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: 1720095
Sex: F
Age: 49
State: FL

Vax Date: 05/27/2021
Onset Date: 06/03/2021
Rec V Date: 09/21/2021
Hospital: Y

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

Lab Data: CT, US , labs, Surgical pathology, taking antibiotics for recurring oral lesions- 6/14 to 6/18 Continued dizziness since vaccine - Cta heart - negative 9/2021@ medical center

Allergies: Pseudoephedrine, erythromycin

Symptom List: Dysphagia, Epiglottitis

Symptoms: Appendectomy for lymphangitis, dilated lymph channels and blood in the pelvic channel, cutaneous boils on legs, groin and oral lesions and abscesses

Other Meds: Topamax

Current Illness: None

ID: 1720096
Sex: M
Age: 28
State:

Vax Date: 08/31/2021
Onset Date: 09/03/2021
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: None

Symptom List: Anxiety, Dyspnoea

Symptoms: Muscle on the left arm bicept area twitch.

Other Meds: None

Current Illness: None

ID: 1720097
Sex: F
Age: 4
State: MI

Vax Date: 11/21/2019
Onset Date: 11/22/2019
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: none

Allergies: n/a

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

Symptoms: The day after the vaccine, patient's leg swelled significantly and the injection site was extremely swollen, red, and hot to the touch. She complained that her leg hurt to walk on. Later in the evening she complained of a headache and no appetite. After getting her to eat a small bit, she continued to complain of stomach ache. Her headache turned severe and she went to bed. Upon climbing into bed she started vomiting and she vomited on two different occasions. She continued to complain/cry about a severe headache, along with intense leg pain, and stomach pain upon which, I (her mother) called the doctors office about the reaction. We were told to try to keep fluids in her and wake her every 2 hours at night to check her for neurological deficits and if any were present to immediately take her to the ER. She did not want to get up out of bed the rest of the evening due to the significant amount of discomfort she was in.

Other Meds: Kids Multivitamin, Vit C, Vit D

Current Illness: None

ID: 1720098
Sex: F
Age: 61
State: MN

Vax Date: 03/12/2021
Onset Date: 09/17/2021
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:

Allergies: simvastatin

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: congestion and today reports chest tightness, starting on 9/17/21

Other Meds: Retin-A cream; Pravachol; Cyclobenzaprine; Trimcinolone; Calcium; Vitamin D; Estradiol; Alendronate; Actonel

Current Illness: none

ID: 1720099
Sex: F
Age: 42
State: NC

Vax Date: 09/21/2021
Onset Date: 09/21/2021
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: NKDA

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

Symptoms: Patient called me over and began feeling light headed and nauseous. We came to the immunization booth where she removed her mask. We took her blood pressure, applied a cold pack to her neck and got some ice water. Timeline below 1:15 pm-nauseous, ice pack applied 1:17 pm-Pt lay head down, BP error 1:20 pm-ice water gotten for pt, able to drink a few sips 1: 23 pm-BP 77/57 1:25 pm BP 80/59 1:27 pm BP 95/66 1:30 pm BP 100/63. Patient states that this is her normal BP. She felt much better and was able to leave the pharmacy on her own. I contacted her later in the day and she was feeling fine.

Other Meds:

Current Illness:

ID: 1720100
Sex: M
Age: 5
State: MN

Vax Date: 08/17/2021
Onset Date: 08/29/2021
Rec V Date: 09/21/2021
Hospital: Y

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: CRP 8.7 Albumin 2.4 ALT 193 AST 88 BNP 539 Elevated cytokines soluble IL2R alpha, IL-6, TNF-alpha, IL-10, IL 18, and IL-8

Allergies: None

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

Symptoms: Incomplete Kawasaki disease with conjunctival injection, erythematous rash, fever. He received IVIG 2 grams/kg once and infliximab mg/kg once. Fever resolved.. On discharge his echocardiogram showed no coronary artery dilation or heart function deficits.

