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: 09/08/2021

ID: 1715747
Sex: F
Age: 48
State: WI

Vax Date: 08/30/2021
Onset Date: 09/06/2021
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: LA

Lab Data: 09/06/2021 Labs: WBC: 8.4 Bands: 11% Segs: 77% Lactic Acid: 2.6 C-Reactive Protein: 35.77 Glucose: 319 BUN: 39 Creat: 1.91 LDH: 500 CK (Total): 786 Troponin I: 0.390 D-dimer: 1.61 CTPE: ?Bilateral, diffuse, peripheral predominant flamelike ?ground glass? opacities, concerning for intention; and pattern suggestive of COVID-19 infection.? CXR: ?Scattered patchy alveolar opacities throughout the lungs. Multifocal airspace opacities, concerning for multilobar pneumonia.? EKG: Sinus tachycardia (HR: 103 bpm). Mild ST elevation (<1mm) in aVR.

Allergies: Clindamycin Compazine Reglan Sulfa

Symptom List: Dysphagia, Epiglottitis

Symptoms: Presented 09/05/2021 with SOB, AMS, chills, rigors, temp 103.2, O2 sat 83% on room air. Diagnosed Covid +; Hypoxic Respiratory Failure

Other Meds: Albuterol Amitriptyline Aspirin Benzonatate Symbicort Carvedilol Cholecalciferol Eszopiclone Ezetimibe Flonase Furosemide Gabapentin Glipizide Losartan Metformin Theragran Prednisone Rosuvastatin Spironolactone

Current Illness: Symptoms of: Fever Chills Rigor Altered mental state

ID: 1715748
Sex: F
Age: 73
State: MI

Vax Date: 09/17/2021
Onset Date: 09/18/2021
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: None

Allergies: NKA

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient got Fluzone HD Friday evening. By the next morning, her upper arm was red, swollen, warm and itchy around the injection site. Patient came into pharmacy 48 hours later to have pharmacist look at redness. Pharmacist recommended applying ice to area, taking tylenol, and allergy medication for itching. Pharmacist called to follow up 9/20 and patient was doing better but asked pharmacist to complete this form so the event could be documented since she has never had a similar reaction post immunization.

Other Meds: Atorvastatin 40mg, HCTZ 25mg, Metoprolol ER 25mg, Omeprazole 20mg, Flonase, Gabapentin 300mg, Lexapro 5mg, Methotrexate 2.5mg, Folic acid 1mg

Current Illness: N/A

ID: 1715750
Sex: F
Age: 37
State: KY

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: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Nsaids, Amitriptyline, Citalopram, Sumatriptan

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

Symptoms: Patients hand began to burn, they were hot to the touch and red. Patient was also shaky.

Other Meds: Atenolol, Duloxetine, Hydrochlorothiazide

Current Illness:

ID: 1715751
Sex: F
Age: 64
State: FL

Vax Date: 05/13/2021
Onset Date: 05/14/2021
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: Recently went through a panel of lab work and also was tested for Covid on September 7 for the third time. The second time was right or about four or five days after my second injection. My symptoms were horrible and I thought I had Covid. I am currently undergoing multiple heart Tests!

Allergies: Phenobarbital, anti-depressants

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Cardiac issues. Elevated blood pressure elevated heart rate. Severe chronic fatigue, increased unbearable body pain. Difficulty doing activities of daily living. I am undergoing cardiac evaluation now and should have the results in A couple of weeks. I am a former nurse practitioner and strongly believe this vaccine caused me to have high blood pressure, an extremely elevated heart rate and the symptoms mentioned above. I have never had high blood pressure or a problem with my pulse?Except one time and that was due to a thyroid crisis several years ago.

