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: 1757442
Sex: F
Age: 42
State: OK

Vax Date: 07/12/2021
Onset Date: 07/21/2021
Rec V Date: 10/03/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Break out in spotty rash on my arms and neck.

Other Meds: Cymbalta, zyrtec

Current Illness:

ID: 1757443
Sex: F
Age: 53
State: GA

Vax Date: 10/01/2021
Onset Date: 10/02/2021
Rec V Date: 10/03/2021
Hospital:

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

Lab Data: none known

Allergies: erythromycin, tetracycline, zantac

Symptom List: Anxiety, Dyspnoea

Symptoms: approx 16 hours after dose, developed fever of 103, aches, joint pain, general malaise, extreme nausea/vomiting requiring rx for ondansetron. symptoms resolved 24-48 hours later.

Other Meds: none

Current Illness: unspecified respiratory infection

ID: 1757444
Sex: F
Age: 22
State:

Vax Date: 09/27/2021
Onset Date: 09/28/2021
Rec V Date: 10/03/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: pt reported to pharmacy after 1 week with bruising at site of injection, bruising size of a half dollar.

Other Meds:

Current Illness:

ID: 1757445
Sex: F
Age: 66
State: PA

Vax Date: 04/23/2021
Onset Date: 05/23/2021
Rec V Date: 10/03/2021
Hospital:

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

Lab Data: Primary Doctor's Appointment- May 28 Blood Work - May 29 Neurologist Apopointment - May 31 Blood Work - June 1 Carotid Artery Ultrasound and Transthoracic Echocardiogram - June 8

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Speech was off, brain fog, extreme yawning, slurred speech. Multiple doctor's visits confirm stroke. Speech came back but post stroke now additionallly taking taking crestor and low dose aspirin, had a psoriasis large patch on inner lower thigh, swollen ankles and feet and foot pain, heart tests from when she had the stroke looked ok.

Other Meds: amlopodamene and bisoprolol

Current Illness:

ID: 1757446
Sex: M
Age: 47
State: CA

Vax Date: 06/25/2021
Onset Date: 07/09/2021
Rec V Date: 10/03/2021
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: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: GUM SWELLING & SERIOUS PAIN, TWO UPPER MOLAR TEETH EXTRACTION ON MID-JULY IN A DENTIST

Other Meds:

Current Illness:

ID: 1757447
Sex: M
Age: 53
State: AR

Vax Date: 10/03/2021
Onset Date: 10/03/2021
Rec V Date: 10/03/2021
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: unknown

Allergies: no

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

Symptoms: pt passed out after receiving 2nd covid vaccine. had convulsions, urinated on floor. had to use ammonia to revive pt.. then shortly after pt started convulsing again . paramedics where called and pt left pharmacy on stretcher

Other Meds: unknown

Current Illness: unknown, pt consent form listed none

ID: 1757448
Sex: M
Age: 58
State: ID

Vax Date: 05/07/2021
Onset Date: 06/05/2021
Rec V Date: 10/03/2021
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: Listed in item 18

