VAERS 2021 Database www.vaers.hhs.gov

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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: 1708570
Sex: F
Age: 36
State: TN

Vax Date: 05/02/2021
Onset Date: 09/09/2021
Rec V Date: 09/17/2021
Hospital: Y

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

Lab Data:

Allergies: NO KNOWN ALLERGIES

Symptom List: Dysphagia, Epiglottitis

Symptoms: 9/10/21 PATIENT SEEN IN THE ER REPORTS FEELING SICK X 2 DAYS.SHORTNESS OF BREATH, COUGH, BODY ACHES, REPORTS TESTED POSTIVIE FOR COVID ON HOME TEST 9/9/21. ALSO REPORTS FEVER, CHILLS, ANOREXIA. NOTED TO BE TACHYCARDIC WITH HR 120s. HYPOTENSION 80/60. MILD LEFT CALF TENDERNESS PRESENT WITHOUT SWELLING OR REDNESS. HYPOKALEMIA NOTED. O2 SAT. 99-100%. 9/12/21 DISCHARGED FROM HOSPITAL TO HOME.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1708571
Sex: F
Age: 67
State: MI

Vax Date: 01/15/2021
Onset Date: 09/12/2021
Rec V Date: 09/17/2021
Hospital: Y

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

Lab Data: Swabbed positive on admission 9/12/21

Allergies: metronidazole, sulfamethoxazole trimethoprim

Symptom List: Anxiety, Dyspnoea

Symptoms: Acute pancreatitis

Other Meds: Zoloft, sudafed, melatonin, climara

Current Illness:

ID: 1708572
Sex: F
Age: 48
State: FL

Vax Date: 04/01/2021
Onset Date: 05/25/2021
Rec V Date: 09/17/2021
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: 1. Blood work to test for hormones 8/27/21 2. Sonogram of left side of neck 9/7/2021

Allergies: Shellfish, iodine, radioactive dyes

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

Symptoms: 1. Menstral cycle became very heavy, bad cramping, began getting my period every 2 weeks since the end of May. 2. Developed a small benign lymph node on left side of neck.

Other Meds: Crestor 10mg Norvasc 5mg

Current Illness: None

ID: 1708573
Sex: M
Age: 71
State: MI

Vax Date: 02/04/2021
Onset Date: 09/05/2021
Rec V Date: 09/17/2021
Hospital: Y

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

Lab Data:

Allergies: NKA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: The patient has multiple health issues, so exact time of onset and symptoms are hard to diagnose, but patient presents with respiratory distress, fever (may be due to sepsis)

Other Meds: Allopurinol 100 mg Tab 100 mg 1 tab(s), PO (oral), qDay Amiodarone 200 mg Tab 400 mg 2 tab(s), PO (oral), bid Aspirin 81 mg Chew 81 mg 1 tab(s), PO (oral), qDay Atorvastatin 40 mg Tab 80 mg 2 tab(s), PO (oral), at bedtime Calcium Carbon

Current Illness: Type 2 Diabetes, prostate cancer, multiple myeloma, atrial fibrilation, chronic diastolic heart failure, end stage renal disease on dialysis, stroke, hypertension, hypothyroid, left ventrical hypertrophy

ID: 1708574
Sex: F
Age: 38
State: MO

Vax Date: 07/05/2021
Onset Date: 07/05/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: None.

Allergies: N/A

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

Symptoms: Thirty minutes after the vaccination was administered, I developed sharp, stabbing pains in my heart in regular intervals every 2-3 minutes until I feel asleep around midnight that night. Each episode lasted approximately 10-20 seconds. I have not experienced the same pains since 7/05/21.

Other Meds: Armour Thyroid; Liothyronine

Current Illness: N/A

ID: 1708575
Sex: F
Age: 46
State: IN

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 09/17/2021
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: This is in my medical record.

Allergies: Penicillin, Gabapentin, Sertraline

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

Symptoms: Immediate dizziness, hot flashes, felt like rapid onset of flu. Fibromyalgia symptoms went into intense unprecedented flare. Fibromyalgia symptoms at intense level persisted for many months afterwards and continue to date.

