VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 11/12/2021
** VAERS DATABASE Last updated: November 12, 2021**
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Manufacturers

Total Manufacturer
199,106MODERNA
36,710JANSSEN
5,381PFIZER\BIONTECH
2,555GLAXOSMITHKLINE BIOLOGICALS
1,469UNKNOWN MANUFACTURER
897MERCK & CO. INC.
627SEQIRUS, INC.
112DYNAVAX TECHNOLOGIES CORPORATION
91SANOFI PASTEUR
75NOVARTIS VACCINES AND DIAGNOSTICS
40EMERGENT BIOSOLUTIONS
14PAXVAX
12TEVA PHARMACEUTICALS
12PROTEIN SCIENCES CORPORATION
9PFIZER\WYETH
4BERNA BIOTECH, LTD.
4SMITHKLINE BEECHAM
3INTERCELL AG
1MEDIMMUNE VACCINES, INC.
1CSL LIMITED

COVID19 Lot Number

VAX LOT Total
2S9CL7,949
7,473
2,547
1,506
1,187
1,051
1,049
s0294561,043
866
IMM209861
816
UT7065MA766
657
579
U62828AA563
557
538
U6737AA516
515
S034636506
4F472471
458
P100253275449
444
276563436
429
418
4BH32414
MENVEO404
PP9L5362
UJ446AA337
319
306
290
271
49TM3270
R1B252M253
4F472179
933622147
C5763AA144
CW3116134
3Y7NL126
UNK114
113
ARBA141A105
104
103
96
300057A90
79
1F4EB73
R1B743M62
56
UJ090AA55
51
UH894AB46
45
UNK44
UNK42
42
EJ168638
Unknown36
35
34
32
32
26
el128424
24
A115A22
22
EN620222
21
UNK20
20
19
Z127A19
19
17
JEV18K95E15
12
111798PI12
10
A739088
No batch number8
3333324181078
6
6
TAR356
5
5
U6935AA5
UNK5
4
unknown4
3
2
55RB72
2
2
2
2
2
U7124AA2
JEV18A68E2
2
ABYB05BA1
1
1
1
1
AMVA436A1
1
1
TJ3521
A130A; VIS give1
1
U7140BB1
1
1
SP UP016AA1
1
1808P08802/ESV01
037K20A300,947
EL1284288,578
57,766
1,432

Incidents per State

State Total
82,750
CA62,821
FL38,209
TX36,512
NY34,921
PA23,646
IN23,622
IL20,597
MI19,590
OH19,426
NJ18,413
NC16,769
GA15,932
WA15,351
VA15,234
MA14,876
AZ14,206
MN12,940
MD12,656
CO11,908
WI11,425
MO10,240
TN9,685
OR8,768
KY8,437
CT8,300
SC6,700
OK6,293
AL5,692
LA5,025
IA4,825
KS4,821
UT4,637
NV4,374
NM3,967
AR3,807
ME3,161
NH3,096
NE2,918
MS2,859
ID2,785
WV2,469
HI2,459
PR2,417
MT2,414
RI2,076
DE1,868
AK1,830
VT1,734
DC1,715
ND1,388
SD1,269
WY866
GU118
VI69
AS47
MP29
MH8
XB6
FM4
QM3
XV2
XL1

ID: 1716891
Sex: F
Age: 50
State: WI

Vax Date: 09/01/2021
Onset Date: 09/18/2021
Rec V Date: 09/20/2021
Hospital:

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

Lab Data: None

Allergies: Yes but unsure of what I am allergic to (I have an epipen but have never used it)

Symptom List: Dysphagia, Epiglottitis

Symptoms: Dear Covid auto form:) I?m a teacher and have been around middle school students (few wear masks)? we have Covid in school? I?m not sure when to worry about having Covid vs. vaccine side effects. I?m thinking I should call to get tested if I?m still having ?side effects? on day 4. Day 1 Start of Fever, headache with in 24 hours, sore arm; Day 2: fever peaked at 103, chills, exhausted, arm has burning spot about the size of a softball at injection site which is hot and hard, shirt was damp from sweat; Day3: not as exhausted so I went to school? fever, (99.3) sweat poured off me during the day a couple times, but I made it through an IEP, arm is worse (hotter and itches), cold sores have also showed up this afternoon?I?ve had them in the past and have started to take Valtrex (100mg) and have googled what to do for my arm? took a Benadryl and used ice pack (didn?t seem to help much.. the ice?we?ll see how things shake out with the Benadryl , mild sore throat.

Other Meds: Amlodepine (sp?) high blood pressure med.

