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

Date Died: 09/19/2021

ID: 1715588
Sex: F
Age: 78
State: KY

Vax Date: 03/19/2021
Onset Date: 09/19/2021
Rec V Date: 09/20/2021
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:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient is a 78 y.o. female with a history of HTN, DMII, anxiety and depression presenting with worsening shortness of breath over the past 1 week. Pt went to PCP on 9/13 and was ordered curb-side rapid COVID test, and was notified the following day that it was positive. Pt underwent Regeneron infusion on 9/15. When symptoms worsened pt came to ED for further evaluation and treatment. Patient was admitted to the COVID-19 cool floor. Patient was placed on AV APS for acute hypoxic respiratory failure. It appears her mask was dislodged, oxygen saturations to dropped patient went into PEA cardiac arrest. ROSC obtained patient was transferred to the ICU where she was coded again. Once again, ROSC regained. Patient was placed on an epinephrine followed by norepinephrine and vasopressin. hydrocortisone followed by hydrocortisone every 8 hr. Family was at bedside they were notified of patient's poor prognosis. They asked patient remains a full code. Once again patient coded, asystole. ACLS protocols were started, family was updated in a asked patient"s status to DNR patient expired soon after. time of death240hr

Other Meds:

Current Illness:

ID: 1715589
Sex: F
Age: 32
State: NC

Vax Date: 09/16/2021
Onset Date: 09/16/2021
Rec V Date: 09/20/2021
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: IV Contrast PPD skin test Advair Sulfa drugs Tramadol Melons Berries Broccoli Nuts

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient history of multiple allergies s/p COVID infection 5/2021, seeing allergist, who considered risks vs benefits and recommended patient receive the COVID vaccine. Patient given Janssen COVID vaccine on 9/16/21 at approximately 12:20PM. During 15 minute observation period, patient experienced "impending doom", starting breathing fast and felt nauseous. Was pacing to "try to prevent vaccine reaction". Reported left arm itching "feels like it is on fire" and difficulty breathing. 1227: BP 164/92, O2 99, HR 154, lungs CTA, reports dizziness and near syncope, hyperventilation 1231: placed in wheelchair and taken to an exam room Patient reported throat "tightness", nausea, labored breathing, pressured speech, dry heaving. Airway clear, no swelling noted. 1231: Benadryl 50mg IM administered R deltoid 1234: BP 155/100, O2 99, HR137 1235: 0.3mg Epinephrine administered Left thigh, EMS called 1236: BP 145/94, O2 99, HR 128-144 1237: HR 152 1239: BP 140/78, O2 99, HR 148 1240: Family Notified 1244: Patient transported to Emergency Department via EMS, patient breathing improved, teeth chattering and body tremors noted EMS: Zofran and duoneb administered. Hospital report: VSS, monitored for 4 hours, Atarax administered for itching, Ativan given for anxiety. NSR, discharged. 9/17/21- Patient called for follow-up, reports continued headache, fever, body aches, itching, tacycardia (115) 9/20/21- Patient called for follow-up, symptoms improved, does report random facial twitching

Other Meds: Singulair Allegra Zyrtec Multivitamin Vitamin D3 Yaz OCPs

Current Illness: None

ID: 1715590
Sex: M
Age: 14
State: NY

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 09/20/2021
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: none

Allergies: no

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

Symptoms: Pfizer vaccine was diluted with NS 0.9% Bacteriostatic which is not recommended for use with this vaccines. Reported to Pfizer and agency. As per recommendation from agency, affected dose should be repeated. Pt was notified and all questions answered. Pt repeated dose on 9/15/21.

Other Meds: unk

Current Illness: unk

ID: 1715591
Sex: M
Age: 66
State: MN

Vax Date: 02/04/2021
Onset Date: 09/13/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: 9/19/21-Tested positive for COVID, negative for strep

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Noticed symptoms of what I thought was cold or strep throat on approximately 9/14/21 (sore throat, head congestion, coughing, feverish)

Other Meds:

Current Illness:

ID: 1715592
Sex: F
Age: 43
State: TN

Vax Date: 03/22/2021
Onset Date: 03/22/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data:

Allergies: Sensitive to fragrances, chemicals, allergic to bee stings, macrobid, contrast dye

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

Symptoms: 30 minutes after injection my throat began to close up. I couldn?t swallow. I wasn?t getting much air and talking was very difficult. I live in a rural area and we were a distance from the vaccination site now (yes I waited the recommended 15 minutes) and didn?t have access to an epi pen. I took my inhaler repeatedly until my throat relaxed and opened up. After the initial reaction I continued to wheeze and need my inhaler A LOT for the next week.