Other Meds: Metoprolol, Amitryptaline, Savella, Bupropion, Lisinopril, Crestor, Multivitamin, Calcium supplements, Xanex

Current Illness: Fibromyalgia

ID: 1708576
Sex: F
Age: 40
State: WA

Vax Date: 09/05/2021
Onset Date: 09/06/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: 9/8/21 Blood work, vaginal exam, and ultrasound. In ER, 9/10/21 f/u on the office with my OBGYN took my IUD Out and drew lab work again. My iron was now extremely low. My dr was worried if I kept bleeding like I was currently that I would need a blood transfusion. She put me on a large dose of hormones to help stop the bleeding. It is now 9/17 and I am still bleeding and cramping. I also feel very bloated and tender in my abdomen.

Allergies: Percocet, Penicillin, Cinnamon

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: 24 hours after the second covid 19 vaccine which was given 9/5/21, I started bleeding very heavily with large clots and pain. Contacted my OB/GYN office and couldn't get in to be seen right away so I went to the ER 9/8/21.

Other Meds: None

Current Illness: None

ID: 1708577
Sex: M
Age: 20
State: TX

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

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

Lab Data:

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: Nauseous, weakness, drop in BP. EMS evaluated and cleared when patient was stabilized.

Other Meds: None

Current Illness: None

ID: 1708578
Sex: F
Age: 20
State: MI

Vax Date: 09/13/2021
Onset Date: 09/15/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data:

Allergies: Unknown

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient received vaccine that was stored in freezer for 19 days.

Other Meds: Unknown

Current Illness: Unknown

ID: 1708579
Sex: F
Age: 64
State: UT

Vax Date: 03/18/2021
Onset Date: 03/19/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: Sinus CT-no abnormalities ; Chest CT- no abnormalities.

Allergies: Extensive pollen allergy; Rocephin injectable antibiotic

Symptom List: Diarrhoea, Nasal congestion

Symptoms: 24 hours after the vaccination - I started having severe asthma attacks and it continues. Some days are better than other days. I went through a period were it did not bother me. But here we are today and it's horrific. It has definitely limited my ability to function in a normal way. I have seen several doctors and have gotten different medications and have not gotten anywhere with them: Azelastine- nasal spray, Fluticasone- inhaler, Flovent-inhaler, Symbicort-inhaler. All of these have been non-effective or I have had an adverse event to them. ENT, DR, he ordered a sinus CT- no abnormalities. Dr, an allergy/asthma specialist, I started allergy session last October before I got COVID -19 and before the vaccine. Our belief was the allergy shot would help me with the asthma, but so far it has not . When my PCP was not available I also saw PA, she gave me a breathing treatment. I have been referred by Dr. to see Dr, a pulmonary specialist who specializes on Long-Haul COVID, and I have an appointment on 09/28/2021. I had COVID-19 December 2020 I had a pretty good case of it and then I got the shot in March. I asked Dr, but he said to ask the long-haul pulmonary specialist the question: They talked a lot about people getting booster shots , I am very concerned about getting the booster because of the AE reaction I had from the original vaccine which may do more of the same to me. I am al worried about getting COVID again because I am in such a bad situation with my asthma, that I may not be able to fight it again if I got the actual disease.

Other Meds: Omeprazole; Effexor; Amoxicillin; Pepcid; Singulair; Trazodone; Baby Aspirin; Zyrtec; One a day Vitamins Womens; Citracal; Vitamin D-3; Fish Oil Pearls; Magtech Magnesium

Current Illness: No

ID: 1708580
Sex: F
Age: 38
State: KY

Vax Date: 08/26/2021
Onset Date: 09/13/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: Covid-19 test.

Allergies:

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

Symptoms: I had coughing, headache, sore throat, and running nose. I went to my doctor for a Covid-19 test, negative.