Current Illness: No

ID: 1716892
Sex: M
Age: 55
State: CA

Vax Date: 06/10/2021
Onset Date: 09/06/2021
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: No tests...I don't know what doctor to target and every office is asking me what is wrong...I don't know. All I know is the only thing that has changed is this vaccine.

Allergies: none

Symptom List: Anxiety, Dyspnoea

Symptoms: [1] no immediate symptoms until three months AFTER vaccination. [2] symptoms Started 08 SEP 2021 Red skin rash all over body following food intake. Rash persists for two hours thence subsides. [3] assumed allergy. Deleted all normal routine foods to eliminate allergy target...negative results. Same rash condition persists. [4] Never had such symptoms in my life.

Other Meds: none

Current Illness: none

ID: 1716894
Sex: F
Age: 42
State: OH

Vax Date: 01/05/2021
Onset Date: 01/06/2021
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: Na

Allergies: None

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

Symptoms: Severe headache, fever over 100 for 5 days, redness and swelling at injection site (photos taken) redness became warm/hot to touch (cellulitis like), the redness moved to different parts of my arm for weeks. I did not seek medical treatment. This happened on both Moderna shots.

Other Meds: None

Current Illness: None

ID: 1716895
Sex: F
Age: 25
State: WI

Vax Date: 12/23/2020
Onset Date: 03/01/2021
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: POCT HCG 6/17/21

Allergies: n/a

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Headache, Severe Nausea, Body Aches, Fatigue @ 0800, Miscarraige at 4 weeks

Other Meds: n/a

Current Illness: n/a

ID: 1716898
Sex: F
Age: 64
State: OR

Vax Date: 06/16/2021
Onset Date: 06/17/2021
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: Metabolic panel Iron level EKG

Allergies: Diclofenac, morphine, penicillin, sulfa, versed

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

Symptoms: 103 degree fever, body aches, extreme fatigue, profuse sweating, rash (raised bumps) x 3 weeks then 4 weeks profuse sweating, extreme fatigue, rash (raised bumps) bruises easily.

Other Meds: Multi Vitamin, Calcium, Vitamin D

Current Illness: None

ID: 1716900
Sex: F
Age: 37
State: WI

Vax Date: 09/19/2021
Onset Date: 09/20/2021
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: Eyes checked and labs drawn by primary care provider in between doses. Nothing notable discovered at that time

Allergies: Morphine, latex, adhesive, dust and pollen

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

Symptoms: Blurred/Double vision in both eyes. Sudden onset lasting about 30 seconds. This also happened after 1st injection within 3 days and occurred twice then.

Other Meds: Citalopram and Adderall

Current Illness: None

ID: 1716902
Sex: F
Age: 26
State: IN

Vax Date: 09/13/2021
Onset Date: 09/14/2021
Rec V Date: 09/21/2021
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: N/a

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Missed menstrual cycle-was supposed to begin cycle 9/14/21. It is now 9/21/21 and still have not started cycle. Took 3 different pregnancy tests- all negative. My cycle is regular and occurs ever 5 weeks. I have never skipped a monthly cycle.

Other Meds: Levothyroxine

Current Illness: N/a

ID: 1716904
Sex: M
Age: 25
State: CA

Vax Date: 03/25/2021
Onset Date: 04/09/2021
Rec V Date: 09/21/2021
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: Lose of appetite two weeks after first shot. Lost about 20 pounds of body weight in 3 days. Extreme pain in mid/lower back affecting basic functions like walking. Pain level was 9/10. A week or two after the second shot, I had severe pain in my chest. The best way I could have described it at the time was it felt like my esophagus was swollen. I now know fully well it was my heart that was swollen.

Other Meds: N/A

Current Illness: None

ID: 1716905
Sex: M
Age: 34
State: NJ

Vax Date: 04/12/2021
Onset Date: 04/13/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Got very sick and feverish in the middle of the night, went into the bathroom and sat down. When I stood up I passed out on the floor, unsure for how long. Also felt a tightness / slight pain in my chest off and on for 3 months following the vaccine, usually in the AM.

Other Meds:

Current Illness:

ID: 1716907
Sex: M
Age: 16
State: FL

Vax Date: 08/22/2021
Onset Date: 08/23/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data:

Allergies: Peanut, Eggs, Red Dye, grass

Symptom List: Diarrhoea, Nasal congestion

Symptoms: He felt sick the following day.(Monday) On Tuesday he still felt sick. Wednesday he felt better, but began to wheeze. He started taking his Xopanex to help him breathe. By Saturday he had to have his xopanex every 4 hours and it would not work. We increased his dosage, but it still wore off. On Sunday he was prescribed a steroid. The steroid didn?t work completely. On Friday he was prescribed more steroids and a separate bronchodilator. He finally felt better the following week.