Other Meds: None

Current Illness: ON August 3rd, 2021 he experienced a 24 hour GI illness with vomiting and diarrhea without fever. Others in the family experienced similar symptoms.

ID: 1720101
Sex: F
Age: 64
State: GA

Vax Date: 09/07/2021
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: LA

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Pt said she experienced severe swelling after getting the shot on her arm. Swelling has gone down but still feeling itching. Told her to apply coco butter and rub ice pack.

Other Meds:

Current Illness:

ID: 1720102
Sex: F
Age: 39
State: OR

Vax Date: 08/14/2021
Onset Date: 08/18/2021
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: Potassium transfusion

Allergies: Penicillin

Symptom List: Pharyngeal swelling

Symptoms: Racing heart, heart palpitations, foggy brain, lifeless, chest pain

Other Meds: Armor Thyroid medicine, hydrochloride 25 Mg

Current Illness: None. Same reaction I had when I had Covid back in Jan. Extremely low potassium racing heart, lifeless.

ID: 1720103
Sex: M
Age: 44
State: WA

Vax Date: 08/31/2021
Onset Date: 09/01/2021
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: LA

Lab Data:

Allergies: none

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Fever, chills, muscle spasms ,cramps,nausea, trouble forming thoughts, balance issues, lasting 48 hrs.

Other Meds: none

Current Illness: none

ID: 1720104
Sex: M
Age: 70
State: CO

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: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Sore arm, lump and sore under the injection site.

Other Meds: none

Current Illness: none

ID: 1720105
Sex: F
Age: 29
State: PA

Vax Date: 04/09/2021
Onset Date: 07/30/2021
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: All results can be found with ER and my gynecologist soon at his office.

Allergies: Amoxicillin

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

Symptoms: One day after receiving the vaccine I ended up at ER with a fever, severe migraine, and could barely stand up because I was extremely weak. They treated it with a steroid shot, benadryl, and Zofran. 2 months later I stopped having periods all together. I'm waiting for an appt. with my gynecologist to see what effects it may have caused and how to treat it if we can. Being that I'm 30 and my husband and I were trying for children this has put a hold on everything.

Other Meds: None

Current Illness: None

ID: 1720303
Sex: F
Age: 40
State: MA

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: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Patient states she has gotten permanent nerve damage in her arm from vaccine administration

Other Meds:

Current Illness:

ID: 1720304
Sex: F
Age: 32
State: NC

Vax Date: 09/20/2021
Onset Date: 09/21/2021
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 states had difficulty catching breathing following day and was extremely tired. Has sharp burning pain across 'spine" area. also states has chest pain. Advised to seek medical advised. Called at approx 8:10 pm on 09.21.21

Other Meds: Unknown

Current Illness: Fibromyalgia

ID: 1720305
Sex: F
Age: 50
State: OH

Vax Date: 09/16/2021
Onset Date: 09/16/2021
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: Emergency room visit Monday 9/20/21 Covid test negative Flu A and B negative Blood Cultures pending Urine Culture pending

Allergies: none

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

Symptoms: Received vaccine on Thursday and by evening, fatigue, achy, headaches and fever. Friday was worsening of those symptoms. Continued through Monday when I went to Emergency room with temp 103.9 and headaches.

Other Meds: Vitamin D3 B12 Iron 325mg Dandelion Capsule 450mg Multi Vitamin

Current Illness:

ID: 1720306
Sex: F
Age: 43
State: WA

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data: None

Allergies: Emgality Nickle

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

Symptoms: Immediatly following shot, the injection site hurt and increased in pain. Left arm verry sore. Went to bed around 9pm and woke up at 2am sicker than I have been in years (than when I had COVID Jan of 2020). I suffered debilitating migraine, horrible left arm pain (barely able to move my left arm), feever, ache (all over body), nausia and heartburn (I NEVER get heatburn). Went through the entire next day sick and night sick. I woke up the 2nd morning feeling much better. I had lingering symptoms - left arm pain until morning of September 15th. I had daily heartburn for an entire week (again - I never have heartburn). I am still experiencing boughts of nausia. My migraines have been much worse since the vaccine - I am suffereing from one now. The Botox knocked my migraines down to a couple a week - I'm having them almost every other day since the vacccine.

