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**
PLEASE CHECK BACK SOON
Download the files above while you wait.







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: 1718966
Sex: F
Age: 53
State: WI

Vax Date: 08/25/2021
Onset Date: 08/25/2021
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: LA

Lab Data: none

Allergies: Penicillin, cephalosporin, Anesthetics like Lydocain, Novocain Many food allergies: Honey, eggplant seeds, parmesan cheese + some aged cheeses, intolerance to cow milk (but not yogurt or cheese) Large swelling from mosquito & bee bites Skin allergies when exposed to the sun (small itchy skin blisters start to develop after 15-30 minutes of sun exposure)

Symptom List: Dysphagia, Epiglottitis

Symptoms: Symptoms 8/25 - 8/27 Extreme chills Very high fever 104.6 (with 2 Tylenols) Headache Irregular rapid heart palpitations Pulse reached 148+ beats/minute at sedentary status Sore injection site and arm on 8/27 injection site was red all around it (elongated circle to almost the elbow) and very itchy Did not call doctor. No treatment from doctor but took 2 Tylenols when fever started to increase.

Other Meds: Allegra but stopped few days before each vaccine dose

Current Illness: none

ID: 1718967
Sex: F
Age: 68
State: GA

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

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

Lab Data:

Allergies: NKDA

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient was given an expired vaccine. Vaccine expired on 09/07/2021. Vaccine vial was mixed with a similar lot number vial. Expired vial lot #002B21A.

Other Meds:

Current Illness:

ID: 1718969
Sex: F
Age: 60
State: MA

Vax Date: 03/14/2021
Onset Date: 09/14/2021
Rec V Date: 09/21/2021
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: Check with my doctor.

Allergies: Penicillin, statins, codeine, Teriparatide, Alendroni c acid, beer, red wine extract

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

Symptoms: Shortly after receiving second shit I broke out with hives on the inside of my lower left arm,. I had a burning/light redness to my face and stomach., this lasted for about four hours and then subsided. The following day spine a fever to 103.3 and unresponsive. The following days I became fatigued and experiencing shortness of breath.. symptoms continue to date. In July was seen at Urgent Care, PCP and twice in the ER. I experienced a horrific outbreak with hives, , went into anaphylactic shock . I had the hives for fourteen straight days. ( have pictures of this). I was seen by allergist. Was informed by docking the presence of my boyfriend that the shot elevated my immune system.. I came into contact with alcohol which resulted in the hives. I am now on an inhaler .

Other Meds: Vitamins

Current Illness: None.

ID: 1718970
Sex: M
Age: 37
State: IL

Vax Date: 08/31/2021
Onset Date: 08/31/2021
Rec V Date: 09/21/2021
Hospital:

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

Lab Data: I had a thorough physical conducted prior to receiving the first dose the same day - 31 August. I was informed by my primary care that I was perfectly healthy, and had no cause for concern of suffering severe side effects.

Allergies: Prone to medicinal side effects

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: 1.) Headaches 2.) Nausea 3.) Tingling sensation equivalent to when your hand/arm etc falls asleep in both my legs and the left side of my face. 4.) Occasional feeling of being short of breath - noticeable when I speak for an extended period. The tingling sensation lasted less than 24 hours. Nausea and headaches persisted for the better part of a week (5 days roughly). The feeling of being short of breath still happens now and again, but I only really notice it if I am speaking for a prolonged period.

Other Meds: Thyroid medication, Ibuprofen, Vitamin D supplements

Current Illness: None

ID: 1718971
Sex: F
Age: 23
State: IN

Vax Date: 02/11/2021
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: IM
Vax Site: LA

Lab Data: COVID PCR +

Allergies: NKA

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

Symptoms: Subjective Patient is a 23-year-old obese female who received the Pfizer vaccine in March of this year but tested positive for Covid 1 week ago she comes in today very anxious breathing about 30 times a minute stating that she cannot catch her breath but her oxygen saturation was 100%. She received the Regeneron infusion yesterday-states she was feeling worse today she also complains of some chest pain with her breathing. States she has had cough which has been dry she denies fever in the last 24 hours-she rates her pain a 6/10 Review of Systems Constitutional: Negative for chills, fatigue and fever. HENT: Negative for congestion, tinnitus and trouble swallowing. Eyes: Negative for photophobia, discharge and redness. Respiratory: Positive for cough and shortness of breath. Cardiovascular: Positive for chest pain. Negative for palpitations. Gastrointestinal: Negative for abdominal pain, diarrhea, nausea and vomiting. Genitourinary: Negative for dysuria, frequency and urgency. Musculoskeletal: Negative for back pain, joint swelling and myalgias. Skin: Negative for rash. Neurological: Negative for dizziness and headaches. Psychiatric/Behavioral: Negative for confusion. The patient is nervous/anxious. All other systems reviewed and are negative.