Other Meds: Synthroid, Remeron, Hydromorphone, klonopin, multiple vitamins, Vit D

Current Illness: Centralized intractable pain, hydronephrosis of kidneys, Osteopenia, hypothyroid, Fibromyalgia

ID: 1715752
Sex: F
Age: 4
State: MD

Vax Date: 09/18/2021
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: none

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

Symptoms: My 4yo was mistakenly administered 3ml of the pfizer covid vaccine at the pharmacy when we went in for a flu shot. she did not experience any adverse side effects and it's been 48 hours after the fact. I wanted to report this as it was an adult dose and obviously emergency authorization has not been granted

Other Meds: none

Current Illness: none

ID: 1715753
Sex: F
Age: 31
State: TX

Vax Date: 09/17/2021
Onset Date: 09/17/2021
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: none

Allergies: none

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

Symptoms: Pfizer-BioNTech COVID-19 Vaccine EUA I received the vaccine at 8:30am. Day of shot-that Friday evening: Body aches started exactly 12 hours after I received the shot. Followed by chills, fever, and fatigue. The fever stated at 99.4, and went up to 101.3, but reduced soon down to 98.5-after I took a naproxen Sodium to reduce the fever, along with ice packs on me, and cold washcloths on my neck as well. By Saturday morning I felt ok, no fever or chills, but had body aches all day and very tired/warn out. While resting on Saturday, by Sunday I felt better and more like myself.

Other Meds: Celexa, Ativan

Current Illness: none

ID: 1715754
Sex: M
Age: 59
State: TN

Vax Date: 02/04/2021
Onset Date: 09/20/2021
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: Abnormal CT of pelvis

Allergies: NKA

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Ongoing hospitalization. Asymptomatic for respiratory symptoms. Has blood in urine

Other Meds: Unknown

Current Illness: Unknown

ID: 1715756
Sex: M
Age: 49
State: NY

Vax Date: 08/05/2021
Onset Date: 08/06/2021
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: None

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: Fever, severe headache, nausea, dizzy, muscle pain from shoulder to elbow in injection arm that lasted until Sunday August 8, 2021.

Other Meds: None

Current Illness: None

ID: 1715757
Sex: F
Age: 25
State: TX

Vax Date: 09/07/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data: none

Allergies: none

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Swollen injection site the size of golf ball according to pt

Other Meds: none

Current Illness: none

ID: 1715758
Sex: F
Age: 69
State: LA

Vax Date: 08/18/2021
Onset Date: 08/18/2021
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: N/A

Allergies: N/A

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Pt had infected arm requiring antibiotic.

Other Meds: N/A

Current Illness: N/A

ID: 1715759
Sex: F
Age: 17
State:

Vax Date: 07/16/2021
Onset Date: 07/19/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: Urine culture made on July 23, 2021 and ultrasound done September 20, 2021 Both came normal.

Allergies: No

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

Symptoms: Frequent urination and Urine urgency and not able to hold it.

Other Meds: No

Current Illness: No

ID: 1715760
Sex: F
Age: 85
State: OH

Vax Date: 09/18/2021
Onset Date: 09/19/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Redness irritation pain at injection site starting day after worsening on day 2..."covid arm"

Other Meds:

Current Illness:

ID: 1715761
Sex: F
Age: 50
State: TX

Vax Date: 09/11/2021
Onset Date: 09/19/2021
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: None

Allergies: None

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

Symptoms: Nonstop nosebleed & vaginal bleeding between periods. Nose blood is not clotting

Other Meds: 20mg Prozac once a day

Current Illness: None

ID: 1715762
Sex: M
Age: 57
State: TX

Vax Date: 06/15/2021
Onset Date: 06/17/2021
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:

Allergies: No

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

Symptoms: Patient came to the pharmacy today complaining about lost of taste and smell. He has lost taste and smell two day after he received the second dose of vaccine. Patient's taste came back a month later but smell. Patient still could not smell anything.

