCINE. SHE WAS CONCERNED THAT THEY RECEIVED THE JOHNSON AND JOHNSON VACCINE IN APRIL 2021 AT PHARMACY. THE PHARMACIST ON DUTY CALLED CDC AND SPOKE WITH A NURSE WHO CONFIRMED THAT WE NEEDED TO CALL AND REPORT THE VACCINATION ERROR AND TO NOT ADMINISTER A SECOND DOSE OF MODERNA.

Other Meds: NONE

Current Illness: NONE

ID: 1693671
Sex: F
Age: 36
State: NC

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

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

Lab Data:

Allergies:

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

Symptoms: Cramping & spotting, abnormal uterine bleeding. Happened with both COVID19 pfizer vaccines.

Other Meds:

Current Illness:

ID: 1693672
Sex: M
Age: 17
State: CA

Vax Date: 09/10/2021
Onset Date: 09/11/2021
Rec V Date: 09/12/2021
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: Completed: EKG Pending: CBC, troponin I, BNP

Allergies: Peanut

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

Symptoms: Chest pain beginning 24hours after vaccination. EKG suggestive of pericarditis

Other Meds: None

Current Illness: None

ID: 1693674
Sex: F
Age: 73
State: MI

Vax Date: 09/03/2021
Onset Date: 09/01/2021
Rec V Date: 09/12/2021
Hospital:

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

Lab Data: Patient denies

Allergies: Sulfa, penicillin

Symptom List: Unevaluable event

Symptoms: Patient reports she received her second dose of the Moderna vaccine on 9/03/21. Approximately 2-3 days ago, a large red rash appeared on her arm and appears to be spreading . She reports she will go see a doctor in the morning.

Other Meds: Losartan/hydrochlorothiazide; atorvastatin; metformin ER; metoprolol ER; Vitamin D; Vitamin C; B12

Current Illness: Patient denies

ID: 1693675
Sex: F
Age: 15
State: CT

Vax Date: 09/12/2021
Onset Date: 09/12/2021
Rec V Date: 09/12/2021
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: None reported

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

Symptoms: Patient fainted a few minutes after administration of Pfizer COVID Vaccine (1st dose), regain consciousness within 30 seconds, looks pale, strange feelings, "in a dream", a few minutes later, she fainted again, but regain consciousness within 10 seconds, talking, feeling tongue tingling, warms on the head and back, applied Cold pack to the forehead, then she felt cold. Ambulance was called. She looks pale but talking, as we wait for the EMS to arrive, she seemed to getting better, able to drink small cup of water, pulse normal, breathing normal. When EMS arrived, suggested to be taken to hospital for observation, agreed by the father, needed assistance to stand up from seating on chair.

Other Meds: None reported

Current Illness: none reported

ID: 1693676
Sex: F
Age: 57
State: SC

Vax Date: 08/18/2021
Onset Date: 08/19/2021
Rec V Date: 09/12/2021
Hospital:

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

Lab Data:

Allergies: Sulfa

Symptom List: Injection site pain, Pain

Symptoms: Immediate pressure on bridge of nose and strange taste in mouth lightheaded ness Next morning severe right hip pain .felt like a screw in the joint . limped for three hours? then pain went away? two hours late could not raise right arm shoulder felt like a screw was in the joint Now? September 12, toes are painful and separating (?) both knees difficult to climb stairs, left thumb is stiff and very painful I walk 40!minutes a day and do yoga and exercises 5 days a week Now every joint in my body aches!!! All since the shot!!!

Other Meds: Melatonin Zinc Vitamin c, A, B D

Current Illness:

ID: 1693677
Sex: F
Age: 40
State: TX

Vax Date: 08/02/2021
Onset Date: 08/07/2021
Rec V Date: 09/12/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Chest pain when bending over, shortness of breath, palpitations

Other Meds: None

Current Illness: None

ID: 1693678
Sex: M
Age: 23
State: ID

Vax Date: 04/22/2021
Onset Date: 04/28/2021
Rec V Date: 09/12/2021
Hospital:

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

Lab Data: April 28th 2021 - CMP14, TSH, CBC - Results: wnl

Allergies: N/A

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

Symptoms: On April 22nd 2021 I got my first dose of the Pfizer Vaccine. I've had symptoms of muscle fatigue, heaviness and pressure in my chest, night sweats 3 nights a week for a month, and a headache for several months.