Other Meds: Acetaminophen (TYLENOL) 325 MG CAPS desogestrel-ethinyl estradiol (KARIVA) 0.15-0.02/0.01 MG (21/5) desvenlafaxine (PRISTIQ) 50 MG 24 hr tablet Ibuprofen 200 MG CAPS ondansetron (ZOFRAN ODT) 4 MG disintegrating tablet promethazine (PHENERGA

Current Illness: 8/5/2021 1. Person under investigation for COVID-19 (COVID negative) 2. Acute nonintractable headache, unspecified headache type 3. Nasal congestion

ID: 1718972
Sex: F
Age: 35
State: TX

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

Allergies:

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

Symptoms: Patient was given 2nd dose of Pfizer COVID-19 vaccine series on Day 14 which was earlier than the recommended minimum interval between the two dose series. Patient reports no major adverse effects

Other Meds:

Current Illness:

ID: 1718973
Sex: F
Age: 81
State: TX

Vax Date: 04/01/2021
Onset Date: 09/17/2021
Rec V Date: 09/21/2021
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: CBC, upper respiratory panel, CXR, CMP, Rapid COVID

Allergies: NKA

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: SOB, cough, chest congestion, pneumonia- antibiotics, decadron,

Other Meds: aspirin, HCTZ, irbesartan, tramadol

Current Illness:

ID: 1718974
Sex: F
Age: 37
State:

Vax Date: 08/23/2021
Onset Date: 08/23/2021
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: Zofran

Symptom List: Pharyngeal swelling

Symptoms: Swelling of the face, lips, eyelids within 3 hours of vaccine administration. Took benadryl orally and aspirin and within 24 hours, the swelling went down.

Other Meds: None

Current Illness: None

ID: 1718975
Sex: F
Age: 67
State: MN

Vax Date: 06/02/2021
Onset Date: 06/03/2021
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: LA

Lab Data: Blood test for inflammation and infection on 7/22/2021. Ultrasound on 8/24/2021.

Allergies: None.

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Woke up with swollen sore shoulder to elbow. Couldn't move arm away from body for 4 days. Followed by weakness, tingling, numbness in whole arm. Waited 6 weeks to see if it got better. Went to see Doctor, they Said there is a lump at injection site. Told me to do exercises. If not better, then come back. Went back. Did blood check for inflammation and infection. Negative. Had ultrasound done. Negative for injury. Tingling and numbness is better. Still can't straighten out my arm completely without pain in left elbow. Seeing a chiropractor now to help with pain and to see if I can get my elbow pain free.

Other Meds: Occasional B12 Vitamins.

Current Illness: Sjorgrens.

ID: 1718976
Sex: F
Age: 71
State: MI

Vax Date: 05/27/2021
Onset Date: 09/17/2021
Rec V Date: 09/21/2021
Hospital: Y

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

Lab Data: Unknown

Allergies: Ambien

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Right lower quadrant abdominal pain with constant throbbing rated 8/10, persistent nausea, SOB, worsening cough, not eaten in the last 3 days. Hospitalization.

Other Meds: Unknown

Current Illness: Unknown

ID: 1718977
Sex: F
Age: 49
State: MN

Vax Date: 03/13/2021
Onset Date: 09/19/2021
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:

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

Symptoms: Tested positive for COVID 9/19/21 after being fully vaccinated.

Other Meds:

Current Illness:

ID: 1718978
Sex: F
Age: 60
State: FL

Vax Date: 05/15/2021
Onset Date: 08/03/2021
Rec V Date: 09/21/2021
Hospital: Y

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

Lab Data: CXR, covid test, lab work.

Allergies: Codeine, IVP dye, morphine, sulfa drugs.

Symptom List: Rash, Urticaria

Symptoms: Pt came to ER c/o cough and SOB, tested positive for Covid 7/28.

Other Meds:

Current Illness:

ID: 1718979
Sex: F
Age: 39
State: NY

Vax Date: 09/13/2021
Onset Date: 09/15/2021
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:

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

Symptoms: Patient c/o low back pain and hip pain and hard to walk and weak in that leg joint post COVID vaccination x1.