Other Meds: Unknown

Current Illness: Unknown

ID: 1715763
Sex: M
Age: 47
State: OH

Vax Date: 08/27/2021
Onset Date: 09/03/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: Covid test - negative; prostate exam; CT scan with fluid

Allergies: REGLAN

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

Symptoms: My first symptom was some muscle tightness in the back around my waist. There was intermittent pain in the groin area. It spread to the body aches over Saturday and Sunday. I had weakness. I could physically walk downstairs and be tired. I would get winded. When I started getting over the body aches, I could do more work, but I just felt off. It was hard for me to concentrate or even come up with a sentence. I ended up using the online patient resource and sent me doctor a message. She said if it didn't get better in the next couple days to go to Urgent Care. I had gone to an Urgent Care and got tested for Covid. I got tested 4 times. They all came back negative. I went to the hospital on Wednesday the following week after my symptoms started and they couldn't figure out what was going on. That has been common since I got my first vaccine. My doctor did a bunch of other tests that all came back fine. They just haven't been able to figure out what's wrong. They checked to see if I had anything leaking inside and found nothing. I have had some headaches. I used to have migraines out of the blue. My headaches were there, but they weren't that severe. It has been hard to get information.

Other Meds: Calcitriol; calcium-citrate vitamin D3; carvedilol; hydralazine; losartan; magnesium; MYFORTIC; omeprazole; sirolimus; sodium bicarbonate; verapamil

Current Illness:

ID: 1715764
Sex: M
Age: 21
State: VA

Vax Date: 09/10/2021
Onset Date: 09/15/2021
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: UA with 100 protein and 2.0 urobiligen, no significant WBC or RBC

Allergies: NKDA

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

Symptoms: Patient with left scrotal enlargement with evidence of right sided epidydimal enlargement

Other Meds: omeprazole, ritalin, buspirone, dicyclomine, tretinoin cream, benzoyle peroxide wash, clindamycin topical gel, multivitamin, vitamin B12, vitamin D3, cetirizine 10mg daily

Current Illness: None

ID: 1715765
Sex: M
Age: 18
State: CA

Vax Date: 09/20/2021
Onset Date: 09/20/2021
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: mone

Allergies: no known drug allergies

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

Symptoms: Patient already had pfizer shot in the July. He told us he wasn't vaccinated and wanted the moderna shot. When we tried to bill moderna, it rejected and said he had pfizer shot already. He did not disclose this information and said he wasn't vaccinated yet to 3 pharmacy staff including the pharmacy district manager.

Other Meds: unknown

Current Illness: none

ID: 1715767
Sex: F
Age: 60
State: NC

Vax Date: 03/17/2021
Onset Date: 09/11/2021
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: Rapid Test : 9/13/21 - Positive PCR Test: 9/13/21 - Positive

Allergies: Penicillin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: COVID19 breakthrough case. Symptoms: Fever, aches, sinus pressure, loss of smell, coughing, sneezing Time course: Began symptoms on Sept 11, 2021 - Worse symptoms were over by 9/15/2021 & Remdesivir Injections, Steroid Injection, Tamiflu, & Antibiotic on Tuesday, 9/14/2021

Other Meds: Levothoxine Sodium 50mcg, Mybetriq 25 mg, Vyvanse 40mg, Loratadine 10mg, Multivitamin, Premarin 2-3 app per week

Current Illness: None

ID: 1715768
Sex: M
Age: 14
State: CA

Vax Date: 09/14/2021
Onset Date: 09/18/2021
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: Physical examination on 09/18/2021.