Other Meds: Qvar

Current Illness:

ID: 1716908
Sex: F
Age: 54
State: VA

Vax Date: 09/07/2021
Onset Date: 09/05/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data:

Allergies: no

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

Symptoms: Muscle aches on legs and lower bag that will not resolve even after 2 weeks. Also hot flash and sweating and pain in Liver.

Other Meds: syntroid 125 mcg

Current Illness: none

ID: 1716910
Sex: F
Age: 29
State: CA

Vax Date: 09/10/2021
Onset Date: 09/11/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data: EKG, X-ray, labs on both date 9/17/2021 and 9/20/2021.

Allergies: Raspberries

Symptom List: Rash, Urticaria

Symptoms: Chest pain; blue lips; headache.

Other Meds:

Current Illness:

ID: 1716911
Sex: F
Age: 47
State: WI

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data:

Allergies: PCN, ASA, APAP, mould (foods/medication/environmental), latex

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

Symptoms: Dose 1: extreme arm pain, swelling, bruising, loss of movement. started within hours, swelling lasted 4 days, pain 6 days, bruising almost 14 days. General malaise, low grade fever 38C 2 days Dose 2: Fever, weakness, lethargy, trouble concentrating, 4 days. Shortness of breath after 1 week, persistent (current through today, 21 Sept 21)

Other Meds:

Current Illness: none

ID: 1716912
Sex: F
Age: 41
State: CA

Vax Date: 04/26/2021
Onset Date: 05/16/2021
Rec V Date: 09/21/2021
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: Have Gynecology appointment in September.

Allergies: None

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

Symptoms: Loss of menstrual cycle. Mentsral cycle has still not returned to date.

Other Meds: None

Current Illness: None

ID: 1716914
Sex: F
Age: 30
State: CA

Vax Date: 08/20/2021
Onset Date: 08/27/2021
Rec V Date: 09/21/2021
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: Indomethacin

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

Symptoms: I was a breastfeeding mother to my 4 month old daughter. After getting my first dose I slowly starting losing my milk supply and by day 7 I couldn?t even pump a drop of milk out. I went from pumping 40 oz of milk a day to zero by day 7 after getting the Covid vaccination.

Other Meds: None

Current Illness: None

ID: 1716915
Sex: M
Age: 51
State: TN

Vax Date: 05/11/2021
Onset Date: 08/02/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Hearing loss in right ear when horizontal and tenitis

Other Meds: allopurinol,

Current Illness:

ID: 1716916
Sex: F
Age: 77
State: NY

Vax Date: 03/16/2021
Onset Date: 06/20/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data: 6/28/21 -PCR positive - Anaplasmosis May 2021 - bilateral mammogram negative. August 2021 - right breast ultrasound was negative.

Allergies: Levaquin; Avelox; Bactrim

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

Symptoms: June 20, 2021 - Anaplasmsis - treated with Doxycycline Hyclate 100 mg July 12, 2021 - Lyme d. - treated with Doxycycline Hyclate 100 mg Late July 2021 - right axillary pain started with paresthesia in right forearm and hand. Persists to present. September 9, 2021 - sudden onset of pain and swelling in 3rd finger Right hand September 20, 2021 - pain on lateral border Left hand

Other Meds: Ursodiol; Nexium; ASA; Famotadine; Pravastatin; Metoprolol; Doxyzosin; Hydrochlorothiazide; Zyrtec; AREDS 2; Slow iron; Calcium with Vitamin D; Vitamin D; Valacyclovir

Current Illness:

ID: 1716917
Sex: F
Age: 37
State:

Vax Date: 08/29/2021
Onset Date: 08/29/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data:

Allergies: Codeine Penciling

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Consistent random spotting , flesh coming out, cramps, headaches, breast tenderness, exhausted, backaches , dizzy, loss of appetite, swollen veins, chest tightness, heart rate lowered.

Other Meds: No

Current Illness: No

ID: 1716919
Sex: F
Age: 40
State: WA

Vax Date: 05/02/2021
Onset Date: 05/25/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: She started to have uneven elevated heartbeat since getting the second dose of vaccine. Initially, it was getting like 150. Now she suddenly gets in 120 , 100 even when sitting and resting.

Other Meds: None

Current Illness: None

ID: 1716920
Sex: F
Age: 40
State:

Vax Date: 09/16/2021
Onset Date: 09/19/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data: Will see doctor this week

Allergies:

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

Symptoms: Blurry eyes - 1 day follow dose Chest sorenes/left side/ - 2 days following Indigestion -2nd day post shot Sore neck Tingling in hands

Other Meds: Synthroid; metformin

Current Illness:

ID: 1716921
Sex: F
Age: 12
State: CA

Vax Date: 07/01/2021
Onset Date: 09/19/2021
Rec V Date: 09/21/2021
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:

Allergies: No

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

Symptoms: Feels numbness in her left left from her ankle to her thigh, she loses strength in her leg and is unable to walk.