Other Meds:

Current Illness:

Date Died: 09/18/2021

ID: 1718980
Sex: M
Age: 60
State: MI

Vax Date: 01/20/2021
Onset Date: 09/08/2021
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: Swabbed positive on admission 9.8.2021

Allergies:

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

Symptoms: Renal transplant recipient Jan 2019, on immunosuppressives, became SOB, cough

Other Meds: albuterol, zyloprim, norvasc, lipitor, eliquis, bumex, coreg, vitamin B 12, neurontin, mycophenolate, prograf, insulin,

Current Illness:

ID: 1718982
Sex: F
Age: 37
State:

Vax Date: 09/13/2021
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:

Allergies: Zofran

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

Symptoms: Swelling of the face, lips, eyelids within 3 hours of vaccine administration. Took benadryl orally and aspirin and within 48 hours, the swelling went down.

Other Meds: None

Current Illness: None

ID: 1718983
Sex: M
Age: 82
State: PA

Vax Date: 09/14/2021
Onset Date: 09/14/2021
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: NKA

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

Symptoms: CLAIMANT ALLEGES THAT AFTER A FLU SHOT WAS ADMINISTERED AT THE PHARMACY THAT HE WAS NOT FEELING WELL. THE CLAIMANT LOST HIS URINE. EMS WAS CALLED AND HE WAS EVALUATED ON SCENE. CLAIMANT REFUSED TO BE TRANSFERRED.

Other Meds: FAMOTIDINE, ISOSORBIDE MONONITRATE, METOPROLOL, FUROSEMIDE, FEXOFENADINE, FINASTERIDE, TAMSULOSIN, PRAVASTATIN,LEVOTHYROXINE

Current Illness:

ID: 1718984
Sex: F
Age: 50
State: TN

Vax Date: 09/13/2021
Onset Date: 09/14/2021
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: none

Allergies: none

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

Symptoms: severe body ache, muscle ache, elevated temp. 37.6C, headache. Second day - right side migraine, severe sensitivity on the right side of the head and face, toothache ( all teeth) on the right side of the face, fatigue.

Other Meds: none

Current Illness: none

ID: 1718985
Sex: F
Age: 32
State: NC

Vax Date: 01/01/2021
Onset Date: 02/01/2021
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: Sulfa

Symptom List: Ear pain, Hypoaesthesia

Symptoms: I have been having irregular periods since 1-2 months after receiving the vaccine. My cycle is normally very regular and tracked in an app. Since the vaccine I?ve started my period several days early some month, several days late other months. I normally have heavy periods, especially the 2nd and 3rd days and now it is unpredictable and has been a lot lighter than normal. With this I?ve also had worse cramping and headaches each cycle, with fluctuations in body temperature feeling very hot at times during my menstrual cycle. I?ve also noticed I?ve been a lot more irritable in the week leading up to it.

Other Meds: Levothyroxine

Current Illness:

ID: 1718986
Sex: F
Age: 48
State: MN

Vax Date: 05/11/2021
Onset Date: 05/11/2021
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: Went to ER - they visually inspected my mouth. Here are the physician notes: Patient is a healthy 48-year-old with a history of baseline tremor on propranolol here with isolated floor of mouth swelling that woke her from sleep. States initially she felt like her teeth were hurting and she checked underneath her tongue and she noticed that it was swollen. Very subtle difficulty breathing/swallowing and came in here for evaluation. On arrival she is mildly tachycardic. Looks well clinically. Heart and lungs normal. She has no voice changes. Tongue is normal. Physical examination revealing isolated edema noted under the tongue bilaterally and symmetrically. No gingival hyperplasia. No uvular edema. No trismus or stridor or drooling. No rash. No pain or swelling externally along patient's submandibular region and anterior neck. No redness suggesting infection. Patient recently received her second Covid vaccination earlier today. Plan to give patient allergy cocktail of methylprednisolone, Pepcid Benadryl and Toradol for tooth pain.

Allergies: Slight allergy to crab legs

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Gums and under the tongue swelling - gums were extremely painful and under tongue was swollen to a flat surface and it was gradually getting tougher to swallow

Other Meds: Propanolol, Zyrtec and birth control pill

Current Illness: None

ID: 1718987
Sex: F
Age: 67
State: RI

Vax Date: 02/24/2021
Onset Date: 02/27/2021
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: I did not have any medical tests completed.

Allergies: I do not have any allergies.