Allergies: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: June 14th: Treated for fatigue In ER by MD. Labs completed:C-Reactive Protein CBC CK Comprehensive Metabolic Panel Troponin I Urinalysis (Macro w/Microscopic if Indicated) Urine Microscopic. Labs in process:COVID-19 Symptomatic Priority 2: Result will change management in the next 1-2 days Gray Tube Serum Separator Tube Urine Container June 15th: Visit with primary provider NP at 6/15/2021 10:45 AM Chief Complaint: ED Follow-up and Fatigue (overall feeling unwell since Friday) 1. Distal muscle weakness He has diffuse distal muscle weakness of bilateral upper and lower extremities on exam. Upper muscle strength is equal and strong. Mild bilateral patellar hyperreflexia. Unclear etiology at this point. Concern is for motor/neuron cause. Labs were normal. CK is normal. Guillain Barre? He has good DTR. He does not have any neck pain or nuchal rigidity. Inflammatory markers are normal to think infectious process. We'll get an MG panel, repeat inflammatory markers, CK, aldolase levels today. Check chest x-ray. Consider MRI of the spine looking for cord compression? Consider lumbar puncture. Addendum 6/16/21: Dr. talked to Dr.. Per neurology's recommendation, stat MRI of the cervical, thoracic and lumbar spine to evaluate for cord compression or MS plaques. Stat Lumbar Puncture looking for protein. Concern for Guillain Barre, despite normal reflexes. No orders of the defined types were placed in this encounter. History ofPresent Illness: Patient is a 58 y.o. male who presents today with a chief complaint of ED Follow-up and Fatigue (overall feeling unwell since Friday) He has not felt well for 2 weeks. He initially started with body aches and fatigue. He was having some chills. The next day, he went to work, and his boss sent him home because he did not look good. He spent the next few days resting. He had diarrhea during this time and fever of 102. He improved. He went back to work for 2 days then started feeling some cramps in his left leg. The next day he wanted to play basketball. His muscles gave out. He just did not have the strength to keep playing. His legs were giving out. He felt like he couldn't run. He didn't push himself too much. The next day he had a hard time getting out of bed to mow the yard, but couldn't. He woke up Saturday (3 days ago) and had no strength. He can't put socks on because he is too weak. His muscles aren't working well. He denies any shortness of breath, chest pain, or cough. He has not had any recurrent abdominal pain, nausea, vomiting, or fevers. His ONLY symptom now is muscle weakness and fatigue. Nobody else is sick. June 16th: NP at 6/16/2021 9:30 AM Ambulatory Visit In an effort to avoid potential COVID-19 exposure in this patient, this visit occurred by telehealth. Verbal informed consent was obtained from patient, parent or guardian to proceed with telehealth service. Patient identification completed: Yes Mode of Communication: Telephone Application Used: Phone Patient Location: Home Residence Provider Location: Clinic Subjective: HPI: Patient is a 58 y.o. male patient with chief complaint of Extremity Weakness One day follow up on distal muscle weakness. Labs were reviewed. The patient is feeling worse. His legs are weaker. His ability to walk is affected. Denies respiratory symptoms. Discussed with neuro. Concern for Guillan-Barre. Given his worsening weakness, an in-patient admission is recommended. June 16th-21st- Hospitalized: 6/21/2021 12:06 PM Discharge Summary 6/21/2021 8:45 AM Progress Notes 6/21/2021 8:19 AM Progress Notes 6/20/2021 5:12 PM Progress Notes 6/19/2021 2:51 PM Progress Notes 6/19/2021 12:15 PM Progress Notes 6/18/2021 1:52 PM Progress Notes 6/18/2021 3:56 PM Progress Notes 6/18/2021 3:33 PM Progress Notes 6/17/2021 5:56 PM Progress Notes addendum by Speech and Language Pathologist 6/17/2021 4:11 PM Progress Notes 6/17/2021 3:51 PM Progress Notes 6/17/2021 2:39 PM Progress Notes 6/17/2021 12:27 PM Progress Notes 6/17/2021 11:49 AM Progress Notes 6/16/2021 6:53 PM H&P 6/16/2021 4:40 PM Progress Notes signed by Speech and Language Pathologist

Other Meds: Omprezole, Lisinopril

Current Illness: None

ID: 1757449
Sex: M
Age: 17
State: DE

Vax Date: 10/03/2021
Onset Date: 10/03/2021
Rec V Date: 10/03/2021
Hospital:

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

Lab Data:

Allergies: No

Symptom List: Pharyngeal swelling

Symptoms: Patient states they "blacked out" soon after vaccination. Patient was unresponsive for approximately 3 minutes. Patient also states they felt "Dizzy" soon after vaccination.

Other Meds: No

Current Illness: No

ID: 1757450
Sex: F
Age: 43
State: NJ

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 10/03/2021
Hospital:

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

Lab Data: N/A.

Allergies: Penicillin

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: I immediately got itchy throat and itching under skin, then chest tightness started. That same night 9/29/21 I had a 101 fever. On 10/1/21, I had a severe headache, flu like symptoms and my hands and feet went numb. As of today 10/3/21, I still have the numbness in my hands and feet.

