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: 1700659
Sex: F
Age: 18
State: MS

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

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

Lab Data:

Allergies: None

Symptom List: Dysphagia, Epiglottitis

Symptoms: Three minutes after receiving vaccine patient experienced ringing in ear for approximately one minute, dizziness, blurry vision. These symptoms all resolved after four minutes. She then began to experience sore throat and tingling around her mouth which lasted five minutes. All symptoms resolved after 10 minutes. Vital signs stable. No other complaints or issues voiced. No rapid weak pulse, difficulty breathing, shortness of breath, wheezes, stridor, pain with swallowing, cough, chest pain, palpitations, nausea/vomiting, confusion, hives, itchiness, flushing of skin, swelling of lips/tongue, runny nose, or swelling of conjunctiva.

Other Meds: Cetirizine 10mg PO daily Saline Nasal Spray daily PRN Clear Eyes eye drops daily PRN

Current Illness: N/A

ID: 1700660
Sex: F
Age: 58
State: OH

Vax Date: 04/15/2021
Onset Date: 06/23/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: First round of prednisone was July 8, 2021. Testing began after the first round of prednisone 7/20/21 ANA by IFA with Reflex - negative, SED RATE at 30, Rheumatoid Factor BL - negative 8/12/21 Xray of knees - negative for arthritis and all tissue looks normal, XRay of hand - small amount of arthritis - not enough to warrant the inflammation and swelling in the hand. 8/24/21 Uric Acid Blood - negative, C-Reactive Protein 2.6 mg/dl, SED RATE at 37, HLA-B27 DNA Result - negative, ANTI ENA ID - negative, HEP Remote Panel BL - negative, Lyme AB Late - negative, Parvovirus B19 IGM Antibodies - negative.

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: Severe pain in both knees, right shoulder and left hand. Started on prednisone for 5 days, pain returned when course was ended. Given 2nd round of prednisone for 12 days, pain returned when course was ended. Lab tested for many things from lyme disease, parvovirus, CCP Antibodies, Uric Acid, Hepatitis, Tuberculosis and more. Sed Rate is at 37 and C-Reactive Protein is at 2.6 - indicating increased inflammation in my body. Began a 3rd round of prednisone that will last 2 months. Doing this now. When it is finished, if the pain persists, my doctor has said that they may try methotrexate for the next treatment plan.

Other Meds: Omeprazole 40mg, 1 per day. Singulair 10mg, 1 per day. Zyrtec 10 mg, 1 per day. Levothyroxine 75mcg, 1 per day. Liothyronine 5 mcg, 2 per day. Ventolin HFA AER 90mcg, as needed for wheezing.

Current Illness: None

ID: 1700661
Sex: F
Age: 75
State: FL

Vax Date: 03/12/2021
Onset Date: 03/19/2021
Rec V Date: 09/15/2021
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: Blood test EKG

Allergies: food sensitivities - tomato, green peppers, eggplants and potatoes

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

Symptoms: 10day 28 Feb. felt I was having fatigue and no energy to walk from Mar2021. My legs felt tingling .health - fainting on 19 one week after the 2nd dose and went cardiologist and all test were benign . Saw doctor 1stMarch2021.Chest pains went to ER twice in March 2021. All test from both ER came back normal. in 30Oct2020 also fainted.

Other Meds: Vitamins - c, d. b12,

Current Illness: on 28 Feb2021.I was having fatigue and no energy to walk from Mar2021. My legs felt tingling.

ID: 1700662
Sex: F
Age: 95
State: PA

Vax Date: 07/27/2021
Onset Date: 09/12/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: 09/12/21 1452 Respiratory virus detection panel Collected: 09/12/21 1244 | Final result | Specimen: Swab from Nasopharynx Adenovirus Not Detected Mycoplasma pneumoniae Not Detect

Allergies: Sulfa (Sulfonamide Antibiotics)DarifenacinOther (document deta

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: ASYMPTOMATIC

Other Meds: acetaminophen (TYLENOL) 325 mg tabletcephalexin (KEFLEX) 500 m

Current Illness:

ID: 1700663
Sex: F
Age: 51
State: GA

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 09/15/2021
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, azithromycin

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

Symptoms: After receiving vaccine, patient reported an "odd feeling" in her tongue and itching all over.