Other Meds: Vyvanse, Sertraline, Lamotrigine

Current Illness: N/A

ID: 1693680
Sex: F
Age: 26
State: AL

Vax Date: 09/12/2021
Onset Date: 09/12/2021
Rec V Date: 09/12/2021
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: VITAL SIGNS: BP 100/72, P 62, RESPIRATIONS 16 NON-LABORED

Allergies: NO KNOWN ALLERGIES

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: 26 year old female receiving her first Moderna Covid vaccination. Immediately after receiving the shot, she felt her hands go numb, said she didn't "feel right", and stopped talking. Her husband and I lowered her to the floor and put her feet on a chair. 9-1-1 was called. Immediately, the patient started talking again, saying she had "cotton" in her ears and felt "woozy". Vital signs assessed: BP 100/72, P 62, respirations 16 non-labored. Upon discussion, patient admitted to having a phobia of needles where she sometimes faints when giving blood. Patient had previously denied reactions following vaccination, NKDA. Paramedics arrived 15 minutes later, assessed the patient, took vitals/EKG, cleared with a refusal to transport, instructed to consume water and gatorade. Patient reported feeling much better, was escorted out with her husband.

Other Meds: NONE

Current Illness: NONE

ID: 1693681
Sex: F
Age: 42
State: CA

Vax Date: 07/22/2021
Onset Date: 07/23/2021
Rec V Date: 09/12/2021
Hospital:

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

Lab Data: 3 D mammogram, Ultrasound costing in total over $450 that the CDC should pay for

Allergies: Penicillin

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: So, I had my first shot around the beginning of July. I was just lethargic after the first shot but right before the 2nd shot I noticed a lump in my breast. I had decided to tell my doctor about it and we wound up doing a 3-D Mammogram and US. I went ahead and had my 2nd shot as I was encouraged by the CDC to do so. I had the second shot and we did the mammogram and US and it turned out that I had an enlarged lymph node. Also, about 12 hours after my second shot my finger tips became numb and I had trouble feeling them and I thought my circulation was being cut off from my fingers. It was the strangest feeling. That plus the lymph node situation...and to top it off, my period was all messed up as it didn't come for 36 days and then it came literally 10 days apart.

Other Meds: None

Current Illness: None

ID: 1693682
Sex: F
Age: 55
State: IL

Vax Date: 09/11/2021
Onset Date: 09/11/2021
Rec V Date: 09/12/2021
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: Headache, Heart rate increased, Injection site erythema, Injection site pain, Injection site swelling

Symptoms: pt got an itchy rash all over body around 5 hours after getting her shot. red welts all over body and very itchy. pt has no such rxn the forst dose. pt did not have trouble breathing.

Other Meds:

Current Illness:

ID: 1693684
Sex: F
Age: 26
State: MI

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

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

Lab Data:

Allergies: Stadol, proprofal

Symptom List: Nausea

Symptoms: Body aches, headache, tender at injection site, rapid heart rate.

Other Meds:

Current Illness:

ID: 1693685
Sex: M
Age: 13
State: HI

Vax Date: 07/25/2021
Onset Date: 09/12/2021
Rec V Date: 09/12/2021
Hospital:

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

Lab Data: none

Allergies:

Symptom List: Injection site pain

Symptoms: Patient under 18 years of age received Moderna vaccine. Dose #1 on 7/25/21; dose #2 on 8/22/21 (lot #021c21a). Patient had no adverse event or significant side effects.

Other Meds:

Current Illness:

ID: 1693686
Sex: F
Age: 46
State: NJ

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

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

Lab Data:

Allergies: Penicillin and sulfa.

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

Symptoms: Fever, headache, nausea, vomiting, body aches, fatigue, soreness at injection site for 24 hours

Other Meds: Nextstellis, biotin, Vit D, Vit C, magnesium, Vit B complex

Current Illness: No other than same reaction to first vaccine as this one.