Other Meds:

Current Illness:

ID: 1708581
Sex: F
Age: 46
State: TX

Vax Date: 09/09/2021
Onset Date: 09/10/2021
Rec V Date: 09/17/2021
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: Eucalyptus oil; Actifed; Thimerosal sensitivity (in contact solution and as vaccine adjuvant)

Symptom List: Rash, Urticaria

Symptoms: Fever (99F 1hr after dose of Extra Strength Tylenol), chills, muscle aches, headache, congestion, nausea, fatigue, elevated heart rate. Typical resting heart rate 50-55 bpm, resting heart rate during event 100-120 bpm. Most symptoms lasted ~2 days. Headache and fatigue lasted 3 days.

Other Meds: Dietary fiber supplement

Current Illness: None

ID: 1708582
Sex: F
Age: 16
State: GA

Vax Date: 07/13/2021
Onset Date: 07/13/2021
Rec V Date: 09/17/2021
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: Vaccine was given to under aged patient. Patient was 16 years of age at the time.

Other Meds:

Current Illness:

ID: 1708583
Sex: F
Age: 64
State: WA

Vax Date: 08/31/2021
Onset Date: 09/02/2021
Rec V Date: 09/17/2021
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.

Allergies: None

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

Symptoms: Severe abdominal cramping lasting for approximately 1 hour with 3 event occurrences. Still getting cramping events. Both hands and forearms have a constant tingling and burning sensations.

Other Meds: Albuterol inhaler; Omega3 fish oil; Vitamin D3; Zinc; Cetrizine; Ashwagandha

Current Illness: None

ID: 1708584
Sex: M
Age: 67
State: CA

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

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

Lab Data: See above.

Allergies: Penicillin; Codeine - makes me vomit

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

Symptoms: The next day in the morning - chills and body aches - started slowly but by mid morning it was more and lasted about 24 hours. In June - shingles symptoms -but not open lesions. The first doctor I saw (June 14), who wasn't my regular doctor, didn't think it was shingles but then I saw my regular doctor (June 25) and he helped me with meds. I had skin pain and it was rather severe - my whole chest was sensitive to touch and back pain - midline wrapped around my whole rib cage and I had a deep pain in right side of spine in back bothered my sleep and doctor gave me Valacyclovir to treat the shingles and Neurontin for the skin pain/neuroleptic pain I was experiencing. It dissipated over a period of three weeks after getting on the Norantin and I weaned myself off that (took the last on August 1) and finished the course of Acyclovir which was about 7 days.Also in June, I have had a dry, hacky cough for a long time and for history : and saw an ENT a couple of times and they told me it was reflux and they put me on Protonix (before the vaccine). I was starting to get more winded then I use to be and and my regular doctor conferred with pulmonologist after an x-ray pulmonologist ( and he ordered a Chest CT and bloodwork and the PFT) for the interstitial lung disease - pulmonologist (July 26th) - pulmonary function test (had in July 23 - show no signs of pulmonary fibrosis but my brother and sister both died from it) and bloodwork done. CT scan - showed progression of fibrosis - PFT was negative; bloodwork was for Sogran's and other kind of stuff to attribute to fibrosis on my lungs. CKD3 - Kidney disease - causing some anemia - could attribute to shortness of breath and exercise intolerance. Note: I had a tetanus shot on the 25th of June when I saw my doctor - had a sore arm for a day.

Other Meds: Tylenol; Metroprolol; Atorvastatin; Protonix; Toprozol; iron supplement; Multi-Vitamin; Vit D3; CoQ10

Current Illness: No

ID: 1708585
Sex: F
Age: 71
State: NY

Vax Date: 09/04/2021
Onset Date: 09/04/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: Blood work and sonogram seem to be OK.

Allergies: Most antibiotics give me C-diff

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

Symptoms: Shortly after going to bed I felt a discomfort in the upper right side of the ribs. During the night and into Sunday the discomfort became more acute and spread to under the rib cage on the right side. I tried lemon water as a way of detoxing. I tried ice on the area to decrease inflamation as it felt like my liver/gall bladder area was swollen. When that failed I contacted my doctor who order blood work and a sonogram. To this point the tests are OK.

Other Meds: Lovastatin, Calcium, HCL, Beta plus, Vitamin C, IBGuard, Multivitamin, Magnesium, CoQ10, Glucosamine/chondroitin

Current Illness: None

ID: 1708586
Sex: F
Age: 68
State: IN

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 09/17/2021
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: Lisinopril; Latex; Shingles Vaccine; Pneumonia vaccine

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

Symptoms: 20 minutes after injection red all over upper border lips had small bumps. Face and top part of body really hot.