Other Meds: No

Current Illness: No

ID: 1716922
Sex: F
Age: 38
State: UT

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 09/21/2021
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: My right arm got tingly and then numb.

Other Meds:

Current Illness:

ID: 1716923
Sex: F
Age: 36
State: ID

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/21/2021
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: Physical examination, including neurological evaluation for sensations to light and deep pressure, which were reduced. Upper and lower extremity reflexes were normal

Allergies: None known

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

Symptoms: Approximately 1.5 hrs following infection, the majority of left side of the the patient's body went numb/tingly, including upper and lower extremeties and the left side of the torso. Symptoms remained for 3-4 days, gradually improving. Patient also experienced severe headache pain, body aches, fever, chills and general malaise which lasted for approximately 2 days.

Other Meds: None

Current Illness: None

ID: 1716925
Sex: F
Age: 30
State:

Vax Date: 09/10/2021
Onset Date: 09/11/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data: ct scan, angiogram 9/11

Allergies: PEG, Almonds, Tamiflu

Symptom List: Injection site pain, Pain

Symptoms: began having chest pain/ tightness and short of breath on exertion, elevated heart rate and blood pressure. No issues prior to vaccination outcome- enlarged pulmonary artery ( had no prior heart issues)

Other Meds: n/a

Current Illness: n/a

ID: 1716926
Sex: M
Age: 29
State: CA

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

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

Lab Data:

Allergies: none known

Symptom List: Injection site pain, Menorrhagia

Symptoms: After receiving vaccines, patient was directed to sit in designated post-immunization observation area for 15 minutes. While seated, patient became light-headed and lost consciousness, causing him to fall from his chair to the floor. He regained consciousness within moments and experienced no additional symptoms. In course of falling from the chair, patient sustained a head injury, causing a minor scalp laceration. Paramedics were summoned. Patient declined transport to medical facility, and was urged to seek follow-up care for the injury to his head.

Other Meds: none known

Current Illness: none known

ID: 1716927
Sex: M
Age: 36
State: AZ

Vax Date: 06/04/2021
Onset Date: 08/26/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data: Urgent Care 08/30/2021 Emergency Room 09/01/2021 Emergency Room 09/03/2021 ENT 09/04/2021 Gastrologist 09/20/2021

Allergies: None

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

Symptoms: Difficulty breathing, palpitations, chest pain, fast beating heart rate, diarrhea, vomit

Other Meds: None

Current Illness: None

ID: 1716929
Sex: F
Age: 24
State: NY

Vax Date: 06/29/2021
Onset Date: 07/04/2021
Rec V Date: 09/21/2021
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:

Allergies: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: I began having a migraine on July 2nd. On July 3rd, I had a migraine, was vomiting and couldn't walk normally. On the 4th I went to the ER after having problems with my ears. A CT scan was done and I was found to have Cerebral Venous Sinus Thrombosis which is a blood clot in the brain. I was admitted to Medical Center where they did another more thorough CT scan and started me on heparin. I was informed that I was close to having a fatal stroke. I was kept in the hospital for 2 days and sent home to recover. It has been two and a half months and I am still having complications. I am currently seeing several doctors to monitor the blood clot as well as intracranial pressure.

Other Meds: Seasonique (birth control), Luvox, Montelukast, Clartin, Albuterol

Current Illness: None

ID: 1716931
Sex: F
Age: 37
State: CA

Vax Date: 04/14/2021
Onset Date: 04/15/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data: Eye exam showed no issues with floaters ER and MRI showed no issues with brain blood tests normal

Allergies: none

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: I reported the first month of symptoms already but wanted to follow up with my ongoing symptoms I went to ER with fish bowl vision and pins and needles throughout body esp left side sensation. Have had a few of these attacks since but worst was night I went to ER. The biggest remaining issue is that I have floaters in my right eye. They showed up the day after vaccine 2 and have very slowly faded but are still there and noticeable. I worry they will never go away. Please note I had a 103 degree fever the 24 hours following the vaccine and a month of horrible headaches and I never had headaches before.

Other Meds: none

Current Illness: none

ID: 1716932
Sex: F
Age: 36
State: NC

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 09/21/2021
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 have yet to seek medical attention as I have doubts much of anything could be done for the situation beyond anti-inflammatories.

Allergies: Sulpha antibiotics. Lactose. Pertussis Vaccine.