Other Meds: Botox & Imatrex - both for migraine Advil Sam-E Miralax Fish Oil B-12

Current Illness: Migraine

ID: 1720307
Sex: M
Age: 56
State: SC

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

Lab Data: None

Allergies: None

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

Symptoms: On 09/15/2021 at or about 9:30 am, I felt numbness on the left side of my face. The next day I had difficulty drinking from a cup or bottle. Later on during the day I couldn't blink my left eye. I noticed because my left eye was extremely dry.

Other Meds: None

Current Illness: No illnesses

ID: 1720308
Sex: F
Age: 40
State: GA

Vax Date: 09/21/2021
Onset Date: 09/21/2021
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: NA

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

Symptoms: Given 1st dose on 09/07; second dose due on 09/28. Given 7 days early and 3 days before the 4 day grace period. Patient aware- no adverse event noted at time of administration.

Other Meds: NA

Current Illness: NA

ID: 1720309
Sex: F
Age: 14
State: ME

Vax Date: 09/16/2021
Onset Date: 09/17/2021
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: None at the time. ECG ordered 5 days after 2nd vaccine

Allergies: Penicillin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 16 hours after receiving her second Pfizer vaccine, patient had a syncopal episode while sitting in class. She felt ill immediately before the episode, lost consciousness for a few seconds, and recovered. She had another episode 4 days later where she felt sick again and shaky while standing at work, but she sat down and did not lose consciousness.

Other Meds: None

Current Illness: None

ID: 1720310
Sex: F
Age: 31
State: MA

Vax Date: 05/30/2021
Onset Date: 05/30/2021
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: Labs Drawn: CMP, TSH, CBC, Iron and Folate, B12 MRA of my cervical spine

Allergies: Relpax any Triptan medications

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: I felt incredibly dizzy as soon as I received the vaccine, the pharmacist made me stay for 30 minutes to make sure nothing else would occur. Every single day after that I would wake up incredibly dizzy and fatigued, brain fog, loss of concentration, Its like the vaccine turned me into a total moron, I've had zero brain function for months! I've seen my PCP 3 times over this matter and my neurologist as well, nobody seems to have any sort of remedy for me or for my suffering. This is going on month 4 I have felt like this, I have a very strict diet/lifesyle I follow for my condition and never in my life have I ever had these symptoms in the 4 years I've had multiple sclerosis! I am now a full-time student suffering more than ever because I have no brain function/power. This vaccine has destroyed my quality of life for 4 months, and is now affecting my ability to finish my college degree. **People Need to see that NOT everyone has no side effect from the Covid19 vaccine**

Other Meds: Vitamin E 268mg qd, Fish Oil 1280mg qd, Vitamin C 450mg qd Vitamin B2 100mg qd, Magnesium 200mg qd, Vitamin D3 250mcg (10,000 IU) 1-2 times per week,

Current Illness: None

ID: 1720311
Sex: M
Age: 44
State: LA

Vax Date: 02/19/2021
Onset Date: 08/05/2021
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: Aldolase, CRP, CK were raised

Allergies: none

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

Symptoms: Hands and feet, knee swelled. Neck joint and jaw joint were stiffen. CPK raised to 400 early August and to 1100 a month later. Did chest CT scan and x-ray. The doctor diagnosed the patient to have polymyositis with Interstitial lung disease. The patient started predniSONE 20 MG tablet on September 14, three times a day.

Other Meds: none

Current Illness: none

ID: 1720312
Sex: F
Age: 35
State: NY

Vax Date: 09/05/2021
Onset Date: 09/05/2021
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:

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

Symptoms: Patient was sitting in waiting area after receiving the vaccination. After about 10 mins after receiving the shot, she passed out for a few seconds and slumped gently from the chair onto the floor to lay down. She was given some water and a candy bar as she composed herself on the floor and after a few minutes was able to get up on her own and leave with her boyfriend.