Other Meds: singulair, gabapentin, hydrocodone, xolair, estradiol

Current Illness:

ID: 1700664
Sex: F
Age: 36
State: CA

Vax Date: 03/10/2021
Onset Date: 03/11/2021
Rec V Date: 09/15/2021
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: See above

Allergies: Tetracycline

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

Symptoms: I woke up about 9:00 am - with a really bad fever. It was already 101 and within an hour it was 104.5. I used everything to reduce the temperature. I was nauseous and my body ached everywhere and I was experiencing chills. I couldn't eat or drink. I had a little soup and vomited. I also had a rash around the injection site. My whole body was drenched in sweat. I had a terrible headache. I was very dehydrated and had a lot of brain fog. The fever left suddenly about 10 PM - it never came down from the 104.5 until this time when it disappeared. During the fever, I tried to do everything to take it down. For a few days, with the brain fog, I was still "out of it." It took about two to three weeks before I didn't feel like my head was stuffed with cotton. Afterwards, I tried to take electrolytes and everything to get re-hydrated. I was so weak and spent that I couldn't get out of bed those few first days. I had a little bit of trouble breathing and I felt like I was "clogged up." I went to the doctor after that - about the third or fourth day, and the doctor said it was just side affects. I had a really bad cold the last week in July. It started with chills and it felt a little flu-ish at first and then it went to something that seemed more bacterial. It choked up my system. My asthma is still acting up. It got my asthma going and they had to give me prednisone and Augmentin (for two weeks for the antibiotic) to calm it down. I took a COVID test each week - I tested negative for COVID six times and negative for RSV and the flu (Influenza A and B) . The cold had such a huge impact on my immune system. I have symptoms - remnants of this cold. One day it feels okay and then the next day, I'm super congested. It's worse at night. I went to allergy doctor doctor - he treated me with the Prednisone and Augmentin and Urgent Care - they did the tests - the three part tests for Influenza tests and RSV and COVID test. Hospital did the other COVID tests.

Other Meds: multiple things: Citrulline; Gabapentin; Duloxetine; Montelukast; Advair; Quvar; Spiriva; Fluticasone; Azelastine; Xtampza

Current Illness: No

ID: 1700665
Sex: M
Age: 53
State: NC

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 09/15/2021
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 required.

Allergies: None disclosed

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: 8/30/2021 3:19:02 PM Spoke with Pt about adverse effects from his most recent COVID vaccine on 8/24/2021. He felt dizzy and weak after the shot. He didn't contact our office until 8/30/2021 at 3:15 PM and didn't contact his doctor.

Other Meds: Unknown

Current Illness: None disclosed

ID: 1700666
Sex: M
Age: 80
State: MN

Vax Date: 02/26/2021
Onset Date: 09/11/2021
Rec V Date: 09/15/2021
Hospital: Y

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

Lab Data:

Allergies: Uncertain

Symptom List: Pharyngeal swelling

Symptoms: Hospitalized on 9/11/21 - due to SOB, loss of taste, and difficulties breathing

Other Meds:

Current Illness:

ID: 1700667
Sex: M
Age: 46
State: CO

Vax Date: 09/11/2021
Onset Date: 09/11/2021
Rec V Date: 09/15/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: two days of chills and fever and three days of headaches, dizziness and fatigue. symptoms are improving except for lingering dizziness.

Other Meds:

Current Illness:

ID: 1700668
Sex: F
Age: 65
State: NY

Vax Date: 02/11/2021
Onset Date: 03/19/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: 3/19/21 Ferritin level :982 standard range:13-150 ng/mL 4/15/21 Ferritin level:1,020 Standard range: 13-150ng/mL Extreme fatigue

Allergies: penicillin & Esomeprazole Magnesium

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Very elevated Ferritin levels.

Other Meds: Nothing was changed for years.