ID: 1693687
Sex: F
Age: 71
State: TX

Vax Date: 09/08/2021
Onset Date: 09/09/2021
Rec V Date: 09/12/2021
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: Seafood of all kinds. Not iodine

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

Symptoms: Soreness, red englargement of arm , tired

Other Meds: Hydromorphone, tizadine, amitiza, Crestor, lyrica

Current Illness: None

ID: 1693688
Sex: M
Age: 52
State: CA

Vax Date: 05/07/2021
Onset Date: 09/08/2021
Rec V Date: 09/12/2021
Hospital: Y

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

Lab Data: Positive Covid-19 disease with hypoxia and typical pulmonary infiltrate on CXR on 09/12/2021

Allergies:

Symptom List: Tremor

Symptoms: Covid-19 infection 09/08/2021

Other Meds:

Current Illness:

ID: 1693689
Sex: M
Age: 56
State: MI

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

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

Lab Data: None yet. Will be following up with Dr. and urologist and oncologist and schedule appointment with nephrologist. Suspect undiagnosed Nephropathy. Suggest caution for people with kidney disease.

Allergies: None

Symptom List: Erythema, Pruritus

Symptoms: Gross hematuria, unresolved as of 9/12/2021.

Other Meds: Vitamin D 2,000 Mg, Vitamin C 1,000 mg

Current Illness: None

ID: 1693690
Sex: F
Age: 44
State: WA

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/12/2021
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: None at this time. I have messages out to my Dr. I don't believe there is anything that can necessarily be done but ride out the symptoms at this point.

Allergies: Keflex, Femara, latex (sensitivity)

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

Symptoms: Immediate bilat legs tingling, 20 mins later face/head tingling, face red hot/flushed with lips ice cold -lasted 2hrs, day one to day three currently intermittent bilat top and bottom of feet sharp/stabbing pains, injection site muscle spasms constantly for 48+hrs, multiple episodes of nausea from day 1-3, woke up day after inj with head to toe aches/chills and fever x24+ hours, migraine started day two and current, fatigue- many naps, day 3- woke up with hot, redness from top of shoulder to elbow on inj site arm, also have a hx of pea sized scar tissue on inside of arm today skin is indented, painful and no scar tissue felt, difficulty raising L arm on day 3. Day 3- profuse sweating when still- had to change clothes as they were drenched. Spouse stated I smell different- like chemicals. When I bend down crown of head feels like it will explode. I am completing this on day three unk if will have more issues. I am still currently having a migraine and body aches, redness /hotness on L arm still present. Also filled out report for first vaccine-issues as well. Pls do note same vaccine lot #. After 1st vaccine did have 1 menses that was longer than usual by 4 days, heavier bleeding and increased clots.

Other Meds: Metformin ER 500mg 1 tab po qd Multivitamin daily

Current Illness: N/A

ID: 1693691
Sex: M
Age: 51
State: NV

Vax Date: 08/19/2021
Onset Date: 08/20/2021
Rec V Date: 09/12/2021
Hospital:

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

Lab Data: was told to stay home and ride it out.

Allergies: milk, strawberries

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

Symptoms: within 12 hours started experiencing muscle and joint pain and loud rising in the ears, within 16 hours degraded eyesight, chills and uncontrollable shivering. the next 2 days experienced increased ringing of the ears, fever (103 degrees highest monitored), profuse sweating alternating with severe chills. Muscular and joint pain from hands to feet. By Day 3 the fever and chills subsided but the muscle and joint pain migrated to the shoulder and neck concentrating in the left arm / shoulder joint. Heavy muscle fatigue, ringing of the ears and degraded eyesight for 12 days after injection.

Other Meds: Xarelto 20 mg, Hydrochlorothiazide-lisinopril 12.5 mg-20 mg, Cholecalciferol 2000 intl units, Atorvastatin 20MG

Current Illness: I had Covid Late Feb 2021, complications included Covid Pneumonia diagnosed in hospital on 03/08/21, Covid related DVT diagnosed in hospital 03/15/21

ID: 1693692
Sex: F
Age: 30
State: NY

Vax Date: 09/08/2021
Onset Date: 09/08/2021
Rec V Date: 09/12/2021
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: allergic to cingular, cherries, pistachios

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Wheezing/ shortness of breath/ respiratory distress 1.5 hours after vaccination - have needed to take rescue inhaler every 4-6 hours since vaccination Hives & swelling on hands 3 hours after vaccination hives on back three hours after vaccination

Other Meds: Albuterol

Current Illness: N/A

ID: 1693693
Sex: F
Age: 86
State: CO

Vax Date: 01/22/2021
Onset Date: 06/25/2021
Rec V Date: 09/12/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Patient fully vaccinated against Covid-19 (1/22/2021, 12/31/2020). Tested positive for Covid-19 on 6/22, requiring hospital admission 6/25.