Other Meds:

Current Illness:

ID: 1720313
Sex: F
Age: 27
State: MD

Vax Date: 09/21/2021
Onset Date: 09/21/2021
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: At 9:30p the hearing in my right ear suddenly went away followed by a low pitch ringing. It lasted about 20 seconds then stopped and my hearing returned. It happened again about 10 minutes later followed by a headache.

Other Meds: Zoloft, Vitamin D, ibuprofen

Current Illness: None

ID: 1720314
Sex: F
Age: 34
State: MA

Vax Date: 09/08/2021
Onset Date: 09/21/2021
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: None

Allergies: NKA

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

Symptoms: Bald spot developed on the back of my head. I went to get my hair done and my hairdresser discovered a large bald patch near the back of my hairline, near my right ear.

Other Meds: Zoloft

Current Illness: None

ID: 1720315
Sex: M
Age: 25
State: MN

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: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: PATIENT FELT FAINT AFTER SHOT, SAID IT HURT A LITTLE MORE THAN THE FIRST ONE, AND SAID HE HAD NOT DRANK ANY WATER OR LIQUID. GOT PATIENT SOME WATER AND HE QUICKLY FELT BETTER AND WENT ON HIS WAY.

Other Meds:

Current Illness:

ID: 1720316
Sex: F
Age: 33
State: MN

Vax Date: 04/01/2021
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: SYR
Vax Site: LA

Lab Data:

Allergies: Cefzil; Septra; Erythromycin; bee sting

Symptom List: Injection site pain, Menorrhagia

Symptoms: headache, sinus congestion, sore throat, productive cough, body aches starting on 9/16/21. Seen in clinic on 9/17/21, tested negative for COVID at that time. Seen again on 9/21/21, tested positive for COVID. Husband tested positive on 9/15/21

Other Meds: ProAir; Immodium; Claritan; Ondansetron; Acetaminophen, Citalopram; Lansoprazole

Current Illness: none

ID: 1720317
Sex: F
Age: 23
State: NJ

Vax Date: 09/07/2021
Onset Date: 09/08/2021
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:

Allergies: none

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

Symptoms: heavy bleeding, possible miscarriage

Other Meds: Prenatal vitamins

Current Illness: none

ID: 1720318
Sex: F
Age: 43
State: NJ

Vax Date: 05/19/2021
Onset Date: 06/27/2021
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: None

Allergies: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: I had intense dizziness in the day directly following my 2nd shot. I was not able to walk without stumbling when I initially got out of bed. The dizzy spells for a consistent basis lasted about 24-48 hours. Dizzy spells are intermittent now but more My menstrual cycle became heavier after receiving the vaccine series. Additionally, I acquired PMS symptoms (breast tenderness) that I do not ever recall having in the last 20 years. This has been in the 7 days immediately preceding my period in every month since receiving the vaccine.

Other Meds: None

Current Illness: None

ID: 1720319
Sex: F
Age: 53
State: WA

Vax Date: 05/28/2021
Onset Date: 05/28/2021
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: Diagnostic exam by Dr. at Rehab on August 24, 2021.

Allergies: Allergies (medications); Floxin (ofloxacin): antibiotic (vomiting); Keflex (cephalexin): cephalosporin antibiotic (vomiting); Sulfa: antibiotics (vomiting); Tigan (trimethobenzamide hydrochloride): anti-nausea (fainting); Inderal (propranolol hydrochloride): migraines (severe headache); Vicodin (hydrocodone/paracetamol): pain (nausea/vomiting); Percocet (oxycodone/peracetamol): pain (nausea/vomiting); Tramadol: pain (nausea/vomiting); Valtrex (valacyclovir): shingles (vomiting, severe headache); Medical tape adhesives (rash/blisters); Contrave: appetite suppressant (severe nausea) Allergies (Environmental); English plantain (scratch tested 2012); Russian thistle (scratch tested 2012); Molds (scratch tested 2012); Sensitivities (Foods); Gluten (respiratory/congestion/migraine); Dairy (respiratory/congestion/migraine); Eggs (respiratory/congestion/nausea)