Current Illness: N/A

ID: 1700669
Sex: F
Age: 36
State: PA

Vax Date: 09/01/2021
Onset Date: 09/11/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data:

Allergies: Influenza vaccine, amoxicillin

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

Symptoms: Malaise lasting over 6 days, decreased appetite, arm pain, body aches, abdominal pain, diarrhea, blurred vision, ringing in the ear, difficulty concentrating

Other Meds: Flagyl

Current Illness: Bacterial vaginosis, yeast infection

ID: 1700670
Sex: F
Age: 32
State:

Vax Date: 08/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: N/A

Allergies: N/A

Symptom List: Rash, Urticaria

Symptoms: Slight soreness the day of administration. When waking the next morning, my arm felt swollen and was very painful to touch from my wrist up to the side of my neck. Pain lasted for about 2 days. I could no move my left arm on my own, I had to use my right hand to move my arm.

Other Meds: Magnesium and vitamins: B2, D3

Current Illness: N/A

ID: 1700671
Sex: F
Age: 75
State: IL

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data:

Allergies: Codeine; Penicillin

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

Symptoms: On the next day I started feeling itchy on my chest. It felt almost like a heat rash. I also had body aches but no fever. I felt very exhausted. Recently like 3 weeks ago I stared having an acapt situation. I never had problems with my heart. I don't know if it has to do with the vaccine or my age. I will be seeing a doctor in regards of this issue.

Other Meds: Levothyroxine; Triamterene; Omeprazole

Current Illness:

ID: 1700672
Sex: M
Age: 51
State: TX

Vax Date: 09/13/2021
Onset Date: 09/14/2021
Rec V Date: 09/15/2021
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: Extreme fatigue Nausea Headache

Other Meds: Omeprazole duloxetine

Current Illness:

ID: 1700673
Sex: F
Age: 38
State: MI

Vax Date: 04/01/2021
Onset Date: 04/15/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: Cbc, metabolic panel, thyroid antibodies, epstein barr, ultrasound of liver, liver antibodies, multiple eye exams, 3 different covid tests, autoimmune test, mri with and without contrast, mra with contrast, and more. All specialists have ruled out other causes.

Allergies: None

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

Symptoms: Sudden onset of extreme fatigue, brain fog, headaches, then vision loss in left eye including double vision in only that eye

Other Meds: Vitamins

Current Illness: None

ID: 1700674
Sex: M
Age: 57
State: MA

Vax Date: 03/13/2021
Onset Date: 08/12/2021
Rec V Date: 09/15/2021
Hospital: Y

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

Lab Data: CT scan - 8/15/2021 Lots of blood work and urinalysis, showing nothing of particular note.

Allergies: None

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

Symptoms: Abdominal pain for 3 days, eventually leading to an Appendectomy.

Other Meds: Prescriptions: Novarel, Mybetriq, Propecia, Cialis Supplements: multi-vitamin, calcium, magnesium, vitamin d-3

Current Illness: None

ID: 1700675
Sex: F
Age: 31
State: ME

Vax Date: 09/11/2021
Onset Date: 09/11/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: None

Allergies: Latex, sulfa, penicillin, cephalosporins, flu shot, Tdap

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

Symptoms: Fever, ibuprofen to treat, onset 3 days post vaccine lasted for 24 hours Body aches, ibuprofen, onset less than 24 hours, not completely resolves Muscle cramps/Charlie horses, rest, onset 6 hours and resolves in 24 hours Left side pain under ribs (spleen area), ibuprofen to reduce pain, ongoing and worsened since 48 hours post vaccine Headache, ibuprofen, onset 48 hours and ongoing

Other Meds: None

Current Illness: None

ID: 1700676
Sex: F
Age: 55
State: WA

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

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

Lab Data:

Allergies: Bee venom

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient reported swelling at the injection site the size of her hand

Other Meds:

Current Illness:

ID: 1700677
Sex: F
Age: 25
State: MS

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

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

Lab Data:

Allergies: augmentin allergy

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Within just a few minutes patient(nurse) leaned back in chair and appeared to pass out(while seated the entire time)- came to in just a few seconds and was confused and slightly upset and began sweating. WE fanned pt and got her a bottle of cold water, wet paper towel and cold pack for her neck. (pt also requested a Sprite and saltine crackers while waiting on her ride-which we provided to her) Two associates stayed in the booth with pt until 10:56 when she felt better (then just one associate stayed with her) and was just waiting on her ride to pick her up. Pt blood pressure was 107/65 with pulse rate 65. Pt was refused ambulance multiple times. Pt left feeling better with her ride around 11:20. Called pt around 1:21 pm and she stated that she was doing her homework and felt better but was still experiencing slight nausea off and on >

Other Meds: unknown

Current Illness: not aware of any illness

ID: 1700678
Sex: F
Age: 58
State: WA

Vax Date: 09/03/2021
Onset Date: 09/08/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: none

Allergies: sulfa, dairy

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

Symptoms: about 3-5 days after the injection i got a rash below the injection site. it was red, felt hot, burned and itched.it was about 3 inch diameter and a roundish shape. it was similar, although covered a smaller area than, to the rash i got after my 2nd Moderna covid vaccine. today is 9/15 and it is almost gone but it?s still visible. still periodically, slightly, itches. i did not treat it because i didn?t want to interfere with my immune system mounting a response. it was uncomfortable & annoying but did not interfere in my day to day activities. i also got a sore arm which lasted from vaccine date for about 5 days.

Other Meds: progesterone capsule, estradiol patch, magnesium citrate, guar fiber, omega-3, xiidra, pataday, zyrtec, vitamin d3

Current Illness: none

Date Died: 08/31/2021

ID: 1700679
Sex: M
Age: 61
State: FL

Vax Date: 03/25/2021
Onset Date: 07/31/2021
Rec V Date: 09/15/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: no

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

Symptoms: patient admitted 7/31/21 for covid 19 pneumonia/acute respiratory failure. Resulted positive for COVID 7/29/21. Patient received covid vaccine in March. Patient was exposed to his brother who was positive for COVID 19. Patient was intubated on 8/19 and expired 8/31/21.

Other Meds: Protonix, Lantus, dicyclomine, quetiapine

Current Illness: Unknown

ID: 1700680
Sex: F
Age: 41
State: MI

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

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

Lab Data:

Allergies: NSAIDS

Symptom List: Unevaluable event

Symptoms: Extreme pain in left shoulder. Left first or pointer finger...achy felt sprained. Throbbing pain in left forearm before elbow. Pain in left armpit/breast/lymph nodes. Pain in lower left leg, through knee and thigh.

Other Meds: Pamprin

Current Illness: PCOS

ID: 1700681
Sex: F
Age: 55
State: NC

Vax Date: 09/12/2021
Onset Date: 09/13/2021
Rec V Date: 09/15/2021
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: Lisinopril

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

Symptoms: 12hrs after shot: Headache (10 of 10), Fever (HIGHEST 102.8) body ache, chills, weakness, tiredness, swollen lymph node in left axillary area took Tylenol 500mg x2 every 6 hrs up to today. Unable to go to work for next 2 days, only went to work on 3d day (with fever99.9, headache, weak) could not afford to pay out of pocket for dr visit. Left arm still very red, warm to touch, SWOLLEN, PAINFUL on day #3. Was positive for Covid with pneumonia 4 Mar 2021 with very bad symptoms lasting 10 days.

Other Meds: Losartan 50mg, Amlodipine besylate 10mg, Atorvastatin 20mg, Bupropion 200mg, Claritan 10mg

Current Illness: none

ID: 1700682
Sex: F
Age: 10
State: CA

Vax Date: 09/02/2021
Onset Date: 09/02/2021
Rec V Date: 09/15/2021
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: pinicilin gallalinium polysorbate

Symptom List: Injection site pain, Pain

Symptoms: 20 min after, itching globally, hives on arms and legs, swelling mouth and throat, injection site and arm swollen, tingling in arms, benadryl helped, more hives appeared next day, hives still there 11 days later, school nurse sent child home for dizzyness and tingling

Other Meds: vitamins a,c,d, fish oil, glutathione

Current Illness:

ID: 1700683
Sex: F
Age: 12
State: MI

Vax Date: 09/12/2021
Onset Date: 09/12/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data:

Allergies: guinea pigs

Symptom List: Injection site pain, Menorrhagia

Symptoms: Rash and itching; the patient's mother describes some of the rash as hard. I have not personally observed the rash.