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

Symptoms: Arm sore by evening of receiving first shot (as to be expected). Soreness waned after a few days. Two weeks later redness and rash appeared for approximately 48 hours. Decided to do second shot the following month in opposite arm. Second shot also caused arm pain and swelling but not as severely and with no rash. Beginning again in August 2021 the left arm at site of original vaccination keeps re-experiencing arm pain like a localized, dull aching bruise. The sensation comes and goes over periods of days. It has been reoccurring enough now that it seems lessikely attributeable to any other particular action or circumstances.

Other Meds: Multivitamin, vitamin D3

Current Illness: None

ID: 1716934
Sex: M
Age: 49
State: TX

Vax Date: 06/04/2021
Onset Date: 06/04/2021
Rec V Date: 09/21/2021
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: Muscle sore and shooting throbbing pain and loose of strength..

Other Meds:

Current Illness:

ID: 1716935
Sex: F
Age: 51
State: FL

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data: Xray chest to check for pneumonia, Predinisone, cough meds, anti vomiting meds. Ompramizole for later stomach issues from coughing so much and vomiting caused flare-up with stomach, Gerd, band issues.

Allergies: Penicillin allergic to. Scared to take booster for Covid since I have had to adverse reactions to first amd second shot.

Symptom List: Injection site pain

Symptoms: Cough, sob, fever, all over body aches, swelling at inj site.

Other Meds: Had Pizer vacc and was sick on first shot amd daughter and I was sick after second shot. She was sick for 3 weeks. I have been sick since. My arm was so swollen and lungs hurt, fever so had video call with phy. Months later, June was dx wit

Current Illness: At time of vaccination I had a fever hours later but at first didn't know it u til the next day. Horrible headaches. Site of inj was red and very swollen. Phy saw it on phone visit. Told me to ice site. Small rash like area.

ID: 1716936
Sex: F
Age: 48
State: TX

Vax Date: 09/07/2021
Onset Date: 09/14/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data:

Allergies: Penecillin

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

Symptoms: I have never skipped/missed s period or been more than 2 days late . I am now a week late with my period.

Other Meds: Vitamin B,C,D Probiotics Zinc Magnesium Fish oils CoQ10

Current Illness: None

ID: 1716938
Sex: F
Age: 44
State: CA

Vax Date: 01/25/2021
Onset Date: 02/15/2021
Rec V Date: 09/21/2021
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: NKA

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

Symptoms: I missed my period for 3 months. From February - May 2021.

Other Meds: NA

Current Illness: NA - In February I have take 2 doses of Claritin

ID: 1716939
Sex: F
Age: 27
State: HI

Vax Date: 09/11/2021
Onset Date: 09/11/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data: 12-lead EKG - normal. CXR - normal => both done at QMC ER

Allergies: benzaclin, spirinolactone, scented lotion detergents

Symptom List: Tremor

Symptoms: patient received pfizer covid vaccine dose #1 on 9/11/2021 at a vaccine clinic. patient, then, experienced a chest pain after the pfizer vaccine. patient went to the QMC ER and was evaluated for chest pain. 12-lead EKG - normal. Chest XR - normal. no labs were drawn in ER. patient followed up in our clinic today. Patient was still having chest pain and was referred to Cardiology for rule out pericarditis.

Other Meds: none

Current Illness: hypertension, UTI, CKD2, vitamin D deficiency

ID: 1716940
Sex: F
Age: 29
State: FL

Vax Date: 04/14/2021
Onset Date: 04/27/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Two weeks after vaccine my period began abruptly. I began having excruciating cramps as soon as I woke up and around 5:30 that evening, I took a shower, trying to ease the aching in my lower abdomen. I looked down & my shower floor was covered in blood. It was not stopping & I began to feel lightheaded. I got out & realized the shower drain was actually clogged with massive clots the size of quarters & silver dollars. I had not been sexually active so I knew I wasn?t having a miscarriage-but it looked like I was. It lasted 2 weeks, I was actually anemic from passing so much blood. Every couple of weeks this happens now. I?ve been having blinding migraines & was prescribed multiple medications that I only take if necessary. My periods were always light & regular. This is taking a toll on my quality of life & I?m pissed.

Other Meds: Multivitamin

Current Illness:

ID: 1717363
Sex: M
Age: 22
State:

Vax Date: 08/26/2021
Onset Date: 08/26/2021
Rec V Date: 09/21/2021
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: Patient receiving his J&J vaccination and the vaccine leaked out, so when the needle was inserted into the Patient arm there was no vaccine to push. Technician stated she was 100% sure there was no fluid that was pushed into the PT arm.