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

Symptoms: Four days after receiving the second dose, I broke out in a rash from my neck to my ankles. I visited my dermatologist, 03/01 and I was prescribed triamcinolone acetonide cream 0.1%. I used the cream and within less than a week, I was feeling better and the rash started to go away. I have had this rash occur two more times after the original breakout. I used the cream that was prescribed to me and it helped. I recently had it refilled in case of another breakout. The doctor was going to treat me with prednisone, but they didn't want it to mix with the vaccine since it was only four days after receiving it.

Other Meds: Omeprazole; a daily probiotic; a multivitamin; Klor Con/potassium; HCTZ-hydrochlorothiazide; Premarin; Zyrtec.

Current Illness: I was not experiencing any illness.

ID: 1718988
Sex: F
Age: 69
State: CA

Vax Date: 07/17/2021
Onset Date: 07/18/2021
Rec V Date: 09/21/2021
Hospital: Y

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

Lab Data: CT, MRCP, labs

Allergies: PCN

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

Symptoms: The patient developed severe hepatitis requiring hospitalization. Other causes of acute hepatitis were ruled out.

Other Meds: Multivitamin Trazodone Creon Levothyroxine Gabapentin Amlodipine

Current Illness: None

ID: 1718989
Sex: M
Age: 25
State: NM

Vax Date: 09/14/2021
Onset Date: 09/15/2021
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: None

Symptom List: Unevaluable event

Symptoms: Neck/spine stiffness and soreness lasting in excess of 1 week Pain at injection site lasting ~3 days Fever lasting through following day Sneezing lasting approximately 1 hr, occurring ~6 hours after vaccination

Other Meds: None

Current Illness: None

ID: 1718990
Sex: U
Age: 65
State:

Vax Date: 03/10/2021
Onset Date: 09/20/2021
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:

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

Symptoms: COVID Positive 9/20/21. Admitted to ICU.

Other Meds:

Current Illness:

ID: 1718991
Sex: F
Age: 33
State: MN

Vax Date: 06/28/2021
Onset Date: 09/17/2021
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:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Tested NAAT positive for COVID 9/17/21 after being fully vaccinated.

Other Meds:

Current Illness:

ID: 1718993
Sex: M
Age: 15
State: FL

Vax Date: 09/03/2021
Onset Date: 09/04/2021
Rec V Date: 09/21/2021
Hospital: Y

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

Lab Data: 09/06/2021 16:00 EDT SARS CoV 2 by PCR Not Detected RSV by PCR Not Detected Adenovirus Not Detected Coronavirus 229E by PCR Not Detected Coronavirus HKU1 by PCR Not Detected Lab Test and Results Continued: Coronavirus NL63 by PCR Not Detected Coronavirus OC43 by PCR Not Detected Metapneumovirus Not Detected Rhino/Entero by PCR Not Detected Influenza A Not Detected H1N1 (Swine) Not Detected Influenza A H1 by PCR Not Detected Influenza A H3 by PCR Not Detected Influenza B Not Detected Parainflu 1 Not Detected Parainflu 2 Not Detected Parainflu 3 Not Detected Parainfluenza 4 by PCR Not Detected Bordetella pertussis by PCR Not Detected Bordetella Parapertussis PCR Not Detected Chlamydia pneumoniae by PCR Not Detected Mycoplasma pneumoniae by PCR Not Detected RPP Commment * , Lab results 09/08/2021 05:34 EDT Troponin iSTAT 7.94 ng/mL HI 09/07/2021 06:37 EDT Troponin iSTAT 13.52 ng/mL HI 09/06/2021 17:03 EDT Troponin iSTAT 10.07 ng/mL HI 09/06/2021 16:54 EDT ANA Pattern None Detected ANA Titer <=1:10 ds-DNA Quant <30.00 IU/mL NA ds-DNA Ab Intrp Neg TPOG Quant <25.00 IU/mL NA TPOG Interp Neg SSA Ab Index 2.388 SSA Ab Interp Negative SSB Ab Units 4.511 NA SSB Ab Interp Neg SM/RNP Ab Index 2.580 SM/RNP Ab Interp Negative SCL70 Ab Units 5.665 NA SCL70 Ab Interp Neg JO 1 Ab Index 3.563 JO 1 Ab Interp Negative C3 Complement 106.0 mg/dL C4 Complement 21.2 mg/dL RF <<8.6 IU/mL SM Ab Units 4.640 NA SM Ab Interp Neg 09/06/2021 16:00 EDT SARS CoV 2 by PCR Not Detected RSV by PCR Not Detected Adenovirus Not Detected Coronavirus 229E by PCR Not Detected Coronavirus HKU1 by PCR Not Detected Coronavirus NL63 by PCR Not Detected Coronavirus OC43 by PCR Not Detected Metapneumovirus Not Detected Rhino/Entero by PCR Not Detected Influenza A Not Detected H1N1 (Swine) Not Detected Influenza A H1 by PCR Not Detected Influenza A H3 by PCR Not Detected Influenza B Not Detected Parainflu 1 Not Detected Parainflu 2 Not Detected Parainflu 3 Not Detected Parainfluenza 4 by PCR Not Detected Bordetella pertussis by PCR Not Detected Bordetella Parapertussis PCR Not Detected Chlamydia pneumoniae by PCR Not Detected Mycoplasma pneumoniae by PCR Not Detected RPP Commment * 09/06/2021 07:21 EDT Troponin iSTAT 20.73 ng/mL HI 09/06/2021 01:47 EDT Troponin iSTAT 40.05 ng/mL HI . Radiology results: CXR 09/06/21 FINDINGS: The lungs are clear. The heart size within normal limits. The trachea is not deviated. CONCLUSION: No acute cardiopulmonary disease seen radiographically. Signature Line ***** Final ***** Thank you for the opportunity to participate in the health care of this patient. I have personally reviewed the images and the report. ECHO 09/06/21 CONCLUSIONS: - No structural abnormalities seen. Normal valvular function. Qualitatively mildly depressed left ventricular systolic function globally. Qualitatively normal right ventricle function. Trivial inferior pericardial effusion.