Other Meds: Multivitamin; Biotin; Aspirin; Losartan; Hydrochlorothiazide; Levothyroxine; Super B Complex; Vitamin C; Magnesium; Calcium plus D; Singular; Atorvastatin

Current Illness: No

ID: 1708587
Sex: F
Age: 38
State: MA

Vax Date: 06/01/2021
Onset Date: 07/01/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: N/a.

Allergies: Penicillin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Irregular menstrual spotting every 2-3 weeks for a few months beginning about 2 weeks after dose 2. I have a hormonal IUD (Lileta) and typically have no menstrual bleeding at all.

Other Meds: Zyrtec

Current Illness: N/a

ID: 1708588
Sex: F
Age: 51
State: MI

Vax Date: 09/14/2021
Onset Date: 09/15/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data:

Allergies: No Known Drug Allergies

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient received vaccine that was stored in freezer for 19 days.

Other Meds: Unknown

Current Illness: Unknown

ID: 1708589
Sex: M
Age: 88
State: MI

Vax Date: 03/02/2021
Onset Date: 09/05/2021
Rec V Date: 09/17/2021
Hospital: Y

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

Lab Data: Swabbed positive for covid on 9/5/2021

Allergies:

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

Symptoms: vomitting

Other Meds: Tylenol, albuterol, mylanta, augmentin, amlodipine, aspirin, lidocaine patch

Current Illness:

ID: 1708590
Sex: F
Age: 32
State: WA

Vax Date: 09/11/2021
Onset Date: 09/12/2021
Rec V Date: 09/17/2021
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: On Tues Sept 14: C reactive protein, sed rate, EKG, chest xray (I believe all results were normal)

Allergies: peanuts, hazelnuts, pecans, walnuts

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

Symptoms: Symptoms occured after both first dose (Aug 21) and second dose (Sept ). Intermittent episodes of chest and upper back pain sometimes accompanied by shortness of breath, dizziness and nausea, beginning 3 days after the first dose and resolved after about day 5. With second dose symptoms began the next day and escalated over several days, still ongoing now (7 days later) but some improvement compared to 2 days ago. Symptoms usually occurred with light exertion (attempting usual activities which normally do not cause these symptoms).

Other Meds: ibuprofren, tylenol, benadryl

Current Illness: none

ID: 1708591
Sex: F
Age: 54
State: NC

Vax Date: 08/23/2021
Onset Date: 08/23/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: ER HAD DONE ECG AND HEART AND BLOOD LABS

Allergies:

Symptom List: Unevaluable event

Symptoms: PATIENT CAME IN 9/17/21 MORNING TO ASK ABOUT IMMUNIZER WHO GAVE HER PFIZER VACCINE ON 8/23/2021 AND TO REPORT THE ADEVERSE REACTION THAT SHE HAD AFTER GETTING VACCINE. PATIENT REPORTED SHE WAS HEALTHY AND NEVER HAD HEART ISSUES UNTIL THE SEOCND DOSE OF VACCINE. SHE HAD BEEN DIAGNOSED WITH HEART PROBLEM AND NOW SHE HAS HEART RATE MONITOR AFTER VACCINE EVENT AND SHE IS NOT BACK TO NORMAL CANNOT GO BACK TO WORK SHE IS STILL LOW ENERGY. PATIENT MENTONED WITH 1 ST DOSE ON 7/28/21 SHE HAD BAD HEADACHE AND SHE TOOK 2 TYLENOL WHICH TOOK CARE AND SHE WAS FINE. ON 8/13/21 SHE HAD SECOND DOSE SHE HAD BAD HEADACHE AND SHE LEFT PHARMACY AFTER 20 MINUTES AND WHEN SHE WENT HOME 10 MINUTES AFTER SHE WAS ABOUT TO TAKE TYLENOL IN KITCHEN AND SHE HAD PASSED OUT. HER HUSBAND CALL 911 AND SHE WOKE UP IN EMERGENCY ROOM WITH HEART RATE MONITOR. AS PEPER FROM ER SHE HAD ABNORMAL ECG. DIAGNOSIS ON PAPER MENTIONED PATIENT HAD SYNCOPE, BRADY CARDIA WITH HEART RATE 30 AND SINUS RHYTUM BIGEMINY. PT NOW SEES CARDILOGIST AND HE IS MONITORING HER. PT WAS NOT HAPPY SINCE HER LIFE IS NOT NORMAL ANYMORE. SHE WANTS SOMEONE FROM CDC TO CALL HER. I INFORMED PATIENT THAT WE WILL BE REPORTING THIS ADR TO CDC , VAERS WEBSITE AS PER PHARMACY INTERNAL SYSTEM.