Other Meds:

Current Illness:

ID: 1717364
Sex: F
Age: 37
State: TN

Vax Date: 09/11/2021
Onset Date: 09/13/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data: N/A

Allergies: Latex Vinyl Hay Seasonal Allergies

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

Symptoms: Bumps On Back Of Tongue & Throat Chest Pain Dizziness Nauseous Diarrhea Fever Headache Exhaustion Pain At Injection Site

Other Meds: Hydrocodone-Acetaminophen Gabapentin Synthroid Vit B12 Vit D2 Zyrtec Benadryl Vyvanse Meloxicam Hydrochlorothiazide Buspirone Allergy Injections

Current Illness: N/A

ID: 1717365
Sex: F
Age: 26
State: AZ

Vax Date: 09/08/2021
Onset Date: 09/09/2021
Rec V Date: 09/21/2021
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: Penicillin, Sulfa and Latex

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Swelling; soreness; warm-to-touch; red. Went away for 4 days then came back and started to itch. After taking Motrin, swelling went down but still sore and the red patch has grown.

Other Meds: Venlafaxine 150mg caps and Buspar 7.5mg tabs

Current Illness:

ID: 1717366
Sex: F
Age: 46
State: LA

Vax Date: 08/03/2021
Onset Date: 08/06/2021
Rec V Date: 09/21/2021
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: After reviewing the first injection of Moderna covid vaccine I begin to feeling itching and discomfort at the injection site but didn't get bothered much by it and considered as normal injection site symptom. A couple of days later, l noticed a red/ purplish in color circular itchy patch on the side of my breast then, more appeared in the chest area, then one on my right upper arm then another on the left side of my neck then two spots in the middle of my back. These spots had rapidly multiplied during the course of 2-3 weeks but mainly in the previous mentioned areas (chest back arms & neck. The second dose on 8/31 made them erupt more in the stomach and lower back area.

Other Meds: None

Current Illness: None

ID: 1717367
Sex: F
Age: 26
State:

Vax Date: 08/01/2021
Onset Date: 09/10/2021
Rec V Date: 09/21/2021
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: Period came almost two weeks early, lasted for 1.5 weeks. Usual period is at the same time each month and only 4 days.

Other Meds:

Current Illness:

ID: 1717368
Sex: F
Age: 37
State:

Vax Date: 09/14/2021
Onset Date: 09/17/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data: Non taken

Allergies: Na

Symptom List: Pain in extremity

Symptoms: The day of the vaccine I had a dead arm. Fever and shivers. Headache followed second and third day along with heart palpitations after coughing in the shower, I went really lightheaded, emotional and my heart was pounding heavily

Other Meds: Cerelle - mini pill (contraceptive pill)

Current Illness: None

ID: 1717645
Sex: M
Age:
State: PR

Vax Date: 03/02/2021
Onset Date:
Rec V Date: 09/21/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: his thyroid is not working, "zero"/problems with his thyroid/problems with his thyroid; This is a spontaneous report from a contactable consumer (patient's mother) reported for her son. A male patient of unknown age received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: Solution for injection, Batch/Lot number was not reported), via an unspecified route of administration on 02Mar2021 as dose 2, single for COVID-19 immunization. The patient medical history and concomitant medications was not reported. Historical vaccine included BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: Solution for injection, Batch/Lot number was not reported), via an unspecified route of administration on an unspecified date as dose 1, single for COVID-19 immunization. On an unspecified date in 2021, the patient experienced his thyroid is not working, "zero"/problems with his thyroid. His endocrinologist says, it was a reaction to the vaccine, and does not know how long it will last. She knows her son had problems with the second dose. He had problems with his thyroid. The doctor said there was nothing to do and the doctor could not give him Synthroid. The doctor said her son had to wait it out. Her son asked how long if it would be 6 months to one year and the doctor did not know. The outcome of the event was unknown. The lot number for the vaccine, [BNT162B2], was not provided and will be requested during follow up.

Other Meds:

Current Illness:

ID: 1717646
Sex: F
Age:
State: PR

Vax Date: 04/11/2021
Onset Date: 04/01/2021
Rec V Date: 09/21/2021
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: Allergic reaction; This is a spontaneous report from a contactable consumer or other non hcp (consumer). A female patient of an unspecified age received BNT162b2 (CONMINTARY, Solution for injection, Lot No, NDC number, Expiry Date: was not reported), via an unspecified route of administration on 11Apr2021 as 1stdose, single for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient experienced allergic reaction on Apr2021. Patient had to visit emergency room from unspecified to unspecified. Dates for patient are telling her to get the second dose from unspecified to unspecified. Reason for no lot number of Covid vaccine was patient was unwilling to complete the report. Patient had her second dose, but if she has already had an allergic reaction does she need the second dose because she does not know what to do. Investigation assessment was not provided. The outcome of the event was unknown. Follow-up attempts are completed. No further information is expected.