Other Meds: none

Current Illness: none

ID: 1700684
Sex: F
Age: 50
State: KY

Vax Date: 08/11/2021
Onset Date: 09/08/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: Did not go to hospital

Allergies: prednisone lamotrigine topamax

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

Symptoms: Severe headache, nausea, vomiting, shivering, facial and head numbness. Still having severe headaches despite medication

Other Meds: Keppra twice daily

Current Illness:

ID: 1700685
Sex: F
Age: 27
State:

Vax Date: 08/11/2021
Onset Date: 08/18/2021
Rec V Date: 09/15/2021
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: labs ordered

Allergies: Biaxin Clarithromycin

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient's mother reports significant hair loss that started one week after receiving first dose of Moderna vaccination series

Other Meds: Fluticasone propionate nasal 50mcg twice daily Levothyroxine 125mcg PO once daily Ketoconazole 2% topically twice daily

Current Illness:

ID: 1700686
Sex: M
Age: 76
State: IL

Vax Date: 09/01/2021
Onset Date: 09/13/2021
Rec V Date: 09/15/2021
Hospital: Y

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

Lab Data: CT for PE Angiogram Planned for Echo and likely cardiac MRI but he left AMA. Will try to get pt evaluate for outpt follow up.

Allergies: none

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: This was the patients third dose given at the time of his flu shot. Pt woke up on 9/13 with CP rated at 7/10. Pain was pleuritic but also found to have inf ST elevation on EKG. Ruled out for PE and given EKG and elevated troponin he was taken to the cath lab. No CAD. Trop contiued to rise overnight and he became hypotensive down t to the 70sys range. This responded to fluids and the next day he was feeling better. BNP was elevated to > 7,000 and trop HS peaked at 809 ng/L(443 to 809 to 601) The pt was treated for pericarditis and the next day he improved. Before waiting for a formal echo or MRI he left the hospital AMA. Suspected pericarditis/ Myocarditis picture

Other Meds: Simvastatin 40mg Vit B12 Also got flu shot at the same time.

Current Illness: none but got the

ID: 1700687
Sex: M
Age: 21
State: WV

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/15/2021
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: to my understanding none

Allergies: unknown

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

Symptoms: patient passed out

Other Meds: unknown

Current Illness: unknown

ID: 1700688
Sex: F
Age: 88
State: MN

Vax Date: 02/26/2021
Onset Date: 07/16/2021
Rec V Date: 09/15/2021
Hospital: Y

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

Lab Data: C-REACTIVE PROTEIN (INFLAMMATION) COMPREHENSIVE METABOLIC PANEL CULTURE BACTERIAL, ANAEROBE CULTURE BACTERIAL, OTHER LAB ONLY-COMPLETE BLOOD COUNT WITH DIFFERENTIAL LAB ONLY-MANUAL DIFFERENTIAL LAB ONLY-URINE MICROSCOPIC REFLEX LACTIC ACID URINE DIP, REFLEX TO MICROSCOPIC, REFLEX TO CULTURE CT HEAD WITHOUT CONTRAST XRAY CHEST 1V - AP/PA Inspiration XRAY HAND MIN 3 VIEWS RT XRAY PELVIS WITH HIP 1 VIEW LT

Allergies:

Symptom List: Nausea

Symptoms: 89yr old female presents from own home with complaints of general weakness, right index finger pain, left hip pain and frequent falls at home. Patient reports she has fallen multiple times at home over last two months. Last night she fell walking in dining room- patient denies injury. Patient complaints of left hip pain that has been getting worse for couple of weeks. Noted swelling, redness and drainage to right index finger. Patient reports she first noticed right index finger hurting yesterday. Cellulitis of finger of right hand Fall, initial encounter Open wound of finger, initial encounter Urinary tract infection without hematuria, site unspecified