Other Meds: Propranolol, montelukast, topamax

Current Illness: None

ID: 1715593
Sex: M
Age: 13
State: CA

Vax Date: 08/21/2021
Onset Date: 08/23/2021
Rec V Date: 09/20/2021
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 Negative (08/29/2021), COVID Test Negative (09/05/2021)

Allergies: Peanuts; shrimp; avocado

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

Symptoms: A few days after the 1st dose, he experienced a sore threat, congestion; however, the cough was dry and became worse after a few days along with the congestion. It went away and started again. I took him to local urgent care and they ran a COVID test that came back negative. I called the school to make sure he was clear to return to school but they wanted him to quarantine for 10 days and had to do another one because the cough continued and then had to stay out of school after receiving the 2nd dose on 09/11/2021 and his cough returned on 08/19/2021 along with a headache and I gave him some ibuprofen for it and the vomiting/diarrhea lasted a few days or so. I called the school and they felt that his symptoms from receiving the vaccine so it was not necessary to quarantine him.

Other Meds: No

Current Illness: No

ID: 1715594
Sex: F
Age: 27
State: MN

Vax Date: 04/08/2021
Onset Date: 09/19/2021
Rec V Date: 09/20/2021
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: POSITIVE COVID TEST 9/19/21

Allergies: PENICILLINS BEE STING ZOLOFT

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: ASYMPTOMATIC

Other Meds: ARIPiprazole (ABILIFY) 30 mg oral tablet OLANZapine (ZYPREXA ZYDIS) 5 mg oral disintegrating tablet dextroamphetamine-amphetamine (ADDERALL) 15 mg oral tablet lamoTRIgine (LAMICTAL) 100 mg oral tablet

Current Illness:

ID: 1715595
Sex: F
Age: 35
State: KY

Vax Date: 08/11/2021
Onset Date: 09/08/2021
Rec V Date: 09/20/2021
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: Covid positive work related

Other Meds:

Current Illness:

ID: 1715596
Sex: M
Age: 41
State: CO

Vax Date: 09/16/2021
Onset Date: 09/18/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data:

Allergies: no

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: After receiving the Johnson and Johnson I have muscle spasms in my left hand----they happen often during the day and at certain times. I never had them before I received the shot, only after being mandated for my job.

Other Meds: atenolol

Current Illness: none

ID: 1715597
Sex: F
Age: 71
State: CA

Vax Date: 06/27/2021
Onset Date: 06/29/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: saw Rheumatology with negative evaluation. Standard lab testing is normal.

Allergies: bet ablockers, bisphosphonates, ibuprofen, morphine, sulfa, mastisol, astelin

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Within a few days the patient developed severe widespread arthralgia, muscle stiffness, but as of today 9/20/21 it has not completely resolved.

Other Meds: aspirin, estrace, estradiol, hydroxyzine, spiriva, vascepa

Current Illness: None

ID: 1715598
Sex: F
Age: 89
State: GA

Vax Date: 02/16/2021
Onset Date: 08/04/2021
Rec V Date: 09/20/2021
Hospital: Y

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

Lab Data: 08/04/2021 PCR+ COVID-19 test at HOSPITAL; 08/04/2021 PCR+ COVID-19 test at facility

Allergies:

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

Symptoms: Breakthrough COVID-19 case with symptom onset 8/4/2021: New loss of taste or smell, Runny nose/Congestion. Hospitalization of unknown duration.

Other Meds:

Current Illness:

ID: 1715599
Sex: F
Age: 66
State: TN

Vax Date: 09/05/2021
Onset Date: 09/18/2021
Rec V Date: 09/20/2021
Hospital: Y

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

Lab Data: Hypotensive, tachycardia, D Dimer, elevated, CTA chest right sided pulmonary nodule. Room air oxygen sat is 97%

Allergies: NKA

Symptom List: Rash, Urticaria

Symptoms: Hospitalized with delirium likely due to alcohol withdrawal. No respiratory symptoms

Other Meds: Unknown

Current Illness: Unknown

ID: 1715600
Sex: F
Age: 59
State: NC

Vax Date: 09/20/2021
Onset Date: 09/20/2021
Rec V Date: 09/20/2021
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: Patient was given 0.5mL of the Pfizer vaccine instead of 0.3mL. She called about an hour later complaining of a headache.