Other Meds:

Current Illness:

ID: 1717647
Sex: F
Age:
State: PR

Vax Date: 04/07/2021
Onset Date: 04/29/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: I'm experiencing severe pain in the chest that doesn't go away, very strong, not normal; This is a spontaneous report from a contactable consumer or other non-healthcare professional (patient reported for herself). A 25-year-old non-pregnant female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection, Batch/Lot Number: ew0151), dose 2 via an unspecified route of administration, administered in left arm on 07Apr2021 at 14:00 (at the age of 25-year-old) as dose 2, single for COVID-19 immunisation. The patient medical history was not reported. No known allergies were reported. Concomitant medications included camellia sinensis, levocarnitine, taurine (FAT BURNER L CARNITINA COMPLEX) taken for an unspecified indication, start and stop date were not reported. Historical vaccine given to patient previously was bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection, Batch/Lot Number: ew0179), dose 1 via an unspecified route of administration, administered in left arm on 28Apr2021 at 12:30 (at the age of 25-year-old) as dose 1, single for COVID-19 immunisation. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient did not receive any other vaccines on the same date the COVID vaccine was administered. Other medications the patient received within 2 weeks of vaccination included fat burner. The patient did not diagnose with COVID-19 prior to vaccination. The patient had not been tested for COVID-19 since the vaccination. On 29Apr2021 at 16:00, the patient experienced severe pain in the chest that did not went away, very strong, not normal. The event had not resulted in for death, life-threatening, prolonged hospitalisation, disabling/incapacitating or Congenital anomaly/birth defect. No treatment was received for the event. The outcome of the event was reported as not resolved. No follow-up attempts are needed. No further information is expected.

Other Meds: FAT BURNER L CARNITINA COMPLEX

Current Illness:

ID: 1717686
Sex: U
Age: 67
State: TX

Vax Date: 09/03/2021
Onset Date:
Rec V Date: 09/21/2021
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: shingles; This spontaneous case was reported by a consumer and describes the occurrence of HERPES ZOSTER (shingles) in a 67-year-old patient of an unknown gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 03-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced HERPES ZOSTER (shingles). At the time of the report, HERPES ZOSTER (shingles) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. No Concomitant medications were not reported. Treatment information was not provided. Most recent FOLLOW-UP information incorporated above includes: On 07-Sep-2021: Follow up received and contains no new information.

Other Meds:

Current Illness:

ID: 1717687
Sex: M
Age: 53
State: TX

Vax Date: 09/07/2021
Onset Date: 09/07/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: High fever body aches shortness breath lost appetite dizziness; High fever body aches shortness breath lost appetite dizziness; High fever body aches shortness breath lost appetite dizziness; High fever body aches shortness breath lost appetite dizziness; High fever body aches shortness breath lost appetite dizziness; This spontaneous case was reported by a consumer and describes the occurrence of PAIN (High fever body aches shortness breath lost appetite dizziness), DYSPNOEA (High fever body aches shortness breath lost appetite dizziness), DIZZINESS (High fever body aches shortness breath lost appetite dizziness), DECREASED APPETITE (High fever body aches shortness breath lost appetite dizziness) and PYREXIA (High fever body aches shortness breath lost appetite dizziness) in a 53-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 07-Sep-2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) .5 dosage form. On 07-Sep-2021, the patient experienced PAIN (High fever body aches shortness breath lost appetite dizziness), DYSPNOEA (High fever body aches shortness breath lost appetite dizziness), DIZZINESS (High fever body aches shortness breath lost appetite dizziness), DECREASED APPETITE (High fever body aches shortness breath lost appetite dizziness) and PYREXIA (High fever body aches shortness breath lost appetite dizziness). On 09-Sep-2021, PAIN (High fever body aches shortness breath lost appetite dizziness), DYSPNOEA (High fever body aches shortness breath lost appetite dizziness), DIZZINESS (High fever body aches shortness breath lost appetite dizziness), DECREASED APPETITE (High fever body aches shortness breath lost appetite dizziness) and PYREXIA (High fever body aches shortness breath lost appetite dizziness) had not resolved. Not Provided The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No Concomitant Medications were provided by the reporter No Treatment Information were provided by the reporter

Other Meds:

Current Illness:

ID: 1717688
Sex: F
Age: 21
State:

Vax Date: 03/05/2021
Onset Date: 04/08/2021
Rec V Date: 09/21/2021
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: Reoccurring migraine; This spontaneous case was reported by a consumer and describes the occurrence of MIGRAINE (Reoccurring migraine) in a 21-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The patient's past medical history included Penicillin allergy. On 05-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1. On 08-Apr-2021, the patient experienced MIGRAINE (Reoccurring migraine). At the time of the report, MIGRAINE (Reoccurring migraine) had not resolved. No concomitant medication was reported. No treatment medication was reported.