Allergies: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: 9/6/21 - Patient is a 15 year old male with no significant PMHx. presenting with chest pain, fever x 1 day, emesis, and diarrhea. Patient received the 2nd dose of Pfizer vaccination on 9/3, and symptoms began on 9/4. Mother also reports some fatigue and tiredness in this period. He denies any palpitations, shortness of breath, exertional dyspnea, orthopnea or peripheral edema. No dizziness, syncopal episodes or seizures. No recent travel, sick contacts or Covid exposures. Due to persistence of the chest pain, he initially went to a local Hospital where CBC was done and unremarkable; BMP revealed hypokalemia (3). EKG done with some non specific ST changes. Troponin was elevated to 44,585 ng/L (44.5 ng/mL). Chest x-ray was unremarkable. SARS-CoV-2 PCR was negative. He was given ibuprofen x1, potassium chloride x1, and referred to ER for further management. At ED, he was vitally stable and without reported chest pain. Repeat EKG was done. Troponin at 40 ng/mL. Patient was then admitted to CICU. 9/7/21 - Patient examined with mother at bedside. He reports chest pain recurred last night around 7 pm. It had the same characteristics as described initially on presentation, lower intensity (6/10) and resolved 40 min after ibuprofen was administered. 9/8/21 - Pt seen with mother at bedside. Mother denies adverse events overnight. No further chest pain and patient was able to tolerate well his walk around the floor last afternoon. VS wnl on room air and only synus arrhythmia seen on telemetry overnight. Patient is improved, stable and medically cleared to continue treatment at home with prescribed medications (lisinopril qDay and Motrin PRN) and follow up apointments as detailed below (Cardiology, ID, Rheum and PCP).

Other Meds: None

Current Illness: None

ID: 1718994
Sex: M
Age: 53
State: GA

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: 025J20A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: Had bloodwork done (June 2021) and it showed a B12 deficiency which I did not have until I received the COVID vaccine.

Allergies: None

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

Symptoms: 1) Tingling, pins and needles on left side of left hand (pinkie finger and down the hand), immediately after shot. This is on-going. B12 supplement has helped, but it has not completely resolved (on and off tingling). 2) Pain at injection site

Other Meds: Asian Ginseng, Fish oil, CBD oil

Current Illness: None

ID: 1718995
Sex: M
Age: 22
State: TX

Vax Date: 08/07/2021
Onset Date: 08/10/2021
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:

Allergies: Zithromax

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: First night and next day felt the expected bad feelings and lack of energy. Cleared up by Monday August 9 2021. Then 1-2 days later I started having odd feelings in my heart. As someone who vapes nicotine I know my body is used to it yet the smallest bit of a hit from the vape made my heart race. I also noticed this occur without having vaped or anything. Sometimes just sitting there I would notice it increase. I also got the worst sinus infection ever and felt completely blocked up. There were a couple days where I would blow my nose and could feel it hurt my teeth. After a couple days maybe about a week I felt the sinus infection alleviate. However the heart issue persisted for a couple more days. Now it?s all done and I can vape and take my adderall like before.