Other Meds:

Current Illness:

ID: 1715601
Sex: F
Age: 45
State: TX

Vax Date: 09/11/2021
Onset Date: 09/12/2021
Rec V Date: 09/20/2021
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. I contacted nurse from my doctor office about my chest hurting. They said it was normal and I'd be fine after a day

Allergies: none

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

Symptoms: About 9pm 9/11/21 my heart started hurting. Felt like how my heart feels when I have a panic attack but I wasn't having a panic attack. 9/12/21 sore arm (expected), every muscle and joint in my body hurt, I was dizzy and could not think clearly, bad headache, low grade fever randomly. I tried morning routine and gave up and went to bed after two hours of pushing it. I slept all day 9/12 then couldn't even get out of bed for dinner. My family brought me food in bed and I ate some then went back to bed until the next day. On Monday 9/13 I still felt really bad. I still had all the symptoms but the joint and muscle pain weren't quite as severe as Sunday. I couldn't mentally keep things straight to work. Normal simple task that would have taken 1 minute, took 10 and I even doubted what I was doing then. I laid down about 2 and rested the rest of the day. On Wednesday 9/14, all symptoms were gone except the headache. By noon the headache went away and I was back to normal.

Other Meds: Vit. D3 - 5000iu PM, 1 benadryl PM, Gabapentin 1600mg/2x day, Hydroxyzine HCL 50 mg PM, Bupropion XL 300mg AM, Oxcarbazepine 150mg 2/x day, Cephalexin 500mg 3x/day

Current Illness: paronychia in 2 toes

ID: 1715602
Sex: F
Age: 39
State: NY

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: NA

Allergies: Doxycycline, Bactrim, augmentin, Lexapro, venlafaxine, and scopolamine.

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

Symptoms: Patient received Pfizer covid vaccine 6 hours and 51 minutes after the vaccine had been reconstituted. Patient has not had any side effects, however, CDC has advised that she will need an additional dose. Waiting for more guidance from CDC as to when to administer another dose.

Other Meds: Quetiapine fumarate, cetirizine, fluocinonide cream, linzess, triamcinolone acetonide nasal spray, promethazine, cyclobenzaprine, buspirone, atenolol, Imitrex, hydroxyzine, acyclovir, fluoxetine, and Ventolin inhaler.

Current Illness: NA

ID: 1715603
Sex: F
Age: 39
State: KY

Vax Date: 08/23/2021
Onset Date: 09/07/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: positive Covid 19 test 09/09/2021

Allergies:

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

Symptoms: Joint pain, headache, nausea, diarrhea. Symptom onset day was 09/07/2021.

Other Meds: Adderall, Zoloft, Konopin, Lyothyrinine

Current Illness:

ID: 1715604
Sex: F
Age: 11
State: WI

Vax Date: 08/25/2021
Onset Date: 08/25/2021
Rec V Date: 09/20/2021
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: Seasonal, amoxicillin

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

Symptoms: VASOVAGAL SYNCOPE

Other Meds: None known.

Current Illness: None known

ID: 1715605
Sex: F
Age: 38
State: FL

Vax Date: 08/10/2021
Onset Date: 08/11/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Bright red rash on vaccine site, turned dark and has a permanent dark spot now. Changes in menstrual cycle, had my period right after the shot and then had it again a few days later. I then had my period two weeks later for just a few days and I have had severe menstrual cramps the last few days

Other Meds: Lamitcal, Clonazapem, Citaproloam, Almodipine, Lisinprol/HCTS, Metforim, Lovastation, Ferrous Sulfate, Levothroxine

Current Illness: None

ID: 1715606
Sex: F
Age: 11
State: PR

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: UNKNOWN

Allergies: UNKNOWN

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: INADVERTENTLY VACCINATED BEFORE AGE 12. WRONG DATA ENTRY INFORMATION, NO CONTACT POSSIBLE.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1715607
Sex: M
Age: 49
State: IL