Other Meds:

Current Illness:

ID: 1717689
Sex: F
Age: 54
State:

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/21/2021
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: Headache; This spontaneous case was reported by a consumer and describes the occurrence of HEADACHE (Headache) in a 54-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 014C21A) for COVID-19 vaccination. The patient's past medical history included COVID-19 (Previously sick with COVID.). Concurrent medical conditions included Sulfonamide allergy (sulfa drug allergy), Allergy to antibiotic (ciprofloxacin allergy), Drug allergy (Celebrex allergy), Contrast media allergy (dye), Iodine allergy (betadyne allergy), Soy allergy, Food allergy (Wheat ), Fish allergy, Shellfish allergy and Bee sting. On 03-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 03-Sep-2021, the patient experienced HEADACHE (Headache). The patient was treated with PARACETAMOL (TYLENOL) for Headache, at a dose of 1 dosage form. On 05-Sep-2021, HEADACHE (Headache) had resolved. Not Provided The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medications were provided

Other Meds:

Current Illness: Allergy to antibiotic (ciprofloxacin allergy); Bee sting; Contrast media allergy (dye); Drug allergy (Celebrex allergy); Fish allergy; Food allergy (Wheat); Iodine allergy (betadyne allergy); Shellfish allergy; Soy allergy; Sulfonamide allergy (sulfa drug allergy)

ID: 1717690
Sex: F
Age: 54
State: CT

Vax Date: 09/03/2021
Onset Date: 09/03/2021
Rec V Date: 09/21/2021
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: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: Hard swelling; Painful; This spontaneous case was reported by a consumer and describes the occurrence of SWELLING (Hard swelling) and PAIN (Painful) in a 54-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 014C21A) for COVID-19 vaccination. The patient's past medical history included COVID-19. Concurrent medical conditions included Sulfonamide allergy (Sulfa drugs), Allergy to antibiotic (Ciprofloxacin), Allergy to antibiotic (Celebrex), Allergy to antibiotic (Betadyne), Soy allergy, Contrast media allergy (Contrast dye), Food allergy (Wheat), Fish allergy, Shellfish allergy and Bee sting. On 03-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 03-Sep-2021, the patient experienced SWELLING (Hard swelling) and PAIN (Painful). The patient was treated with PARACETAMOL (TYLENOL) for Adverse reaction, at an unspecified dose and frequency; NAPROXEN (NAPROSYN E) for Adverse reaction, at an unspecified dose and frequency and DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE]) for Adverse reaction, at an unspecified dose and frequency. On 10-Sep-2021, SWELLING (Hard swelling) was resolving. At the time of the report, PAIN (Painful) outcome was unknown. Not Provided The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant were provided.

Other Meds:

Current Illness: Allergy to antibiotic (Ciprofloxacin); Allergy to antibiotic (Celebrex); Allergy to antibiotic (Betadyne); Bee sting; Contrast media allergy (Contrast dye); Fish allergy; Food allergy (Wheat); Shellfish allergy; Soy allergy; Sulfonamide allergy (Sulfa drugs)

ID: 1717691
Sex: F
Age: 54
State: CT

Vax Date: 09/03/2021
Onset Date: 09/10/2021
Rec V Date: 09/21/2021
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: but tender at spot where vaccine was injected; Rash 6 days after injection; This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION SITE PAIN (but tender at spot where vaccine was injected) and RASH (Rash 6 days after injection) in a 54-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 014C21A) for COVID-19 vaccination. The patient's past medical history included COVID-19 (Previously sick with Covid). Concurrent medical conditions included Sulfonamide allergy (Allergic to sulfa drugs), Allergy to antibiotic, Drug allergy, Drug allergy, Contrast media allergy, Soy allergy, Food allergy, Fish allergy, Shellfish allergy and Bee sting hypersensitivity. On 03-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 10-Sep-2021, the patient experienced RASH (Rash 6 days after injection). On an unknown date, the patient experienced VACCINATION SITE PAIN (but tender at spot where vaccine was injected). At the time of the report, VACCINATION SITE PAIN (but tender at spot where vaccine was injected) outcome was unknown and RASH (Rash 6 days after injection) had not resolved. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. No concomitant medication was reported. No treatment medication was reported. Large red rash, measures 3 inches by 6 inches on left arm was reported.

Other Meds:

Current Illness: Allergy to antibiotic; Bee sting hypersensitivity; Contrast media allergy; Drug allergy; Fish allergy; Food allergy; Shellfish allergy; Soy allergy; Sulfonamide allergy (Allergic to sulfa drugs)

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am