Other Meds: Amphetamine salt combo 20mg extended Amphetamine salt combo 10mg instant Famotidine Omeprazole

Current Illness: None - felt great

Date Died: 09/11/2021

ID: 1718996
Sex: F
Age: 79
State: MN

Vax Date: 09/01/2021
Onset Date: 09/11/2021
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:

Allergies: No known allergies

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient received a 3rd dose of Moderna vaccine on 09/01/2021. Patient passed away on 09/11/2021 from cardiac arrest.

Other Meds: Coumadin, Fosamax, Coreg, Lasix, Cozaar, Klor-Con, Tylenol, Calcium-Vit D

Current Illness:

ID: 1718997
Sex: M
Age: 32
State: TX

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

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

Symptoms: Within hours my arm was sore, I was commuting and unable to eat. I ran a fever that did not exceed 102 for 24 hours. It was difficult to keep balance while walking or standing. I could not keep fluids down and had extreme muscle aches. The headache lasted a full 48 hours and might have been the worst part. I was for the vaccine until I had this occur. It was a definite horrible experience.

Other Meds: Testosterone injection

Current Illness: None

ID: 1718998
Sex: M
Age: 46
State: VA

Vax Date: 05/04/2021
Onset Date: 07/01/2021
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: xray and inspection by Dr. August 4th 2021. Recommended that I see him again about 6 months out if it does not resolve and/or I am still concerned about it.

Allergies: stomach hurts when I take nsaids

Symptom List: Nausea

Symptoms: No issues immediately after the vaccination. A month or so later started developing severe bursitis in my left inner elbow. I then found a knot on the top front side of my left bicep. I went to Dr. with Orth State. He immediately dismissed the possibility of the knot, in his opinion, a swollen lymph node, of being related to the vaccination. However, it still persists and I have heard of others getting severe bursitis and arthritis from the vaccination. I want to know what I can expect from this. Will symptoms resolve? Is this permanent? Is there further concerns beyond what I have experienced so far?

Other Meds: generic flonase

Current Illness: no

ID: 1719000
Sex: F
Age: 58
State: NJ

Vax Date: 03/16/2021
Onset Date: 08/16/2021
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: Strep covid-19

Allergies: Penicillin

Symptom List: Injection site pain

Symptoms: I start having a sore throat. I had sneezing, congestive, and a light cough. I also have a headache. I went to the doctor to get a strep test and a Covid-19 test done. They were negative. Then I another Covid-19 test, which was negative. Then I started having loss of smell that lasted one day. I got another Covid-19, which came out positive.

Other Meds: Synthroid .88mkg

Current Illness:

ID: 1719001
Sex: M
Age: 85
State: TX

Vax Date: 01/23/2021
Onset Date: 09/17/2021
Rec V Date: 09/21/2021
Hospital: Y

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

Lab Data: CBC, CMP, CXR, EKG,

Allergies: NKA

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

Symptoms: altered mental status, general weakness

Other Meds: None Found

Current Illness:

ID: 1719002
Sex: M
Age: 76
State: GA

Vax Date: 01/12/2021
Onset Date: 09/08/2021
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: Xray, CTscan 9/9/2021

Allergies: No allergies that I'm aware of.

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

Symptoms: Blood Clots in lung.

Other Meds: Losartan Potassium - 50mg, amLodipebesylate 5mg, Omerprazoledr-40mg, Rosuvastatin Calcium-20, Low Dose Asprin, Centrium Sliver, Vitamin B12 c

Current Illness: No illnesses.

ID: 1719003
Sex: F
Age: 46
State: KY

Vax Date: 04/22/2021
Onset Date: 09/15/2021
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: COVID 19+ Antigen

Allergies: NKA

Symptom List: Tremor

Symptoms: Sore Throat This is a new problem. The current episode started yesterday. The problem has not changed since onset.There has been no fever. Associated symptoms include diarrhea (x3 over 24 hours, watery), trouble swallowing and cough (yellow production). Pertinent negatives include no congestion and no shortness of breath. She has tried nothing for the symptoms. No loss of taste or smell. COVID vaccinated x2

Other Meds: ARANELLE 0.5/1/0.5-35 MG-MCG TABS cetirizine (ZYRTEC) 10 MG tablet Multiple Vitamins-Minerals (MULTIVITAMIN PO)

Current Illness:

ID: 1719004
Sex: M
Age: 73
State: TX

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

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

Lab Data: Heart Cath 9/9/2021 and 9/10/2021. Blood test daily. Ultrasound on 9/11/2021 and 9/14/2021.