Vax Date: 09/16/2021
Onset Date: 09/19/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: WENT TO HOSPITAL

Allergies: n/a

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

Symptoms: VISION BLURRY AND HEADACHE WHEN TRY TO CONCENTRATE AND FOCUS ON OBJECT

Other Meds: n/a

Current Illness: n/a

Date Died: 09/19/2021

ID: 1715608
Sex: M
Age: 84
State: MN

Vax Date: 04/09/2021
Onset Date: 09/04/2021
Rec V Date: 09/20/2021
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: COVID-19 VIRUS MOLECULAR TEST POSITIVE 9/4/21

Allergies: CLINDAMYCIN, AMIODARONE, XARELTO

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

Symptoms: HOSPITALIZATION AND DEATH RELATED TO COVID-19 WHEN FULLY VACCINATED

Other Meds: CYCLOBENZAPRINE, FISH OIL, FLAX SEED OIL, FLECAINIDE ACETATE, LASIX, METOPROLOL, MULTIVITAMIN, ONDANSETRON, OXYCODONE, PREDNISONE, PROBIOTIC ACIDOPHILUS, SENOKOT S, WARFARIN SODIUM

Current Illness: NONE

ID: 1715609
Sex: F
Age: 53
State: KY

Vax Date: 05/03/2021
Onset Date: 08/31/2021
Rec V Date: 09/20/2021
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: Unevaluable event

Symptoms: Covid positive unknown contact

Other Meds:

Current Illness:

ID: 1715610
Sex: M
Age: 53
State: MN

Vax Date: 08/19/2021
Onset Date: 09/17/2021
Rec V Date: 09/20/2021
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: 9/17/21- SARS CoV-2, PCR, Rapid, V Detected

Allergies:

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

Symptoms: pt developed s/s of COVID and tested positive 9/17/21, was subsequently admitted to the hospital.

Other Meds:

Current Illness:

ID: 1715611
Sex: F
Age: 34
State:

Vax Date: 09/07/2021
Onset Date: 09/07/2021
Rec V Date: 09/20/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: 2nd dose was given early.

Other Meds:

Current Illness:

ID: 1715612
Sex: M
Age: 61
State: FL

Vax Date: 01/19/2021
Onset Date: 02/15/2021
Rec V Date: 09/20/2021
Hospital: Y

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

Lab Data: Covid test, cxr, labwork.

Allergies: NKA

Symptom List: Injection site pain, Menorrhagia

Symptoms: Pt came to ER c/o weakness unable to get out of recliner. Onset 2 days prior.

Other Meds:

Current Illness:

ID: 1715613
Sex: F
Age: 31
State: OR

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: none Claritin 10mg po at 1115

Allergies: Lanreotide : Hives Lisinopril : Cough Now Moderna Covid Vaccine

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

Symptoms: During the 30 minute waiting period the patient absentmindedly started to itch. When asked if this was new the patient reported yes. When asked if she was having difficulty swallowing she reported her throat felt tight. BP 160/88 93 98% on room air at 1105. Cough is dry. Doctor in to see patient and Claritin 10 mg ordered and given at 1115 The patient O2 sat at 1120 was 98% but still felt she was not getting enough air. O2 at 2 liters applied with good relief of symptoms, 1130 132/80 86. 1200 states throat feels better, is just itchy now. 1205 O2 sat 99% on room air and feeling ready to go home. Seen by the doctor and precautions given. Will go to family Members house for monitoring. Pregnancy at 22 weeks, estimated date of delivery 01/04/2022

Other Meds: Tylenol, Proventil inhaler, ASA 81 mg, labetalol 200 mg, magnesium oxide 400 mg, omeprazole 20 mg DR , ondansetron 4mg disintegrating tab, polyethylene glycol, Prenatal vitamin, triamcinolone 0.1% ointment.