Allergies: No known drug allergies

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Symptoms: right sided facial droop and numbness CN VII weakness (decreased strength with closing eye, smiling, and blowing out cheeks; preserved eyebrow raising). Numbness; inability to hold liquids in mouth. Preserved strength in upper and lower extremities. This started with numbness on 09/17/2021, weakness noticeable on 09/18/2021

Other Meds: None

Current Illness: None

ID: 1715769
Sex: F
Age: 41
State: TX

Vax Date: 09/18/2021
Onset Date: 09/18/2021
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:

Allergies:

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

Symptoms: Employee calling to report a reaction after receiving a COVID-19 vaccine. Vaccine Name - Pfizer Vaccine Date - ? 09/18/2021 Is this your first or second dose- 1st Date of symptom onset - ? 9/18/2021 Symptoms - ? Fever of 101, body aches, and chills Last day of work and shift - ? NA Home remedies- Employee stated she took Tylenol/ibuprofen for fever and body aches Any improvement- Symptoms have resolved Recommendation- Advised to employee to inform us if symptoms return Employee voiced understanding Employee of information ? Yes Employee voiced any concerns No Employee's questions answered to employee's satisfaction -Yes

Other Meds:

Current Illness:

ID: 1715770
Sex: F
Age: 40
State: HI

Vax Date: 09/10/2021
Onset Date: 09/13/2021
Rec V Date: 09/20/2021
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: 09/15/2021 Abnormal EKG Chest X-ray clear Cardiac blood work within normal limits 09/16/2021 D-dimer within normal limits Pulse ox applied and pt made to ambulate with noticeable drop in O2 saturation level EKG done

Allergies: Sulfa

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

Symptoms: Chest pain with dyspnea upon exertion that began 3 days after the 2nd dose. EKG, chest X-ray, blood work done. Follow up with PCP. High dose ibuprofen prescribed as well as colchicine for suspected pericarditis..

Other Meds: Dupixent Mirena

Current Illness: None

ID: 1715771
Sex: F
Age: 28
State: GA

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:
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: SULFA, CEPHALOSPORINS, MMR - HIVES

Symptom List: Unevaluable event

Symptoms: Patient was monitored for 30 minutes instead of 15 due to her previous reaction of hives to an MMR. At 28 minutes after the vaccine was administered the patient got extremely foggy headed and thought she was going to pass out. I put a pulse ox on her (oxygen saturation was 99 and pulse was 84) and gave her an orange juice. I then took her blood pressure and it was 154/104mmHg. She says it normally runs 120/80mmHg. I took it with a different machine and cuff. It was 152/104mmHg. I let her sit a few more minutes, took her blood pressure on the opposite arm, it was 148/102mmHg. I asked the patient if she had a doctor, she said no. I asked her if I could call EMS. She said yes, she had no one else to help her. EMS arrived 5 minutes later and she was taken to hospital for further evaluation.

Other Meds: BENADRYL 25MG 1 HOUR PRIOR TO SHOT

Current Illness: MODERNA COVID-19 1ST DOSE GIVEN 08/19/2021

ID: 1715773
Sex: F
Age: 30
State: MT

Vax Date: 09/13/2021
Onset Date: 09/13/2021
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: D-Dimer 3.54 Tropine 0.242 @1847, 0.783 @ 2111, 1.346 @ 0435 (9/16), 1.029 @0755, 0.467 @1409

Allergies: oseltamivir

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

Symptoms: nausea, vomiting, then chest pain - diagnosis - myocarditis

Other Meds: baclofen, cyclobenzaprine, ibuprofen, propranolol, rizatriptan, topiramate, trazodone

Current Illness:

ID: 1715774
Sex: M
Age: 51
State: WA

Vax Date: 04/09/2021
Onset Date: 07/28/2021
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: None

Allergies: None on File

Symptom List: Injection site pain, Pain

Symptoms: Patient received Janssen on 04/09/21. On 07/28/21 & 08/18/21 the patient received a dose of Pfizer on each of those dates. No adverse events were noted.

Other Meds: Unknown

Current Illness:

ID: 1715775
Sex: F
Age: 55
State: TX

Vax Date: 09/05/2021
Onset Date: 09/10/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: I had lightheaded, dizzy, blurred vision, and fainting. I went to urgent care.