Other Meds:

Current Illness:

ID: 1700689
Sex: F
Age: 55
State:

Vax Date: 04/09/2021
Onset Date: 09/06/2021
Rec V Date: 09/15/2021
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: Injection site pain

Symptoms: Received call from EE about known COVID + community exposure. EE and her son, with whom she lives, were exposed on 9/3 at the game. EE states that she found out today, that her friend tested COVID +. Started having s/s on 9/6 of HA, fatigue, and feverish. Which then progressed to cough, chills, dizziness, loss of smell and taste, today while at work.

Other Meds:

Current Illness:

ID: 1700690
Sex: M
Age: 35
State: WI

Vax Date: 09/14/2021
Onset Date: 09/15/2021
Rec V Date: 09/15/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Tachycardia resting heart rate 125

Other Meds: None

Current Illness: None

ID: 1700691
Sex: F
Age: 4
State: CA

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

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

Lab Data: None

Allergies: None

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

Symptoms: Vaccine Administration Error - Patient moved while Dtap was being administered and did not receive a full dose due to the needle coming back out (25Gx1) ; patient also moved while Polio was being administered and did not receive a full dose due to the needle bending (retractable Vanish Point needle). The vaccines are normally given together in a combination vaccine (Kinrix) at 4 years old, but we were out of stock for that vaccine. Patient received full Dtap dose in left deltoid with assistance and full Polio dose in the right deltoid with assistance.

Other Meds: None

Current Illness: None

ID: 1700692
Sex: M
Age: 69
State: CO

Vax Date: 03/12/2021
Onset Date: 04/12/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: Blood tests: had elevated levels of PMR in bloodstream.

Allergies: Reacted to levafloxicin antibiotic (trigger finger)

Symptom List: Tremor

Symptoms: About a month after the vaccine, developed sciatica, got bursitis of shoulder, could not roll over in bed, move light objects, very debilitating. Got physical therapy, but the pain continued to worsen; unable to exercise. Went to doctor on 6/30, given prednisone, within 3 hours of prednisone 90% of symptoms relieved; diagnosed with PMR autoimmune condition. Taking prednisone daily, expected take a long time, may be a lifetime recovery.

Other Meds: N/A

Current Illness: N/A

ID: 1700693
Sex: M
Age: 37
State: CA

Vax Date: 09/14/2021
Onset Date: 09/14/2021
Rec V Date: 09/15/2021
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: none

Symptom List: Erythema, Pruritus

Symptoms: 102 fever, strong kidney and lymph node pain, and bed-soaking sweat that occurred 4-6am the morning after.

Other Meds: Testosterone replacement therapy medication, and multi vitamin

Current Illness: none

ID: 1700694
Sex: M
Age: 19
State:

Vax Date: 05/07/2021
Onset Date: 09/10/2021
Rec V Date: 09/15/2021
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: GROUP A STREPTOCOCCUS SARS-COV-2, INFLUENZA A+B, AND/OR RSV NUCLEIC ACID TESTING PANEL performed 2

Allergies:

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

Symptoms: Reason for Visit Cough Generalized Body Aches Headache Diagnoses RSV bronchitis Nausea Cough Sorethroat Periodic headache syndrome, not intractable Generalized body aches

Other Meds:

Current Illness:

ID: 1700695
Sex: M
Age: 36
State: OR

Vax Date: 07/26/2021
Onset Date: 08/01/2021
Rec V Date: 09/15/2021
Hospital: Y

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

Lab Data: ECG, troponin, coronary angiography and percutaneous intervention

Allergies: Cefprozil: rash

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

Symptoms: 1 August, 2021: Acute ST elevation myocardial infarction due to mid- Left Anterior Descending coronary artery thrombotic occlusion

Other Meds: propranolol 20mg daily as needed (not sure when last taken) escitalopram oxalate 10mg daily calcium carbonate 200mg po as needed (not sure when last taken) Centrum vitamins for men, taken daily

Current Illness: none apparent

ID: 1700696
Sex: F
Age: 65
State: MI

Vax Date: 03/13/2021
Onset Date: 09/10/2021
Rec V Date: 09/15/2021
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:

Allergies: penicillin

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Pt has a history of COPD and had a COVID exposure at home. She has had increasing shortness of breath and a fever.