Other Meds:

Current Illness:

ID: 1708592
Sex: F
Age: 54
State: CA

Vax Date: 08/13/2021
Onset Date: 08/18/2021
Rec V Date: 09/17/2021
Hospital: Y

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

Lab Data: abdominal CT and bloodwork (8/18/2021)

Allergies: erythromycin - nausea

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

Symptoms: 5 days after vaccine (8/18/2021) I was in ER with acute appendicitis that resulted in emergency surgery to have appendix removed

Other Meds: Amlodipine

Current Illness: n/a

ID: 1708593
Sex: F
Age: 39
State: NY

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

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

Lab Data: Went to cardiologist on 9/13/2022. Awaiting results of test.

Allergies: Penicillin

Symptom List: Injection site pain, Pain

Symptoms: Began having palpitations and heart flutters with chest discomfort about a week after vaccine. Comes and goes and has a been up until now.

Other Meds: Amlodipine 5mg

Current Illness:

ID: 1708594
Sex: M
Age: 68
State: IN

Vax Date: 03/04/2021
Onset Date: 03/05/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: No.

Allergies: Compazine

Symptom List: Injection site pain, Menorrhagia

Symptoms: The next morning after the vaccine my arm at the injection site was swollen to about 2" across and about .5" tall, I felt very queasy and sluggish the whole next day which diminished by that next day and the swelling diminished within the next 3 days.

Other Meds: Auristatin, Propranolol, Vitamin D complex, Calcium 600mg, Multivitamin, Fish Oil 1000mg, Dicyclomine-Sodium, Aspirin, Melatonin

Current Illness: No

ID: 1708595
Sex: F
Age: 73
State: WA

Vax Date: 03/13/2021
Onset Date: 03/15/2021
Rec V Date: 09/17/2021
Hospital: Y

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

Lab Data: Iron tests (extremely low hemoglobin).

Allergies: Penicilin (suspected), Shellfish (aniflactic shock)

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

Symptoms: Severe anemia post-vaccine (levels of hemoglobin dropped down to 6.2), had to have a covid test, marked as still positive from January, told by doctor people can test positive for up to 90 days after initial infection. Internal bleeding due to an ulcer in the stomach. Hospitalized 5 times during the event, given iron infusions, the second hematologist stopped the iron tablets (because they upset the stomach), the irritation of the stomach seemed to stop and have not had the bleeding since then. Double transfusion, iron infusions, have been feeling much better.

Other Meds: Insulin (Type II Diabetes), Iron Supplement, Iron Infusions, Gabapentin (2x/day, diabetic neuropathy ) Mitoporal (2x/day, blood pressure), Ropinerol (at night), Atorbistatin (at night), Vitamin D3, Losartin Potassium, Multivitamin, Forisimi

Current Illness: N/A

ID: 1708596
Sex: F
Age: 81
State: NC

Vax Date: 09/10/2021
Onset Date: 09/11/2021
Rec V Date: 09/17/2021
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: n/a

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: red arm, sore, swollen, warm to the touch

Other Meds: atorvastatin, levothyroxine, omeprazole

Current Illness:

ID: 1708597
Sex: F
Age: 86
State: WI

Vax Date: 02/12/2021
Onset Date: 09/06/2021
Rec V Date: 09/17/2021
Hospital: Y

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

Lab Data: COVID-19 PCR NP Swab 9/6/21 Chest Xrays 9/6/21 The cardiomediastinal contours and pulmonary vasculature are within normal limits. There are patchy areas of airspace disease, consistent with infection, including Covid 19. There is no pneumothorax or pleural effusion.