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Massive heart attack after 2 days after 2nd injection. Coded twice, once on life flight and once at emergency room. Attempted to remove clot with clot buster after/during heart cath. Only have 35% heart function, feel weak, nauseous and wearing life vest defibrillator for 3 months.

Other Meds:

Current Illness:

ID: 1719005
Sex: M
Age: 30
State: SC

Vax Date: 03/29/2021
Onset Date: 03/30/2021
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: Large amount of swelling of lymph nodes in left armpit lasting for approximately 7 days

Other Meds:

Current Illness:

Date Died: 09/12/2021

ID: 1719006
Sex: F
Age: 89
State: MN

Vax Date: 02/17/2021
Onset Date: 09/12/2021
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: Lipitor

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

Symptoms: Patient passed away on 09/12/2021

Other Meds: Roxanol, Senna, Dulcolax, Insulin glargine, Miralax, Cardizem, Nystatin

Current Illness:

ID: 1719007
Sex: M
Age: 60
State: KY

Vax Date: 09/13/2021
Onset Date: 09/13/2021
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: na

Allergies: na

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Difficulty breathing, rapid heartbeat, dizziness, weakness, short of breath, severe headaches and body aches.

Other Meds: na

Current Illness: na

ID: 1719008
Sex: M
Age: 77
State: FL

Vax Date: 04/05/2021
Onset Date: 08/03/2021
Rec V Date: 09/21/2021
Hospital: Y

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

Lab Data: Covid test, cxr, lab work.

Allergies: NKA

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

Symptoms: Pt came to ER c/o left upper and lower extremity weakness.

Other Meds:

Current Illness:

ID: 1719009
Sex: F
Age: 26
State: GA

Vax Date: 09/17/2021
Onset Date: 09/17/2021
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:

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

Symptoms: Patient was given an expired vaccine. Vaccine expired on 09/07/2021, and was given on 09/17/2021.

Other Meds:

Current Illness:

ID: 1719010
Sex: M
Age: 42
State: FL

Vax Date: 09/17/2021
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:

Allergies:

Symptom List: Pain in extremity

Symptoms: Employee came to the pharmacy on 09/17/21 to receive second dose of Pfizer vaccine, first dose was administered at Hospital. On 09/17/2021, Dose was administered by pharmacist at pharmacy. Upon logging information into SHOT by pharmacist, first shot was confirmed to be received on 09/09/2021. Per patient, hospital advised to schedule next dose in "about a week". Recommendation is to separate doses by 21 days however, dose was only separated by 8 days. Patient was monitored for 20 minutes with no observed side effects. Subsequent dose was canceled due to most recent recommendations to not repeat additional doses for second dose administered with fewer than 17 days. As of 09/21/2021, patient reported right arm soreness as side effect. FAILURE POINT: Upon patient verification, immunization history should have been collected to ensure appropriate administration of COVID 19 Vaccine. ACTION: Pharmacy to implement COVID Immunization card verfication/SHOTS verification prior to administration of COVID-19 vaccines

Other Meds:

Current Illness:

ID: 1719011
Sex: F
Age: 35
State: FL

Vax Date: 03/17/2021
Onset Date: 07/06/2021
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: Labs-7-22-2021 and 8-20-2021 Hospital ER Visits-7-8-2021, and 8-13-2021-Medical Center Hospital ER Visits-7-22-2021, 7-25-2021, and 8-22-2021- Medical Center Hospital ER Visit-9-14-2021- Medical Center Echo-7-20-2021, Holter Monitor-7-14-2021, Event Monitor-8-2-2021, DAS-9-13-2021.

Allergies: n/a

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

Symptoms: I got my second shot March 17, 2021. July 5, 2021, I started to have chest pain. Went to the ER, my troponins were slightly elevated. I was discharged home, due to acute myocarditis/pericarditis. The following week, I started to experience rapid heart rates, my troponins were still slightly elevated. I have been to the ER a total of 5 times, I now have to take a beta blocker for my heart rate, and I still have the chest pain. I have been dealing with this since July. I have no health problems, no family history of heart disease. The only thing I've done differently is get the vaccine. I had to have an Echo, holter monitor, event monitor and stress test done, due to this. This is very frustrating. I have never had any health issues. This has affected my daily living, working, and all around my health. They have diagnosed it as pericarditis. I also work in the health field, a nurse at my cardiology office. I have undergone GI evaluation to rule that out, work up was negative. It has affected my anxiety which I now have to take medication for. I have never been on any type of medication beside OTC vitamins. I am very upset that this was not listed as a possible side effect.