Other Meds: None

Current Illness: n/a

ID: 1757451
Sex: M
Age: 66
State: FL

Vax Date: 02/08/2021
Onset Date: 04/17/2021
Rec V Date: 10/03/2021
Hospital:

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

Lab Data: Neck biopsy = urticaria

Allergies: None

Symptom List: Diarrhoea, Nasal congestion

Symptoms: 4-17 Fever with flu for 24 hrs., 5-12 Fever with flu for 24 hrs., 6-7 Fever with flu for 24 hrs., 7-20 Fever with flu for 24 hrs. 7-30 burning and itching of lips, itching gradually spread to face, neck and chest. Per MD discontinued Celecoxib and Lisinopril. Itch continued to intensify and referred to dermatology. Biopsy taken on neck. Several topicals prescribed to affected areas. Diagnosed as seborrheic dermatitis. Some improvement with treatment but itch continues. Late August noted lot of dry secretions in upper nasal passages as well as some dried blood.In last month nasal passages occluding requiring ENT intervention. Superficial blood clot left lleg.

Other Meds: Lisinopril/HCTZ, Omeperazole, ASA 81 mg, Metforman, Resuvostatin

Current Illness: None

ID: 1757452
Sex: F
Age: 50
State: GA

Vax Date: 03/13/2021
Onset Date: 04/26/2021
Rec V Date: 10/03/2021
Hospital: Y

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

Lab Data: Full Cancer screening tests. Blood tests . CT scans. Pet Scans MRI scans.

Allergies: none

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

Symptoms: Approximately 2 weeks after receiving the second shot, a 4 cm tumor developed under the right arm pit near the breast . Contacted Doctors and was told this was a normal reaction to the vaccine. 4 weeks later demanded Dr. run tests. Was determined the tumor was cancerous and metastatic. After numerous tests the cancer origin was unknown and treatment for triple negative breast cancer or occult breast cancer was began. Due to having Hashimotos disease numerous CT and MRI scans were run prior to receiving the Moderna Vaccination . All were negative. After receiving the vaccination the tumor develops with unknown origins. The belief and circumstantial evidence point the the cancer being caused by this vaccine.

Other Meds: none

Current Illness: Hashimotos disease

ID: 1757453
Sex: F
Age: 45
State: NM

Vax Date: 05/21/2021
Onset Date: 05/22/2021
Rec V Date: 10/03/2021
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: I got my period the day after the vaccine on May 22nd. I wasn't due to get it for another week. Then my period has come two more times starting on these dates: July 25 & Sept. 6. As you can see it's been extremely irregular. Before the vaccine I was extremely regular, every 28 days. I believe the vaccine really put a shock on my system. I hope it's regulating itself back to normal. I'll see if the next one comes when it should on Oct. 6th.

Other Meds:

Current Illness:

ID: 1757454
Sex: F
Age: 67
State: MN

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 10/03/2021
Hospital:

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

Lab Data: Mri April 27 showed stroke parietal region mri aug 18/2021 stroke healed

Allergies: sulfa pcn

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

Symptoms: After the 2nd dose of the Moderna vaccine, that evening I had a bad headache, felt like my head was getting squeezed I was also very tired and had no energy, this went on for a couple weeks, then contacted my Dr. was ordered, which showed a small stroke, from there I went to see a neurology Dr. on which I had a cardiac workup consisting of TEE, carotid ultrasound, 48 hour holter moniter , and limited exam by the neurologist. A repeat mri on august 18/2021 showed the stroke had healed

Other Meds: amlodipine,aspirin,atorvastin,vit d3,losartin,mesalamine,

Current Illness: none

ID: 1757455
Sex: F
Age: 50
State: CA

Vax Date: 09/18/2021
Onset Date: 09/27/2021
Rec V Date: 10/03/2021
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: I visited an ENT doctor 2 months before I was considering getting vaccinated. They checked my ears which were clean and tested my hearing which is better than average but said there was no help for tinnitus. Nothing they could do for me.

Allergies: None

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

Symptoms: I'm a lifelong tinnitus sufferer. I have managed living with the sounds 24/7 in both ears. The volume has definitely increased after the 2nd dose. I noticed no volume change after the 1st dose. Second dose received 9/18 with noticeable volume and pitch increase since 9/27 and remains consistently louder than my usual volume. It is noticeable and life-altering, especially in moments of silence. I had heard this was a possibility to happen with the vaccine but I felt forced to get it. Kind of regretting it now.