Other Meds: Aphronia

Current Illness:

ID: 1715776
Sex: F
Age: 11
State: TX

Vax Date: 09/19/2018
Onset Date: 09/20/2018
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: SYR
Vax Site: LA

Lab Data: Flu and strep tests negative. Labs and bloodwork normal or within normal limits for her age. Mono test showed previous infection but no active infection. Stool samples showed no abnormality. X-rays showed normal findings in stomach and large intestine. No identified pathogens, yet symptoms progressed and persisted for 4+ months. Patient scheduled for endoscopy and colonoscopy, however, these tests not done bc patient ended up in the ER on March 1, 2019, due to uncontrollable symptoms. ER visit resulted in diagnosis of mild UTI and Wolfe-Parkinson-White.

Allergies: None

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

Symptoms: Adverse events included facial swelling, extreme fatigue, headache, nausea, vomiting, sore throat, rash, "creaky" bones, diarrhea, loss of appetite, leg pain, stomach pain (described as a "stinging" pain), generally not feeling well, congestion, wheezing, coughing, visual disturbance, single incidence of SVT (racing heart). Symptoms progressed and worsened over a 4-month time span. Symptoms were inconsistent on a daily bases, and persisted over a 4-month timeframe. Patient missed over 40 days of school due to severe and ongoing symptoms. Course of illness began with facial swelling, progressed to flu-like illness including diarrhea, then to visual disturbance in Dec 2019, and incidence of racing heart occurred in Feb 2019. Patient ended up in ER on March 1, 2019 where tests were run, mild UTI and Wolfe-Parkinson-White were detected and diagnosed.

Other Meds: None

Current Illness: None

ID: 1715778
Sex: M
Age: 14
State: MA

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: LA

Lab Data: none

Allergies: amoxicillin, azithromycin, ceftriaxone, egg, peanut, milk, nuts (tree), sesame, shellfish, soy, sunflower oil

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: PMH: Numerous medication and food allergies, prior history of anaphylaxis Family Hx: Reviewed and noncontributory Social hx:lives with family Immunizations UTD Briefly, Syncere is a 14-year-old young man with a prior history of anaphylaxis, multiple food medication allergies, presenting with chest tightness and throat tightening in the setting of receiving his second Covid vaccine about 15 minutes prior. No hives, shortness of breath or wheezing noted on exam. Received an EpiPen and taken down to the ED for evaluation. Examination revealed the patient to be active, alert, and in no distress. The HEENT exam was clear, the neck was supple, the lungs clear to auscultation, no abnormal cardiac sounds, the abdomen was nontender throughout.

Other Meds: Albuterol HFA , cetirizine, EpiPen

Current Illness: none

Date Died: 08/24/2021

ID: 1715779
Sex: F
Age: 78
State:

Vax Date: 02/21/2021
Onset Date: 08/10/2021
Rec V Date: 09/20/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: diagnosed positive for COVID on 8/10/21; changes in mental state on 8/21/21 with hypoxia and hypoglycemia, was seen in ED and admitted to hospital where condition worsened; Acute hypoxemia respiratory failure due to COVID pneumonia

Other Meds:

Current Illness:

ID: 1715780
Sex: F
Age: 23
State: MN

Vax Date: 01/05/2021
Onset Date: 09/14/2021
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: I got tested at a state testing site on 9/15, received positive result on 9/17.

Allergies: None

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

Symptoms: I developed a cough on 9/14 after being exposed to an individual on 9/10 and 9/12 who tested positive for covid on 9/13. I then developed congestion, loss of taste and smell, headache, and fatigue. I tested positive for covid on 9/15 via PCR test.

Other Meds: Progestin oral birth control pills

Current Illness: None

ID: 1715781
Sex: F
Age: 33
State: CO

Vax Date: 09/14/2021
Onset Date: 09/15/2021
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: Latex, Most fresh fruits and vegetables

Symptom List: Nausea

Symptoms: headache, stomach pain, fatigue, weak, tired, diarrhea, nausea. all started day after (9/15/21), still having headache and stomach pains (9/20/21).