Other Meds: albuterol 2.5mg/3mL nebulized q6hr aspirin 81mg PO qday atorvastatin 80mg PO qday ferrous sulfate 325 mg PO bid fosamax 70mg PO qweek nitrostat 0.4mg sublingual PRN potassium chloride 99mg qday prednisone 20mg 1/2 tab PO bid prilosec 40mg

Current Illness: COPD right lung nodule left thyroid nodule

ID: 1700697
Sex: M
Age: 75
State: IL

Vax Date: 04/15/2021
Onset Date: 09/12/2021
Rec V Date: 09/15/2021
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 presented to the ED on 9/12/21 with report of fevers, chills, malaise, and nausea for 1 week PTA. Patient was found to be COVID positive in the ED on 9/12 (despite being fully vaccinated for COVID), but his chest X-ray was negative for pneumonia. His foley bag had cloudy urine suspicious for infection, so antibiotics were started. Patient's urine culture later grew out Klebsiella pneumoniae. Patient has now been hospitalized for 3 days, and he has not been hypoxic since admission. Therefore, patient's febrile illness is believed to be a combination of COVID and CAUTI. Patient is not currently on any treatment for COVID since he is not hypoxic.

Other Meds:

Current Illness:

Date Died: 02/07/2021

ID: 1700698
Sex: F
Age: 78
State: FL

Vax Date: 01/16/2021
Onset Date: 01/28/2021
Rec V Date: 09/15/2021
Hospital: Y

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: Covid test, CXR.

Allergies: NKA

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

Symptoms: Pt came to ER c/o difficulty breathing and cough.

Other Meds:

Current Illness:

ID: 1700699
Sex: F
Age: 99
State: MN

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

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

Lab Data: Lab Tests Completed BRAIN NATRIURETIC PEPTIDE C-REACTIVE PROTEIN (INFLAMMATION) COMPREHENSIVE METABOLIC PANEL GLUCOSE BY METER, POCT LAB ONLY-COMPLETE BLOOD COUNT WITH DIFFERENTIAL LIPASE TROPONIN I performed 2 times URINE DIP, REFLEX TO MICROSCOPIC, REFLEX TO CULTURE Icon Imaging Orders Placed Today Imaging Tests EKG XRAY CHEST PORTABLE -

Allergies:

Symptom List: Pain in extremity

Symptoms: Chest Pain Dizziness Nausea Weakness dehydration

Other Meds:

Current Illness:

ID: 1700700
Sex: M
Age: 37
State: LA

Vax Date: 08/12/2021
Onset Date: 08/12/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: N/A

Allergies: insect bites

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

Symptoms: Migraine headache, severe muscle cramping, shortness of breath, confusion

Other Meds:

Current Illness:

ID: 1700701
Sex: F
Age: 36
State: TX

Vax Date: 08/14/2021
Onset Date: 09/14/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Started having on and off headache and stomach pain after eating 2 weeks after taking the vaccine. Negative results in Covid19 PCR and antibody test taken 09/12 12nn.

Other Meds: Multivitamins, bromelain supplement

Current Illness: none

ID: 1700702
Sex: F
Age: 45
State: FL

Vax Date: 03/12/2021
Onset Date: 06/01/2021
Rec V Date: 09/15/2021
Hospital: Y

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

Lab Data: Heart catherization which was normal, Cardiac stress test, S-ICD, MRI -- everything was normal. Blood test was normal.