Other Meds:

Current Illness:

ID: 1693694
Sex: F
Age: 15
State: TX

Vax Date: 09/12/2021
Onset Date: 09/12/2021
Rec V Date: 09/12/2021
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 passed out . No fall injury occurred and patient recovered from the episode immediately. Removed from vehicle to EMS to get vitals. Patient has had syncope episodes or nausea in the past after receiving a shot. Patient then returned to vehicle and was monitored by EMS for an additional 30mins.

Other Meds:

Current Illness:

ID: 1693695
Sex: M
Age: 31
State: WI

Vax Date: 09/12/2021
Onset Date: 09/12/2021
Rec V Date: 09/12/2021
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: Pain in extremity

Symptoms: Patient nearly lost consciousness about 10 minutes after receiving vaccine. His eyes rolled back and he was initially not very responsive. However, after calling his name and grabbing his arm, he came to. He was able to answer questions weakly. He reported feeling thirsty, dizzy, and cold. He was given water. He vomited. Emergency services were called. He eventually reported starting to feel better and refused to go to the hospital.

Other Meds:

Current Illness:

ID: 1693696
Sex: F
Age: 51
State: PA

Vax Date: 09/10/2021
Onset Date: 09/11/2021
Rec V Date: 09/12/2021
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: PCN, tomatoes, bananas, mango, papaya, shrimp, Propylene Glycol sensitivity

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

Symptoms: Painful tongue sores Painful sore on inner mucosa of bottom lip

Other Meds: VIT D, Vit A, Zinc, Quercetin, Vit K2

Current Illness: None

ID: 1693697
Sex: M
Age: 49
State: CA

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

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

Lab Data: Had an Covid-19 anti-body test on Aug. 18th which came back positive. SARS-CoV-2 Semi-Quant Total Ab SARS-CoV-2 Semi-Quant Total Ab 1155.0 Reference Range: Negative<0.8 U/mL Antibodies against the SARS-CoV-2 spike protein receptor binding domain (RBD) were detected. It is yet undetermined what level of antibody to SARS-CoV-2 spike protein correlates to immunity against developing symptomatic SARS-CoV-2 disease. Studies are underway to measure the quantitative levels of specific SARS-CoV-2 antibodies following vaccination. Such studies will provide valuable insights into the correlation between protection from vaccination and antibody levels. Did not want the vaccine because my team of providers said I had a natural immunity already. My wife made me get it and regret my decision .

Allergies: None

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

Symptoms: Experienced malaise within two days. The side effects got progressively worse and on the 5th night had 6 vaccine related adverse events- chills, low-grade fever, headache, nausea, GI upset, shallow breathing. Been in bed for 24 hours and limited relief. I would categorize all these side effects as mild-moderate.

Other Meds: Sertraline 25MG QBREXZA

Current Illness: None

ID: 1693698
Sex: F
Age: 53
State: CA

Vax Date: 09/02/2021
Onset Date: 09/03/2021
Rec V Date: 09/12/2021
Hospital:

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

Lab Data: unknown

Allergies: Keflex

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

Symptoms: swelling on collar bone (left), and breast tenderness started Friday afternoon 9/3/21

Other Meds: unknown

Current Illness: unknown

ID: 1693699
Sex: F
Age: 71
State: CA

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

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

Lab Data: Haven't seen a Doctor yet as it is the weekend although called my primary care physician and I will recieve a call back from them tomorrow morning hopefully to schedule an appointment ,my son also called poison control center and they weren't very helpful and might be taking me to the emergency room if necessary.Ive been trying to contact rite aid with no avail as of yet concerning the vaccinations that they gave me without consent and my authorization.