Other Meds: Triamcinolone 1% Cream, Furosemide 20mg Tablet, Microgestin 1/20 1-20mg-mcg Tablet

Current Illness: none

ID: 1715782
Sex: F
Age: 62
State: PR

Vax Date: 08/30/2021
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: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: The patient was vaccinated the 30th of August with the first dose of PFIZER at the Plaza. The patient verbalized they were feeling weakness in their knees that day. The following morning they she woke up at 730 in the bed, the patient said they their knees were swollen. Even so, she decided not to go to the doctor or hospital. Instead she took 500mg of naproxen 2 times a day. Currently today, 9/20/2021 the patient still has slightly swollen left knee. Patient proceeded to consult Doctor and she recommends vaccinating the patient and leaving her in observation for 30minutes in case she has any inflammation in the extremities of her body. After being vaccinated the patient goes to the observation area but does not stay for the recommended 30minutes. In turn the patient was recommended that if she has any manifestation she should visit her doctor or hospital.

Other Meds:

Current Illness:

ID: 1715783
Sex: F
Age: 57
State: TX

Vax Date: 03/11/2021
Onset Date: 03/11/2021
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: none

Allergies: none

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

Symptoms: within 1 hour of receiving the 2nd vaccine both of my cheeks went completely numb. within 24 hours there was some restoration of feeling however to this day it is not fully gone. I can bite on my cheek on the inside and feel pressure but no pain. I can smile.. pucker, blink move my eyebrows.. talk normal. just still don't have full feeling back in cheeks.

Other Meds: Armour Thyroid, Vit D3 5000, Magnesium, Zinc, Calcium

Current Illness: none

ID: 1715784
Sex: M
Age: 26
State: MO

Vax Date: 08/22/2021
Onset Date: 08/27/2021
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: None this provider is aware of.

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

Symptoms: Pt presented with "rash" - sudden onset, began on his back and also on abdomen. Endorses some pain, but states it is tolerable. Denies itching. The rash is constantly present. No drainage. -No hx of similar rash in the past. No recent exposure to animals/pets or plants. -Denies change in body products. No new foods or medications. -Denies FH of known rheumatologic or autoimmune conditions. 3 vesicles with clear fluid on abdomen (over distal end of ribcage ). Multiple vesicles with clear fluid + drying vesicles on back (bottom of left scapula). No drainage or signs of infection. Pt given script for Acyclovir (1 tab 5x/day for 7 days) for presumptive shingles.

Other Meds: None this provider is aware of.

Current Illness: None this provider is aware of.

ID: 1715785
Sex: F
Age: 55
State: WI

Vax Date: 06/04/2021
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: No allergies

Symptom List: Tremor

Symptoms: Patient contracted COVID after being fully vaccinated

Other Meds: Glucosamine Chondroitin cyclobenzaprine 10mg HS PRN for spasms gabapentin 60mg TID levothyroxine 150mcg daily multivitamin naproxen PRN for pain omeprazole 20mg PRN for pain Aspercreme 10% topical

Current Illness: None documented

ID: 1715786
Sex: F
Age: 38
State: NY

Vax Date: 09/20/2021
Onset Date: 09/20/2021
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: EKG, fingerstick, labs including qualitative beta, CT head, MRI brain, MRA head/neck -- all within normal limits and/or normal

Allergies: Lactose, latex

Symptom List: Erythema, Pruritus

Symptoms: Patient became slow to respond, somewhat altered and lethargic. She was immediately brought to the ED for evaluation. A stroke was ruled out however the patient was admitted for further evaluation and workup.