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Arm soreness at injection site within first six hours of injection, unresolved after three months. Rash below injection site (red, itchy, warm) within 48 hours of injection, resolved within one week. Muscular arm pain and decreased mobility onset approximately one week after injection, unresolved after three months with increasing pain and decreasing mobility. Medical attention sought approximately three months after injection; diagnosed with adverse reaction to vaccine by two medical professionals. Currently under treatment to increase mobility and decrease pain (six sessions completed at Rehab), treatment is improving condition, however, it is still unresolved.

Other Meds: Amlodipine, chlorthalidone, metformin, l-tyrosine, grapeseed oil, evening primrose oil, black cohosh, allergy essentials, probiotic, calcium citrate, b-complex, D3, chromium, zinc picolinate, astaxanthin, coQ10, magnesium citrate, r-lipoic

Current Illness: None

ID: 1720320
Sex: F
Age: 62
State: MD

Vax Date: 08/14/2021
Onset Date: 08/27/2021
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: 8/31/21 - had pelvic and transvaginal ultrasound 9/30/21 - schedule for surgery

Allergies: All NSAIDS type medications

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

Symptoms: I received the Pfizer vaccine on 8/14/21. On 8/27/27, I began to bleed from my uterus. I called my gynecologists to report the problem and I was requested to have a pelvic and transvaginal ultrasound that will lead to surgery - hysteroscopy and D&C. Prior to the vaccine I had not had any problems with bleeding. I am a 62-year-old healthy woman and have gone through menopause. I have not bled in over 15 years nor ever experienced abnormal bleeding. Yet, after two weeks after the Pfizer shot, I began to experience bleeding as if I am having a menstrual period. I am not suggesting that the vaccine caused the outcome of ultrasound, however, I strongly believe that some component of the Pfizer vaccine caused a chemical change in my body that triggered the abnormal bleeding.

Other Meds: Lisinopril 40mg daily Amlodipine 10mg daily Women multi vitamins daily fish oil joint/bone supplement memory supplement

Current Illness: None

ID: 1720321
Sex: F
Age: 65
State: MN

Vax Date: 08/18/2021
Onset Date: 08/18/2021
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: PT OBTAINED A 3RD DOSE OF THE MODERNA VACCINE WITHOUT MEETING GUIDELINES THOUGH SHE SAID SHE DID.

Other Meds:

Current Illness:

ID: 1720322
Sex: F
Age: 34
State:

Vax Date: 04/25/2021
Onset Date: 05/16/2021
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: This form does not let me fill out all the accurate information, so I will do so as follows: 1st Dose: PFIZER 4-25-2021 Covid-19; Vaccine Lot# EW0175; Exp: 08-2021; Pfizer 5-16-2021 Covid-19; Vaccine Lot#: EW0186 Exp: 08-31-2021

Allergies:

Symptom List: Injection site pain

Symptoms: It was between 5-7 days after my second dose, the bizarre symptoms began. My taste and smell changed (and no, I did not have Covid-19). It started with onions, then went to garlic, eggs, peanut butter, coffee... this rancid, sweet smell of rotting meat. It is something that's very hard to describe as I have never experienced this smell before in my life. It would keep me awake at night, I could smell it across the room and even different levels of the house, my sense of smell was so enhanced it was absolutely abnormal. The top of my head tingled, as did the back of my neck, and my tongue constantly felt like pop rocks were on my tongue. As this progressed, I had two days where I could hardly get out of bed. My insides, every organ, was just terribly sore and cramped. I had bloodwork done and the technician could hardly take blood because my vein kept collapsing. She also commented I must have been dehydrated because she couldn't understand why my blood was so thick and dark looking. I've had bloodwork taken before, and this was very unusual. I never need OJ or food after giving blood, I bounce back right away, but this time it took me 4 days to feel somewhat human again. It was at this point a friend jokingly said they were testing to see if I was magnetic and I WAS. Not a fridge magnet, but a paperclip. It was in my clavicle and uterus, I could track it. The detox happened through my skin, I got these hard lumps in the back of my neck, skin tags on my stomach, and some other crazy things I'm not even sure how to explain. The toxic aspects of this vaccine does detox through the skin, as people around me who had not been vaccinated, became sick. This needs to be taken seriously. Either the lot I was given was contaminated with graphene, OR the vaccine contains graphene and my body did not have a favorable response.