Allergies: Latex

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

Symptoms: I started having syncope and near-syncope episodes in June 2021. And this was intermittent, random, unprovoked and just happened. Wasn't sure if it was blood pressure, heart or seizures. I was worked up by Cardiology and they had me wear a heart monitor at the end of august because this thing went in overdrive at the end of July. They stopped me from driving because they weren't sure what was causing me to pass out. After a report in August, I was immediately hospitalized because I was having runs of ventricular fibrillation and ventricular tachycardia. Max heart rate was 387bpm. I was in ICU cardiac arrest - mind you I am a very healthy person. No body knows what's going on, my diagnosis is idiopathic ventricular fibrillation.

Other Meds:

Current Illness: No

ID: 1700703
Sex: F
Age: 67
State: CT

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

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

Lab Data: see above

Allergies: sulfa

Symptom List: Vomiting

Symptoms: Developed chest wall pain along with stabbing pain LLLobe that lasted a week before I saw MD. Had positive Ddimer. CT chest showed moderate peri-cardial effusion. Confirmed on echocardiogram. After seeing cardiologist and rheumatologist there is no answer as to why this occured. Thats why I thought it should be reported since I am otherwise a very healthy person.

Other Meds: none

Current Illness: none

ID: 1700704
Sex: F
Age: 39
State: NJ

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 09/15/2021
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: no

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: started getting bad headaches as she speaks she feels throbbing pains, when walking she has to walk slowly and if she does to much she gets pain in the base of her neck then pains goes to the right side of her head and ear

Other Meds: vit d3, vit b12

Current Illness: no

ID: 1700705
Sex: F
Age: 61
State: MS

Vax Date: 02/02/2021
Onset Date: 02/01/2021
Rec V Date: 09/15/2021
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: X-ray of back

Allergies: Penicillin; Scopolamine

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

Symptoms: I began having stabbing pain in my left hip. It increased after the 2nd dose. I went to my orthopedic doctor and he x-rayed my hip and found no arthritis or any reason for the pain. He sent me to physical therapy which helped a little. Since I have been discharged from physical therapy, it has been getting progressively worse. I saw my internal medicine doctor last week and he gave me a cortisone shot. It helped some but now it's back and hurts again. The doctors are scheduling me for an MRI to make sure it's not a nerve involved. I'm at a point to where it is hard to walk now. My internal medicine doctor said that he doesn't think the long-term medicines I am on are causing this.

Other Meds: Toprol; Zocor; Protonix; Famotidine; Fiber Gummies

Current Illness:

ID: 1700706
Sex: M
Age: 20
State: FL

Vax Date: 09/01/2021
Onset Date: 09/03/2021
Rec V Date: 09/15/2021
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: No

Symptom List: Injection site swelling, Limb discomfort

Symptoms: The veins in my left forearm are more noticeable,they also bulged often as if I did a workout but I am fully relaxed i also have pain in my chest at night

Other Meds: None

Current Illness: No

ID: 1700707
Sex: F
Age: 54
State: FL

Vax Date: 08/23/2021
Onset Date: 08/23/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data:

Allergies: Pnc, Cipro, Helcion,- life threating. ASA (low dose seems to be ok) Ibuprofen, Hydrocortisone, Cortisporin- Breathing issues Phenergan, Compazine- Drops BP Very low Erythromycin ? allergy when I was a kid but, have been on low dose z-packs without issue. Food allergies: Shellfish, Gluten, Black Pepper, Aspartame, Garlic

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

Symptoms: Lips, tongue, and face tingling , lips and face swelled. with in 45 mins, after the first dose of vaccine. lasting about an hour. 3 weeks later still dealing with fatigue, migraines, autoimmune flare

Other Meds: omeprazol, unithroid, Liothyronine, zofran as needed, B-12, Magnesium, low dose aspirin,

Current Illness:

ID: 1700708
Sex: M
Age: 73
State: OR

Vax Date: 09/11/2021
Onset Date: 09/13/2021
Rec V Date: 09/15/2021
Hospital:

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

Lab Data: none

Allergies: NONE

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

Symptoms: Flu like symptoms. General weakness. Headache. Low exercise tolerance. Not able to work. Symptoms lessening after 4th day.

Other Meds: Benicar 40 mg. / day HCTZ 15 MG / DAY

Current Illness: NONE

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am