Allergies: Environmental, Onion, Sertraline

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient completed COVID-19 vaccine series on 2/12/21. Patient was admitted to reporting hospital on 9/6/21 and discharged on 9/15/21. Patient was admitted due to confusion and severe COVID-19 with pneumonia and acute hypoxic respiratory failure. Admission test for COVID-19 was positive per PCR NP swab on 9/6/21.

Other Meds: albuterol 1089, Fosamax 70mg every 7 days, aspirin 81mg, Lipitor 40mg, Dulcolax, Pulmicort Flexhaler, Vitamin D3, Flonase, Diltiazem, Breo ellipta, Lasix, Mucinex, Duoneb, Singular, Prilosec, predinisone 5mg, Florajen3, Nebcin 80mg/2mL,Cell

Current Illness: CREST syndrome, ILD, osteoporosis, asthma, sepsis with acute pneumonia, HTN, HFpEF

ID: 1708598
Sex: F
Age: 70
State: PA

Vax Date: 03/16/2021
Onset Date: 03/18/2021
Rec V Date: 09/17/2021
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: Examination in the dermatologist office.

Allergies: Shellfish, dairy, penicillin, erythromycin, narcotic pain relievers, latex

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

Symptoms: A couple of days after the second vaccine I developed a rash on my face, both sides but the right is worse. I still have the rash after several treatments by dermatologists

Other Meds: Synthroid, Multivitamin, and Calcium

Current Illness:

ID: 1708599
Sex: M
Age: 26
State: FL

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

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: pain in left arm at injection site followed by severe headaches. Arm was sore for the next 2 days

Other Meds:

Current Illness:

ID: 1708600
Sex: F
Age: 47
State: OH

Vax Date: 09/13/2021
Onset Date: 09/15/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: 9/17/21 evaluated, and prescribed Meclizine 25 mg TID PRN dizziness.

Allergies: None

Symptom List: Injection site pain

Symptoms: Developed dizziness, vomited once on 9/15/21, was seen at the clinic on 9/17/21, is still dizzy.

Other Meds: None

Current Illness: None

ID: 1708601
Sex: F
Age: 62
State: FL

Vax Date: 08/28/2021
Onset Date: 08/30/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: SEP 9 2021 URGENT CARE, COVID TEST NEGATIVE. SOME KIND OF UNKNOWN VIRUS DECTECTED.

Allergies: SHELLFISH; IODINE INTRAVENUS

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

Symptoms: CHILLS, FEVER, DRY MOUTH DRY, COUGH, ACHES, PAINS, NO TASTE, AND EXTREME TIREDNESS SINCE THEN.

Other Meds: PAIN KILLERS; OMEPRAZOLE; PROZAC

Current Illness: OSTEOPOROSIS; PSORIATIC ARTHIRTIS; HYPERTENSION; ASMATHIC; CHRONIC BRONCHITIC; HIGH CHOLESTEROL; CHRONIC CERVICAL; LUMBAR PAIN ANXIETY

ID: 1708602
Sex: F
Age: 35
State: CA

Vax Date: 09/15/2021
Onset Date: 09/17/2021
Rec V Date: 09/17/2021
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: Ciprofloxycin

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

Symptoms: Menstruation after not having one since IUD placement in January 2021. Dime sized Blood Clots falling into toilet when tampon removed, also had Diarrhea.

Other Meds:

Current Illness:

ID: 1708603
Sex: F
Age: 35
State: NY

Vax Date: 09/13/2021
Onset Date: 09/17/2021
Rec V Date: 09/17/2021
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: I've had abnormal Vaginal bleeding. My period is not due for another two weeks. I track my cycle and have tracked my cycle for the last three years never once have I had vaginal bleeding apart from my menses which is always a regular at 28 to 29 days.

Other Meds: None

Current Illness: None

ID: 1708604
Sex: F
Age: 74
State: FL

Vax Date: 02/22/2021
Onset Date: 03/22/2021
Rec V Date: 09/17/2021
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.