Other Meds:

Current Illness:

Date Died: 05/15/2021

ID: 1720323
Sex: M
Age: 79
State: CA

Vax Date: 01/19/2021
Onset Date: 01/21/2021
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: I asked 3 drs about the vaccine - They all said "NOT ENOUGH DATA" including the Infections Disease Doctors.

Allergies: anaphylaxis , aburetrol

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

Symptoms: After 1st dosage: Complaints of breathing problems, lite chest pains, tiredness, dizzy and headaches. (Vitals ok) After 2nd dosage: Worsen, breathing problems worsen, vitals change dramatical, Oxy levels, blood Pressure, heart went into AFIB. 3 ER "Chest Compression" to stabilize. Body swollen, feet, hands and legs In March, Same challenges, -- A chest scan was done, Lung cancer came back, Heart still acting up. diabetes fluctuated, swollen lymph nodes, etc. loose stools, tired, dizzy, - Still suffering for oxygen. March/April ? In Intensive care: stabilized introduced chemo to shrink the cancer. Blood transfusions, monitoring afib, vitals, he needed constant respiratory therapy to continue to breathe. | Note: Dec 2020 he was in remission of the lung cancer. All his medications were the same. The only new toxin that was introduced to his system was the Moderna Vaccines. One on January 19th, 2021 and 2nd Feb 19,th 2021. If you need all his medical records - Please let me know. My father was a strong man, even with his alignments he was strong a fighter. If he didn't take the vaccines, we could have had more time with my dad. The vaccine is dangerous and should be noted. Please confirm receipt of my submission. 3 EMT Emergencies - 3 Heart Compression Shocks.

Other Meds: atorvastatia,Plavix, hydrodiuril, junuvia, cozaar, glucopagne,

Current Illness: Remission of Lung Cancer (Dec 2020), Diabetic, artery disease,

ID: 1720324
Sex: M
Age: 59
State: PA

Vax Date: 05/06/2021
Onset Date: 05/01/2021
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: Blood Work, B-12 Level, Lyme's Disease, CBC, CMP. For his legs : A doppler was completed. He just had a spinal MRI. Dr at the Clinic stated : The patient had an EMG of both the upper and lower extremities and the neurologist stated that he has CIDP. Chronic Inflammatory Demylienation Polyneuropathy which is closely R/T GBS which is associated with this disease.

Allergies: None

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

Symptoms: One week after the vaccine he started coughing up specks of blood. He went to his PCP who wanted him to have a bronchoscope but it was a 2 month wait since everything is so backed up. Two weeks after the vaccine, numbness and tingling began in the hands and then began to travel to his legs and bilateral lower extremities. As the neuropathy got worse in his extremities, he began to feel like his legs were just giving out from under him and he began falling. States his calves lose the ability to support himself and he has caught himself from actually falling however there are 3 times he did not catch himself.

Other Meds: MVI, Fish Oils, Co-Q10, Red Yeast Rice, Baby ASA

Current Illness: None

ID: 1720325
Sex: F
Age: 47
State: TX

Vax Date: 08/31/2021
Onset Date: 09/02/2021
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: NKA

Symptom List: Tremor

Symptoms: Severe menstrual bleeding over a 10 day period. Had been in menopause and not had a period for 18 months prior to receiving first dose of vaccine.