Other Meds: n/a

Current Illness: n/a

ID: 1719012
Sex: M
Age: 43
State: WI

Vax Date: 09/09/2021
Onset Date: 09/10/2021
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: no blood clots, no heart attack. D-dimer labs and xrays normal.

Allergies: None

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

Symptoms: Pain in chest. Irregular heartbeat. Pounding heartbeat, short of breath. headache. Patient did not seek treatment for 1 week after symptoms began, did not understand the seriousness of the symptoms. Symptoms decreased with time.

Other Meds: None

Current Illness: None

ID: 1719013
Sex: F
Age: 36
State: MN

Vax Date: 01/26/2021
Onset Date: 09/18/2021
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: Tested NAAT positive for COVID 9/18/21 after being fully vaccinated.

Other Meds:

Current Illness:

ID: 1719014
Sex: F
Age: 55
State: IL

Vax Date: 08/14/2021
Onset Date: 08/14/2021
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: None.

Allergies: None

Symptom List: Vomiting

Symptoms: Same day left arm pain. Worsening in days two through five. Arm pain so severe could not raise arm above hip. No overheard reach with L arm for approximately two weeks. L arm pain has continued when lifting arm laterally or when extending/reaching arm out in front or in back of the body. Arm pain so significant cannot lay on L arm. L arm pain awakens me at night if I accidentally sleep on it. I have not sought medical attention as of yet. When I received the third dose (booster), on 8/19/21 the person who administered it at the pharmacy stated the vaccine "was not going into the arm as it should" and she had to reposition her needle. It is unknown if the arm pain is related to the repositioning of the needle or due to the vaccine. I am making an appointment with my medical provider but not sure if there is anything she can do.

Other Meds: Buspirone, HCL, 10mg/2X day Duloxetine HCL DR. 30mg/2X day

Current Illness: None and no known health conditions

ID: 1719015
Sex: F
Age: 33
State: NY

Vax Date: 06/24/2021
Onset Date: 07/20/2021
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: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Severe migraines that have been happening at least twice a week and last 2-3 days. Migraine medicine (Relpax) and prevention medication (Topamax) is not helping. I have been extremely tired and having memory loss as well.

Other Meds:

Current Illness: None

ID: 1719016
Sex: M
Age: 15
State: OH

Vax Date: 09/17/2021
Onset Date: 09/19/2021
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: RA

Lab Data: Elevated troponins, BNP, ST elevation on EKG

Allergies:

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

Symptoms: Patient developed chest pain and difficulty breathing 2 days after COVID Pfizer vaccine #2 administered. Diagnosed with myopericarditis in the setting of acute inflammatory reaction to mRNA vaccine.

Other Meds:

Current Illness:

ID: 1719017
Sex: F
Age: 57
State: WV

Vax Date: 07/27/2021
Onset Date: 07/27/2021
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: Xray Echocardiogram ECG bloodtesting

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: heart palpations ear ringing essential hypertension.. still occurring 7 weeks after 1 shot and still under blood pressure treatment. normal BP before shot 120/65 now under medication consistently over 145/90

Other Meds: estradiol vaginal cream

Current Illness: none

ID: 1719018
Sex: M
Age: 60
State: PA

Vax Date: 09/14/2021
Onset Date: 09/16/2021
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: None yet. Will schedule appt with doctor if symptoms continue for a few more days.

Allergies: Seasonal allergies. Some allergy to thin-skinned fruits and vegetables.

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

Symptoms: Beginning after about 1 day after vaccination, and up until the writing of this report, experiencing itching (intense at times) on arms, hands, chest and back, including intermittent, small hives/lesions, mostly on back of hands and forearms. Called primary care physician after 2 days and I have been taking an over-the-counter antihistamine , 2-3x per day. Itching has continued, but hasn't gotten worse.

Other Meds: Rosuvastatin Levothyroxine Saw Palmetto Vitamin C Vitamin D Zinc Quercetin Fish Oil Alpha Lipoic Acid

Current Illness: subdural hematoma

ID: 1719019
Sex: F
Age: 28
State: OR

Vax Date: 09/05/2021
Onset Date: 09/06/2021
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: None

Allergies: None

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

Symptoms: Muscle soreness, extreme sensitivity to cold, sharp shooting pain in ears periodically

Other Meds: Levothyroxine, womans multivitamins

Current Illness: None

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am