Other Meds:

Current Illness:

ID: 1715787
Sex: M
Age: 34
State: IA

Vax Date: 09/07/2021
Onset Date: 09/07/2021
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:

Allergies:

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

Symptoms: Headache and dizziness started at 9:00PM and 400mg of ibuprofen was taken (13 hours after vaccination). Chills and body aches began shortly after at 9:30PM. By 10:00PM all symptoms drastically worsened with a pounding headache, extreme dizziness and nausea, severe chills and aching with uncontrollable shaking, fever of 103?F, and delirium that continued until 1:00AM. At 1:00AM chills, aching, and delirium were gone but 101.5?F fever remained with headache and dizziness. The day after the vaccination, low grade fever of 100?F, headache, dizziness, and exhaustion persisted all day long from 7:00AM until sleep at 11:00PM. There was also minor pain at the vaccination site in right arm. By the third day, headache and dizziness were gone but still feeling tired and pain at vaccination site. On the fourth day almost entirely back to normal.

Other Meds:

Current Illness:

ID: 1715788
Sex: F
Age: 37
State: TX

Vax Date: 08/28/2021
Onset Date: 08/30/2021
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:

Allergies: eggshell membrane

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

Symptoms: I don't know where she received the vaccine. The patient came with symptoms consistent with Guillain Barre Syndrome I am covering for the IP at who is off. This is based on chart review.

Other Meds: Albuterol, cholesystramine Flonase

Current Illness: Polycystic ovarian sysdrome, anxiety, asthma, pseudotumor cerebri

ID: 1715789
Sex: M
Age: 73
State: MO

Vax Date: 09/14/2021
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: none

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient came in on 9/18/21 with hives all over his arms and trunk. He said it started the day he got the vaccine. I recommended that he take some Benedryl and to let his doctor know about this reaction. I documented the allergy in our system as well.

Other Meds: atorvastatin, losartan, trazodone, pantoprazole, gabapentin

Current Illness: none

ID: 1715790
Sex: M
Age: 60
State: CA

Vax Date: 04/08/2021
Onset Date: 04/09/2021
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:

Allergies: None

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

Symptoms: Joint soreness and stiffness in the shoulder and wrist in the arm that I received the vaccine. The wrist stiffness and soreness went away after a few days, however, the shoulder soreness and stiffness has been getting worse. I have not injured the shoulder and I am an active, fit 60 year old man that exercises several times per week. My shoulder soreness and stiffness is getting worse even though the injection was six months ago. I am confident this is the result of the injection because the soreness/stiffness started the day after the injection and has not subsided.

Other Meds: Vitamin C Fish Oil Glucosamine Chondroitin

Current Illness: None

ID: 1715792
Sex: M
Age: 59
State: TX

Vax Date: 04/27/2021
Onset Date: 04/27/2021
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:

Allergies: Penicillin

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

Symptoms: High Heart Beat, severe dizziness, High Fever, unable to stay awake, this lasted for 36 hours

Other Meds: None

Current Illness: Neuropathy of the lower legs

ID: 1715793
Sex: F
Age: 51
State: AZ

Vax Date: 09/19/2021
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: None

Allergies: None

Symptom List: Pain in extremity

Symptoms: Blurt hazy vision, hard to focus and spots like when you have a migraine

Other Meds: Iron Antacid

Current Illness: None

ID: 1715794
Sex: F
Age: 84
State: AR

Vax Date: 03/12/2021
Onset Date: 09/06/2021
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: Coronavirus Testing: 09/05/2021 - detected

Allergies:

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

Symptoms: Admitted 9/6/2021: Patient is a 4-year-old female with past medical history of Alzheimer's dementia, hypothyroidism, COPD currently on 2 liters nasal cannula, and IBS who presents today with chief complaint of weakness, fever, altered mental status. Patient is accompanied by a daughter who provides history. Patient started states that 2 weeks (8/22) ago patient developed some weakness, confusion, cough seen it, and fever. Patient was seen and examined by a physician who discharge patient home. Daughter tested her mother for COVID with a home test on 8/24 and it was positive. Daughter took her mom to the hospital and patient was treated with monoclonal antibodies, Z-Pak, and steroids. Daughter took her mom to the hospital and patient was treated with monoclonal antibodies, Z-Pak, and steroids. Daughter states that patient improved the following day after treatment. Approximately 1 week ago daughter states that the patient developed increasing weakness, confusion, difficulty standing, and shortness of breath. Daughter states that this morning patient was unable to stand which prompted her to bring patient into the ED today. Pt discharged 9/14/2021. Pt discharged to health facility and Rehab.