Current Illness:

ID: 1715614
Sex: F
Age: 35
State: VA

Vax Date: 09/08/2021
Onset Date: 09/10/2021
Rec V Date: 09/20/2021
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: avocado/watermelon/latex - oral reaction including itchy throat and mouth

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: immediately started menstrual cycle on 9/8 which was 13 days early. Got the same reaction after first shot. on 9/10 I developed a rash that looks like hives- itchy red rash on under arms and torso. Still have the rash after 10 days

Other Meds: lexapro 10MG

Current Illness: none

ID: 1715615
Sex: F
Age: 47
State: TX

Vax Date: 09/16/2021
Onset Date: 09/17/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: She received covid vaccine of Pfizer on 9/16/2021 started to experience, burning throughout the body in certain area, headache, ringing of the ears,teeth pain eye pain, dizziness, took Tylenol to help with side effects, hasn't take any other medication that she takes on daily to to medical history but still are having side effect have not gone to see doctor as of 9/20/2021

Other Meds:

Current Illness:

ID: 1715616
Sex: M
Age: 50
State: CA

Vax Date: 09/20/2021
Onset Date: 09/20/2021
Rec V Date: 09/20/2021
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: N/a

Allergies: N/a

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

Symptoms: N/a

Other Meds: N/a

Current Illness: N/a

ID: 1715617
Sex: M
Age: 82
State: VA

Vax Date: 09/13/2021
Onset Date: 09/14/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data:

Allergies: UNKNOWN

Symptom List: Nausea

Symptoms: The patient called the pharmacy to report a bad reaction from an injection last week. Last Monday he had both the flu ad seasonal flu vaccine and his 3rd dose of Moderna Covid-19 vaccine as he is a transplant patient. He stated the following morning he got dizzy and sat down in a chair. Then fell out of the chair hitting his head but was ok from that. When he went to get up he could not move his arms and legs to roll over. He called for his wife and laid there for a while until he could work his way up to a stool and eventually a chair. He was extremely weak in his arms and could not even hold his upper body up. After about 18 hours and calling his doctor, he started to feel better. He called today a week later to report the effect. No history of bad reaction like this from previous vaccinations

Other Meds: MYCOPHENOLATE 250MG CAPS, SIROLIMUS 1 MG, PREDNISONE 5MG, AND OTHERS NOT KNOWN BY PHARMACY

Current Illness:

ID: 1715619
Sex: F
Age: 69
State: AL

Vax Date: 03/18/2021
Onset Date: 08/21/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: Covid 19 positive

Allergies: Codeine

Symptom List: Injection site pain

Symptoms: Diagnosed with covid 19 and only had mild symptoms for covid-19 on 24 Aug2021. It started with sinus, loss of sense of taste and smell.

Other Meds: Multivitamin; fish oil

Current Illness: No

ID: 1715620
Sex: F
Age: 45
State: IN

Vax Date: 04/15/2021
Onset Date: 04/16/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: 06/09/2021 ultrasound on left side of lymph node 5mm mass and will remeasure and evaluate in 12/2021.

Allergies: Iodine; Seasonal Environmental Allergies

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

Symptoms: 04/16/2021 evening achenes, feeling fatigue, chills body aches, nausea. 04/17/2021 severe Lymph node swelling above left collar bone. 4 weeks later lymph node swelling left side go the doctor for a scheduled appt. 05/13/2021 observation. 05/27/2021 order a test ultrasound on.

Other Meds: Metformin 500mg twice daily; New 07/2021 Antidepressant Citalopram 10mg once daily; Olmesartan Medoxomil 20mg once daily; Claridone

Current Illness: No

ID: 1715622
Sex: M
Age: 75
State: KY

Vax Date: 08/24/2021
Onset Date: 09/04/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Covid positive contact unknown

Other Meds:

Current Illness:

ID: 1715623
Sex: F
Age: 12
State: WI

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 09/20/2021
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: Tremor

Symptoms: The HPV vaccine was administered at 04:20, within 20 sec patient stated she felt sick to her stomach and a bit dizzy. She then passed out on the exam table. She then seemed to have a seizure type activity which lasted about 20sec. We raised her feet in the air and told her to open her eyes. She woke up and was very confused as to what happened. She was kept laying down for 30 minutes and then was helped to slowly sit up. Patient stated she felt nauseous. Dr. ordered oral Zofran. She was then discharged from the clinic. On her way out, she did vomit in the waiting room and stated she felt much better. Parent was told to contact Dr. via cell phone if she had any concerns that night. No call from parent occurred.