Other Meds: None

Current Illness: None

ID: 1720326
Sex: F
Age: 76
State: MO

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

Lab Data: unknown

Allergies: unknown

Symptom List: Erythema, Pruritus

Symptoms: Patient reports rash, swelling of my mouth, headache, rapid heart beat and fluttering heart rate and pounding headache

Other Meds: raloxifene, levothyroxine, estradiol

Current Illness: unknown

ID: 1720327
Sex: M
Age: 40
State: ID

Vax Date: 09/20/2021
Onset Date: 09/20/2021
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 wanted only a Covid shot, but received a flu shot. Patient was then given Covid shot - patient said they are feeling okay today, only minor headache.

Other Meds:

Current Illness:

ID: 1720328
Sex: M
Age: 24
State: CA

Vax Date: 08/31/2021
Onset Date: 09/01/2021
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: Covid 19 test -9/15/2021 Blood testing pending imaging pending

Allergies: Eggs and Dairy

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

Symptoms: Fatigue, Nausea, Dizziness/Vertigo, Floaters in eyes, Muscle pain from arm that was injected goes to upper neck and middle back by right shoulder blade feels like burning sensation, ringing in the ears.

Other Meds: None

Current Illness: None

ID: 1720329
Sex: F
Age: 12
State: OK

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

Allergies: NONE

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: PATIENT HAS A KNOWN HISTORY OF FAINTING WHEN GETTING BLOOD DRAWN; HOWEVER, PT (MINOR) FILLED OUT THE QUESTIONAIRE WITH ALL NO'S AND MOTHER SIGNED THE FORM. IT WAS NOT BROUGHT TO PHARMACIST ATTENTION THAT MINOR HAD A HISTORY OF FAINTING UNTIL AFTER THE MINOR WAS ON THE FLOOR. 911 WAS CALLED AND SHE WAS EVALUATED; HOWEVER, DECLINED MEDICAL TREATMENT. PT WAS CALLED THE NEXT DAY 9/19/21 AND WAS DOING GOOD.

Other Meds: NO

Current Illness: NONE

ID: 1720331
Sex: F
Age: 31
State: CA

Vax Date: 08/13/2021
Onset Date: 08/16/2021
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:

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

Symptoms: No period the month on August and heavier than usual period in September

Other Meds: Lexapro, Trazadone

Current Illness:

ID: 1720332
Sex: F
Age: 69
State:

Vax Date: 09/21/2021
Onset Date: 09/21/2021
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: Throat swelling and dysphagia.

Other Meds:

Current Illness:

ID: 1720333
Sex: F
Age: 49
State: FL

Vax Date: 08/08/2021
Onset Date: 08/17/2021
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: Compazine

Symptom List: Pain in extremity

Symptoms: COVID arm starting day 11: swelling, redness, localized fever at injection site Menstrual cycle change: missing/erratic cycles since first shot

Other Meds: Zoloft 150 mg daily, ibuprofen 600mg daily,100mg zinc daily

Current Illness: None

ID: 1720334
Sex: F
Age:
State: KY

Vax Date: 08/17/2021
Onset Date: 08/26/2021
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:

Allergies:

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

Symptoms: Swollen and painful armpit

Other Meds:

Current Illness:

ID: 1720336
Sex: F
Age: 71
State: AL

Vax Date: 06/02/2021
Onset Date: 07/07/2021
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: None

Allergies: None

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

Symptoms: Vertigo for three weeks. Several falls in house due to vertigo . Unable to drive a car for two weeks. Treated by performing Epley maneuvers. Gradual improvement over one month's time.