Other Meds:

Current Illness:

ID: 1715795
Sex: M
Age: 41
State: TN

Vax Date: 08/23/2021
Onset Date: 08/24/2021
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: Pennicillin

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

Symptoms: Extreme fatigue, 103.2F fever- not responsive to ibuprofen or acetaminophen, severe joint aches in hips and knees, nausea, migraine headache, radiating pain from injection site (elbow to shoulder of left arm), chills. These symptoms lasted for 10-12 hours beginning approximately 20 hours after receiving the shot

Other Meds: Multi-vitamin (daily), Epicor (daily)

Current Illness: None

ID: 1715796
Sex: F
Age: 52
State:

Vax Date: 04/28/2021
Onset Date: 05/01/2021
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: None.

Allergies: Codine.

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

Symptoms: 1) Began period on April 9,2021, 2days after 1st injection. Previous menstrual activity began June 24,2020, and lasted 8 days. 2) A feeling of a slightly constricted throat, a few weeks after final injection. Have never had anaphylaxis in previous history. Slight throat constriction is active approximately 75% of the time. If I tilt head backward, I can definitely feel a more open Feeling.

Other Meds: Clonazepam .5mg/eve. Lexapro 10mg/day. Vit D3 6,000IU/day. Vit C 1000mg/day. CoQ10 200mg/day. Fish Oil 1400mg/day. Magnesium Taurate 1000mg/Eve. Multivitamin 1serving/day.

Current Illness:

ID: 1715797
Sex: F
Age: 41
State: WI

Vax Date: 09/18/2021
Onset Date: 09/18/2021
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: We were at a community event offering vaccines and testing. when asked if the patient had received any covid vaccines in the past she stated no. We did not have internet access to access WIR.

Other Meds:

Current Illness:

ID: 1715798
Sex: F
Age: 25
State: GA

Vax Date: 09/19/2021
Onset Date: 09/20/2021
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: N/A

Allergies: Allergy to bee stings, wasp stings etc

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Headaches, body aches started approx 17 hours after shot Chills approx 19 hours after shot Fever of 102.7 F was first taken 23 hours after shot Fever of 100 F 24 hours after shot Extreme fatigue and malaise started 6 hours after shot

Other Meds: N/A

Current Illness: N/A

ID: 1715799
Sex: M
Age: 22
State: AZ

Vax Date: 09/17/2021
Onset Date: 09/17/2021
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: none

Allergies: none noted

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

Symptoms: Service member presented to point of distribution to receive 2nd Pfizer Covax one week after receiving first dose. Member was educated on waiting period between vaccinations. Early presentation was not caught by ordering team, nor vaccinator before being erroneously administrated. No adverse reactions noted at time of distribution or time of reporting

Other Meds: none noted

Current Illness: none noted

ID: 1715800
Sex: F
Age: 64
State: KY

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: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Bad headache, tingling in arm/hand, hoarseness, severe tremors, severe body aches and pain, fever 102, extreme fatigue, insomnia,

Other Meds:

Current Illness:

ID: 1715801
Sex: M
Age: 46
State: NY

Vax Date: 05/01/2021
Onset Date: 06/01/2021
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: None

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

Symptoms: Heart flutter/palpitations Chest tightness Headaches

Other Meds: None

Current Illness: None

ID: 1715802
Sex: F
Age: 67
State: IN

Vax Date: 09/08/2021
Onset Date: 09/10/2021
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: None

Allergies: Ceclor, Codeine, other narcotics

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

Symptoms: Sore arm muscle at injection site for about 3 days

Other Meds: Pulmacort and multi-vitamin

Current Illness: none

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am