Allergies: None

Symptom List: Erythema, Pruritus

Symptoms: Horrible joint pains throughout body, severe thinning of hair, and hair loss.

Other Meds: Synthroid 150mg

Current Illness: None

ID: 1708605
Sex: F
Age: 61
State: WI

Vax Date: 09/08/2021
Onset Date: 09/15/2021
Rec V Date: 09/17/2021
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 done at this point. Talked to my Doctor and recommendation is to come in for an office visit regarding the vertigo and hypertension.

Allergies: Bactrim; suture material

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

Symptoms: Initial adverse reaction on day of vaccine and on day 2 was muscle ache. Especially in neck and shoulders. More so on left side where vaccine was given. Then, 1 week following vaccine, on September 15 at 7 AM, I woke up with extreme vertigo. Tried to slide my way out of bed and made it to the bathroom for emesis. Very dizzy all day long. Blood pressure was elevated with reading of 191/92 on 9-16. Today (9-17) reading was 182/91 Pulse 57. Feel like my head has a lot of pressure and again had emesis this morning at 8:30 AM. I am normally a person who very, very rarely had emesis. Cannot remember the last time that has occurred since 2 days ago.

Other Meds: Lisinopril; Multivitamin; Vitamin D; Zinc 50

Current Illness: None

ID: 1708606
Sex: F
Age: 43
State:

Vax Date: 03/13/2021
Onset Date: 09/12/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: PATIENT HAD JANSSEN VACCINE ON 03/13/2021, AND TESTED POSITIVE TO COVID.

Other Meds:

Current Illness:

ID: 1708607
Sex: F
Age: 29
State: FL

Vax Date: 04/22/2021
Onset Date: 04/22/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: None.

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Immediately upon receiving the vaccine I felt a tingling in my arm. About 8-10 Minutes afterwards I began to lose my vision and hearing as the room closed in around me. I began to sweat profusely. My husband called over the lady who administered the vaccine and she looked concerned. I threw up in a grocery bag. I went home and had to rest for several days. Had pain at the site and my left arm was sore for a week.

Other Meds: None

Current Illness: None

ID: 1708608
Sex: F
Age: 28
State: GA

Vax Date: 08/26/2021
Onset Date: 09/02/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: About week after I got my shot, I started having increase depression. I started seeing a counselor.

Other Meds: Wilburton

Current Illness:

ID: 1708609
Sex: F
Age: 63
State: MA

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/17/2021
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: None.

Allergies: Clindamycin; Statins

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

Symptoms: Muscle and bone pain over one week in duration, Joint pain over one week in duration, episodic flushing, hot flashes w/o fever, and episodic vision changes.

Other Meds:

Current Illness:

ID: 1708610
Sex: F
Age: 69
State: MN

Vax Date: 02/14/2021
Onset Date: 08/08/2021
Rec V Date: 09/17/2021
Hospital: Y

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

Lab Data: See above....Covid test, CT scan, blood work and stool cultures

Allergies: None known

Symptom List: Pain in extremity

Symptoms: Approximately 5 months after my second dose shot, I began to experience intestinal cramping and diarrhea. By the 2nd day, I notice blood in my stool, intense pain and cramping. I was given a CT scan and diagnosed with "pan colitis". I was given pain medication, IV fluids and a restricted diet. Cultures revealed no bacterial cause and I was discharged from the hospital.,

Other Meds: Lisinopril, fish oil, multi-vitamin, low dose aspirin

Current Illness: None

ID: 1708611
Sex: M
Age: 69
State: VA

Vax Date: 03/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: PSA test approx 5 weeks ago and again on 9/16. Not previously elevated

Allergies: None

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

Symptoms: On examine for Insurance Coverage PSA (below) level elevated and testicale swollen (9/11) Neither previous issues

Other Meds: Calcium with D3

Current Illness: None

ID: 1708612
Sex: M
Age: 84
State: TN

Vax Date: 03/03/2021
Onset Date: 09/09/2021
Rec V Date: 09/17/2021
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: 9/9/21 COVID-19 PCR = DETECTED.