Other Meds: Premarin

Current Illness: None

ID: 1720337
Sex: F
Age: 54
State: CA

Vax Date: 09/18/2021
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: N/A

Allergies: NKA

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

Symptoms: 9/18 HEADACHE, LIGHT MENSTRUAL BLEEDING 9/19 HEAVY HEADACHE PARACETAMOL 1 GRAM + IBUPROFEN 200 MG, LIGHT TO MODERATE MENSTRUAL BLEEDING 9/20 MODERATE TO HEAVY MENSTRUAL BLEEDING 9/21 HEAVY MENSTRUAL BLEEDING

Other Meds: LOSARTAN 50 MG OD, SIMVASTATIN 20 MG OD, ELDERBERRY 2000 MG OD, ZINC 35 MG OD, CALCIUM 500 MG OD, VITAMIN D 50,OOO UNIT EVERY WEEK.

Current Illness: NONE

ID: 1720338
Sex: F
Age: 28
State: NC

Vax Date: 09/21/2021
Onset Date: 09/21/2021
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:

Allergies:

Symptom List: Vomiting

Symptoms: maybe 5-10 minutes after the 2 shots, patient was sitting in waiting area for her wait time after shot administration. Technician notified me that the person was not feeling well.. I went out to check on her and she was sweating pefusley..(sweat beads on her forehead) and she said, she felt like she was going to pass out.. so I talked with her to calm her down, because she was very nervous before receiving the shots anyways.. I explained to her that I might need to give her an Epi shot and she said she was beginning to feel better.. I gave her some water and after drinking some water she said she was feeling normal again and I asked if someone could drive her home instead of driving herself and she said she was talking with her sister and she was calming her down as well. I insisted she stay for 30 more minutes to make sure she was still ok.. I checked on her multiple times and had the tech near her..keep an eye on her and while i was giving other shots I had the manager in training of the store stay with her.. she was doing just fine and she wanted to drive home and I told her to stay another 10 minutes, which she agreed to and said she is completely fine and apologized to me for causing this and was very appreciative for our help

Other Meds:

Current Illness:

Date Died: 04/24/2021

ID: 1720339
Sex: M
Age: 65
State: MA

Vax Date: 03/01/2021
Onset Date: 03/01/2021
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: myocarditis ... died April 24th 2021 - one month after 2nd dose.

Other Meds: none

Current Illness: none

ID: 1720341
Sex: M
Age: 31
State: MN

Vax Date: 09/20/2021
Onset Date: 09/21/2021
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: High fever of 103, diffuse body aches, cough, nausea, light headedness, headaches

Other Meds:

Current Illness:

ID: 1720342
Sex: M
Age: 55
State: MN

Vax Date: 07/22/2021
Onset Date: 07/22/2021
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: N/A

Allergies: Penicillin

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Tinnitus remains in both ears

Other Meds: None

Current Illness: None

ID: 1720343
Sex: F
Age: 29
State:

Vax Date: 09/15/2021
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:

Allergies: None known

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

Symptoms: Patient received second dose of Pfizer on Wednesday 9/15/2021. She noticed some swelling by her collarbone the next day and stiffness in her arm when trying to raise it. She did experience body aches and fatigue from the vaccine as well. Around Sunday, 9/19/2021, she noticed the redness and swelling migrated from her collarbone to her neck/shoulder area. She has not taken anything yet, but states it has not gotten any better. The pain and swelling continues to be localized to this area and was palpated by pharmacist on duty today on 9/21/2021. It was noted not to be any warmer than the rest of that area, but was noticeably swollen, traveling along the lymphatic system in that area. It was recommended to try taking ibuprofen to help with the swelling and pain, but if it does not get any better or worsens to seek medical attention at an urgent care or emergency room.

Other Meds: N/A

Current Illness:

ID: 1720520
Sex: F
Age: 49
State: WA

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: 037K20A
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data: None

Allergies: Codeine, morphine, gabapentin

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

Symptoms: Fatigue, feel feverish but no fever, skin rash and marks on right lower leg (resolved after a few hours- happened2 days in a row). Headache, arm pain at vaccine site. High heart rate over 100 at rest a couple times a day. High blood pressure.

Other Meds: Bariatric multivitamin, calcium, magnesium, Tylenol, lamisil

Current Illness: None

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am