Allergies: None

Symptom List: Vomiting

Symptoms: First and foremost I never even scheduled or authorized the vaccine for the shingles vaccine that I was given only the other three vaccines I gave my consent and authorized. On the first evening at 9:00 pm is when I first started feeling bad headaches,chills ,and fever I was also very fatigued went to bed and next day on the tenth and eleventh I was feeling very I'll still vomiting , constipation,headaches severe nausea,face pale and eyes cyanotic,vomiting ,Very fatigued.soreness severe bilateral arms.

Other Meds: None / although I do take some medications but only as needed not on a regular basis .But nothing prior to or during vaccination.

Current Illness: I only have physical impairment s.

ID: 1693701
Sex: F
Age: 30
State: CO

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

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

Lab Data: Following severe pain from very little stimulus (scratching my back felt like I had a radiating bruise), testing tender points left intense lingering pain, my rheumatologist diagnosed me with fibromyalgia on 4/09/2021 Clinic

Allergies: Amoxycillin, Zythromax, Sulfa, Pneumonia Vaccine, Shellfish

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Starting 72 hours after my first vaccine, I experienced severe flu symptoms: all-over body aches, 102-103 degree fever, nausea, some vomiting. These severe symptoms persisted for 72 more hours. I could not sleep due to the pain at times - Tylenol did nothing. The all-over body aches did not go away. My second injection was identical to the first in that I suffered high fever, nausea, vomiting and body ache. The ache subsided after about a week, but it was still present, especially when certain pressure points were pressed, often times for no reason at all in my hands, feet, back, legs and neck. Please see Item 19 for diagnosis and current symptoms.

Other Meds: Lexapro

Current Illness: None

ID: 1693702
Sex: M
Age: 51
State: NV

Vax Date: 09/10/2021
Onset Date: 09/11/2021
Rec V Date: 09/12/2021
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: Milk, Strawberries

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

Symptoms: Neck/shoulder muscle and joint pain and loud ringing of the ears within first 8 hours. Fever, chills, foggy brain, and whole body pain within the first 12 hours. Highest recored fever 101.6. Fever, chills and whole body pain continued until approximately 23:30 on 09/11. The pain then centered in the shoulder joints and was significant preventing sleep. Ice and heat) did not resolve the pain. I took over the counter Tylenol with helped slightly. Ringing of the ears continued and got louder. by 16:30 on 09/12 the pain in my shoulder joints decreased. Whole body fatigue is still present as is the ringing of the ears.

Other Meds: Cholecalciferol 2000 intl units, Xarelto 20 mg, Hydrochlorothiazide-lisinopril 12.5 mg-20 mg, Atorvastatin 20MG

Current Illness: COVID 19 Infection late February, 2021. COVID Pneumonia and Covid related DVT March, 2021. Prior negative reaction to first Pfizer COVID-19 Vaccine dose - see report 642525

ID: 1693703
Sex: F
Age: 18
State: WI

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

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: NONE

Allergies: none

Symptom List: Injection site swelling, Limb discomfort

Symptoms: PATIENT WAS VERY NERVOUS ABOUT GETTING A SHOT AND HAS FAINTED IN THE PAST FROM A TETANUS SHOT WHEN SHE WAS 12. SHE FAINTED ABOUT 10 MINUTES AFTER VACCINATION AND THEN PROCEEDED TO VOMIT. EMT WAS CALLED TO THE STORE AND THEY CHECKED PATIENT OUT AND RELEASED HER WHICH WAS ABOUT 30 MINUTES AFTER VACCINATION WITHOUT FURTHER INCIDENT

Other Meds: not available

Current Illness: none

Date Died: 05/23/2021

ID: 1693704
Sex: F
Age: 19
State: CA

Vax Date: 05/08/2021
Onset Date: 05/23/2021
Rec V Date: 09/12/2021
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: The decedent was found deceased at home on 05/23/2021. The decedent's cause of death is acute fentanyl toxicity. The pathologist found blood clots in her lungs during autopsy, and she was concerned the blood clots may be related to the vaccine she received on 05/08/2021.

Other Meds: none

Current Illness: none

ID: 1693705
Sex: M
Age: 57
State: NC

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

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

Lab Data:

Allergies:

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

Symptoms: Patient was suppose to receive a 2nd dose of Pfizer and received Moderna

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am