Allergies: NO KNOWN MEDICAITON ALLERGIES

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

Symptoms: 9/9/21 SEEN IN THE ER WITH LOW OXYGEN 88%. SENT FROM PRIMARY CARE MD FOR HYPOXIA ON AMBULATION. ADMITTED TO HOSPITAL DUE TO PNUEMONIA SECONDARY TO COVID. ACUTE CHF.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1708613
Sex: M
Age: 53
State: AR

Vax Date: 04/15/2021
Onset Date: 04/16/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: Primary Care Physician states I should discuss this with you. I have no tests.

Allergies: None

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

Symptoms: This is my 2nd report to this site and you should have that first report on record. It has been almost 5 MONTHS and since then for the duration I have had the same remaining mild and dull headache. It persists and on occasion, becomes a problem while trying to concentrate. This chronic headache condition WAS NOT present prior to the 2nd shot. I have not seen my Primary Care physician for over 4 years, and when attempting to make an appointment with them TODAY explaining my condition, they advised me to contact the CDC for help and WOULD NOT accept me as a patient. I explained that I had contacted the CDC, and they advise going to a PCP. PLEASE HELP. I need assistance in this matter.

Other Meds: None

Current Illness: None

ID: 1708614
Sex: M
Age: 12
State: MI

Vax Date: 09/14/2021
Onset Date: 09/15/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data:

Allergies: No Known Drug Allergies

Symptom List: Vomiting

Symptoms: Patient received vaccine that was stored in the freezer for 19 days before moving to refrigerator.

Other Meds: Unknown

Current Illness: Unknown

ID: 1708615
Sex: F
Age: 30
State: WA

Vax Date: 09/01/2021
Onset Date: 09/01/2021
Rec V Date: 09/17/2021
Hospital:

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

Lab Data: Having MRI done, currently scheduled on 09/24/2021. Possible referral to neurology.

Allergies: Sulfa, Latex, Nitrofurantoin

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Horrific migraine attack that has not let up after 2 weeks. Started late night of 9/1. Missed 40 hours of work, need imaging, unable to function at full compasity for days at a time. Temporary confusion, temporary loss of short term memory.

Other Meds: N/A

Current Illness: Flu like symptoms for 4 days after 1st Covid vaccine dose given on 08/11/2021. Recovered with rest.

ID: 1708616
Sex: F
Age: 80
State: OR

Vax Date: 03/09/2021
Onset Date: 04/23/2021
Rec V Date: 09/17/2021
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: CBC to find thyroid and adrenal insuffiency. MRI on pituatary which was negative.

Allergies: Augmentin; Levaquin; Penicillin

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

Symptoms: Excessive swelling in legs, adrenal insufficiency, abnormal thyroid test, light headedness, pain and numbness in left foreman and thumb, wrist pain, balance issues, and brain fog.

Other Meds: Prednisone, Latanoprost, Spiriva, Losartan, Ketoconazole, Rosuvastain, Advair, Albuterol inhaler, Raloxifene, Montelukast, Furosemide, Chlorhexedrine nasal rinse

Current Illness: Pseudomonas in lung

ID: 1708617
Sex: F
Age: 57
State: IA

Vax Date: 07/22/2021
Onset Date: 07/22/2021
Rec V Date: 09/17/2021
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: PCN

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Diarrhea and vomiting after Dose 1. Sore arm, decreased energy, and queasy after Dose 2.

Other Meds: Aspirin 81 mg; Metoprolol 50mg; Claritin 10mg; Nitroglycerin 04.mg

Current Illness:

ID: 1708618
Sex: F
Age: 45
State: CA

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/17/2021
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: No

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

Symptoms: Pressure, burning in left armpit, neck/face, and left breast including nipple.

Other Meds: No

Current Illness: No

ID: 1708619
Sex: F
Age: 47
State: PA

Vax Date: 09/09/2021
Onset Date: 09/10/2021
Rec V Date: 09/17/2021
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: no

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

Symptoms: dizziness, arms and legs wouldn't stop moving and started falling all over the place

Other Meds: Lyrica, Inderal, Wellbutrin, Klonopin

Current Illness: no

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am