Other Meds: none

Current Illness: none

ID: 1715624
Sex: F
Age: 58
State: WI

Vax Date: 03/18/2021
Onset Date: 08/21/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: All on 09/07/2021 CULTURE - URINE Urogenital microbiota isolated. General Information Collected on 09/07/2021 1:18 PM (Urine) Resulted on 09/08/2021 2:58 PM Result Status: Final result WBC, URINE 22 /HPF <=5 /HPF H WBC CLUMPS Occasional RBC, URINE 1 /HPF <=2 /HPF SQUAMOUS EPITH Occasional BACTERIA 10-50 /HPF None, <10 /HPF A General Information Collected on 09/07/2021 1:18 PM (Urine) Resulted on 09/07/2021 2:06 PM Result Status: Final result Component Your Value Standard Range Flag COLOR Yellow Yellow, Colorless, Light Yellow, Dark Yellow CLARITY Slightly Cloudy Clear, Cloudy, Slightly Cloudy LEUKOCYTE ESTERASE 2+ Negative A NITRITES Negative Negative OCCULT BLOOD 1+ Negative A SPECIFIC GRAVITY <=1.005 1.005 - 1.025 KETONE Negative Negative BILIRUBIN Negative Negative GLUCOSE, URINE Negative Negative ALBUMIN, URINE Negative Negative PH - URINE 5.5 5.0, 5.5, 6.0, 6.5, 7.0, 7.5, 8.0 General Information Collected on 09/07/2021 1:18 PM (Urine) Resulted on 09/07/2021 1:45 PM Result Status: Final result

Allergies: none

Symptom List: Erythema, Pruritus

Symptoms: Beginning approx. 08/21/2020 I started having bladder infection or kidney stone symptoms which lasted straight thru until I saw the doctor finally on 09/07/2021. I was treated for an injection with sulfamethoxazole-trimethoprim 800-160 mg tablet for 3 days and that seems to have cleared up the problem. Was only tested for infection, not kidney stones at that time.

Other Meds: escitalopram 10 mg tablet cholecalciferol 1,000 unit tablet cyanocobalamin 1,000 mcg tablet atenoloL 25 mg tablet

Current Illness: none

ID: 1715625
Sex: F
Age: 34
State: SC

Vax Date: 09/16/2021
Onset Date: 09/16/2021
Rec V Date: 09/20/2021
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: X ray

Allergies: Sulfa Zofran Cats Dogs Mold

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

Symptoms: Started with ant bite feeling around injection site and arm. Spread to entire body. Then chest became so tight it felt like my ribs were being crushed. I called the nurse line and they sent me to the ER. At the ER I was treated with steroids and benadryl. The stinging Started to go away. They did an x-ray and said my lungs and heart looked OK. Since being discharged I am still sick. Freezing then hot. Pain all over. My chest is till tight. Too dizzy to walk or drive. No energy.

Other Meds: Vitamin D&k Vitamin C Multivitamin Clonazapam

Current Illness: None

ID: 1715626
Sex: F
Age: 77
State: GA

Vax Date: 03/31/2021
Onset Date: 05/31/2021
Rec V Date: 09/20/2021
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: 05/31/2021 PCR+ COVID-19 test at Medical Center

Allergies:

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

Symptoms: Breakthrough COVID-19 case. Hospitalized 5/31/2021 for unknown duration. I25.10-Atherosclerotic heart disease of native coronary artery without angina pectoris** I13.0-Hypertensive heart and chronic kidney disease with heart failure and stage 1 through stage 4 chronic kidney disease, or unspecified chronic kidney disease** N18.31-Chronic kidney disease, stage 3a** J44.9-Chronic obstructive pulmonary disease, unspecified** J22-Unspecified acute lower respiratory infection** R26.2Difficulty in walking, not elsewhere classified** M62.81-Muscle weakness (generalized)** G89.4-Chronic pain syndrome** F33.1-Major depressive disorder, recurrent, moderate** H35.3221-Exudative age-related macular degeneration, left eye, with activechoroidal neovascularization

Other Meds:

Current Illness:

ID: 1715627
Sex: F
Age: 54
State: NC

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: rcvd 2 separate vaccines

Other Meds:

Current Illness:

ID: 1715628
Sex: M
Age: 11
State: PR

Vax Date: 06/03/2021
Onset Date: 06/03/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: UNKNOWN

Allergies: UNKNOWN

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

Symptoms: INADVERTENTLY VACCINATED BEFORE AGE 12. ERROR IN DATA ENTRY MADE CONTACT IMPPOSSIBLE.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1715629
Sex: F
Age: 36
State: MA

Vax Date: 06/17/2021
Onset Date: 06/25/2021
Rec V Date: 09/20/2021
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: Na

Allergies: Ragweed,pollen

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

Symptoms: Menstrual cycle is only 2 days long and heavy,my normal menstrual cycle is normally 7 days long and heavy,its a good adverse affect,I just wanted to make you aware because other women are having changes in menstruation as well,and there seems to be a correlation between the vaccine and menstrual cycle changes

Other Meds: Escitalopram 10 mg po daily,Ativan 0.5 mg 1 tab prn daily

Current Illness: Na

Date Died: 09/14/2021

ID: 1715630
Sex: M
Age: 89
State: MI

Vax Date: 02/02/2021
Onset Date: 09/14/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: COVID positive swab 09/04/2021.

Allergies: Penicillins

Symptom List: Pain in extremity

Symptoms: Fully vaccinated patient positive COVID test on 09/04/21 in ED, 24 hour stay and discharged with dexamethasone no O2 needs. Patient fell on 09/06/21 and was admitted inpatient. Some hypoxia (87%), cough, shortness of breath. Dyspnea continued to worsen, starting having runs of SVT. Required Bipap for increased respiratory needs. Patient requested to move to hospice care and agressive therapy was discontinued per his request. Patient died on 09/14/21.

Other Meds: Eliquis, lipitor, lisinopril, lopressor, Preservision vitamin

Current Illness: Inpatient admission for SVT.

ID: 1715632
Sex: M
Age: 80
State: MO

Vax Date: 02/04/2021
Onset Date: 07/01/2021
Rec V Date: 09/20/2021
Hospital: Y

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

Lab Data: many more complications have occurred form the brain bleed.

Allergies: NA

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

Symptoms: Brain bleed leading to stroke

Other Meds: ozempic, eliquis

Current Illness: None

ID: 1715633
Sex: M
Age: 51
State:

Vax Date: 01/15/2021
Onset Date: 09/14/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient had a positive covid test on 9/14/2021

Other Meds:

Current Illness:

ID: 1715634
Sex: F
Age: 78
State: MN

Vax Date: 03/19/2021
Onset Date: 09/14/2021
Rec V Date: 09/20/2021
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: 9/14/2021- SARS CoV-2 RNA, TMA Detected

Allergies:

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

Symptoms: Tested positive for COVID on 9/14, was admitted to the hospital on 9/17/21

Other Meds:

Current Illness:

ID: 1715636
Sex: F
Age: 39
State:

Vax Date: 01/12/2021
Onset Date: 09/16/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: Patient had a positive COVID test on 9/16/2021

Other Meds:

Current Illness:

ID: 1715637
Sex: M
Age: 11
State: PR

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: UNKNOWN

Allergies: UNKNOWN

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: INADVERTENTLY VACCINATED BEFORE AGE 12. WRONG PHONE NUMBER, INCOMPLETE ADRESS, COULD NOT BE REACHED

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1715638
Sex: F
Age: 26
State:

Vax Date: 09/15/2021
Onset Date: 09/16/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: pt reported that she experienced tiredness, soreness for her entire body, head felt "cloudy",,,symptoms got better with tylenol. It happened one day after administering the vaccine

Other Meds:

Current Illness:

ID: 1715639
Sex: F
Age: 67
State: GA

Vax Date: 01/29/2021
Onset Date: 08/01/2021
Rec V Date: 09/20/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient have been hospitalized since 08-03-2021 due to difficulty in breathing

Other Meds:

Current Illness:

ID: 1715640
Sex: F
Age: 19
State: PA

Vax Date: 01/06/2021
Onset Date: 02/27/2021
Rec V Date: 09/20/2021
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: Banana nut muffins from Food Store

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

Symptoms: After I got the vaccine, I have now noticed a dent in my arm from where I got the vaccine from. There is a small, red scar, and the dent goes far into my muscle. It feels like there is no muscle there anymore. If I press on it for too long it starts to hurt.

Other Meds: Iron Supplements

Current Illness: I had Covid-19 unknowingly during the first shot.

ID: 1715641
Sex: F
Age: 37
State: KY

Vax Date: 03/19/2021
Onset Date: 09/12/2021
Rec V Date: 09/20/2021
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: Covid positive contact unknown

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am