Other Meds: No prescriptions. Supplements are pro-biotic daily, every other day is Krill Oil, Spirulina and Green Superfood.

Current Illness: None

ID: 1757456
Sex: F
Age: 54
State: NV

Vax Date: 08/26/2021
Onset Date: 08/26/2021
Rec V Date: 10/03/2021
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: Sulfa, Pen, food allergies

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

Symptoms: Starting 20 minutes after the 1st dose. Intense headache in the back of my head, dizzy/fuzzy feeling, tired, swollen face, swollen lymph glands in both the front and back of my neck and underarm areas. Pounding heart that was felt all over my body so bad that it was throbbing from head to toe. Severe joint pain all over my body/every joint, even my fingers and toes. Chest pain like my heart hurt. I did not have a fever from the vaccine, but I felt a heat in my body for several days. My worry is that if the first dose did this and I still have the heart, vascular, lymph and joint issues, then it may not be a good idea for me to get the 2nd shot for fear of making my symptoms worse or prolonged.

Other Meds: Multi vitamin and vitamin C

Current Illness:

ID: 1757457
Sex: M
Age: 12
State: KY

Vax Date: 10/03/2021
Onset Date: 10/03/2021
Rec V Date: 10/03/2021
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: NKDA

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

Symptoms: I was talking to the patient about giving the COVID vaccine and asked him if he wanted to watch or look away. Patient reports he wanted to look away during the administration of vaccine. Patient reports he would like the vaccine in the left arm. The moment the needle when in to the left deltoid the patient pulled away, and I was unable to administer the vaccine injection at that time. Discussed with father if he wanted to try again on the right arm and father with patient agreed to try again. Needle was switched out and syringe was re-primed. Went to administer the covid vaccine in the right deltoid, as I was administering the vaccine the patient pulled away for the second time, some of the vaccine was squirting out of the syringe as patient pulled away. Patient may have gotten roughly 0.1 ml of the COVID vaccine. Patient and father did not want to try for a third attempt today. Will follow up with pfizer to see if he needs an additional dose. Bandages applied to both needle site injections. Patient well but tearful as father reports that he usually doesn't a really good job with vaccines and is unsure as to why he pulled away today.

Other Meds: unknown

Current Illness: none

ID: 1757458
Sex: M
Age: 51
State: NC

Vax Date: 07/02/2021
Onset Date: 07/12/2021
Rec V Date: 10/03/2021
Hospital: Y

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

Lab Data: Eye exam at eye doctor, on July 13, 2021. Vitrectomy with scleral buckle on July 19, 2021.

Allergies: None

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

Symptoms: On July 12 began seeing starbursts in vision. This progressed to distorted colors. Eventually Went to eye doctor on July 13 2021 and was diagnosed with a detaching retina. Had surgery to repair on July 19, 2021.

Other Meds: Flonase, Rosuvastatin, Loratadine

Current Illness: None

ID: 1757459
Sex: F
Age: 39
State: TX

Vax Date: 09/25/2021
Onset Date: 09/27/2021
Rec V Date: 10/03/2021
Hospital:

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

Lab Data: None

Allergies: None known

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Multiple tender, swollen lymph nodes in left axilla initially, later moving also into left supraclavicular and left cervical lymph nodes. Started about 36 hours after vaccine administered and ended by 5-6 days after vaccine administered.

Other Meds: Jaimiess birth control pills, multivitamin, fish oil, Coenzyme Q10, Vitamin D

Current Illness: None

ID: 1757460
Sex: F
Age: 27
State: CO

Vax Date: 09/29/2021
Onset Date: 09/30/2021
Rec V Date: 10/03/2021
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: Next day: Fever Chills Dizziness Nausea Vomiting Body aches Drowsiness 2 days after: Congestion Phlem Coughing Sneezing Loss of appetite 3 days after: Loss of smell Tightness in chest Increased heart rate

Other Meds: Daily multivitamin w/ iron (whole foods brand)

Current Illness: None

ID: 1757461
Sex: F
Age: 69
State: SC

Vax Date: 09/08/2021
Onset Date: 09/08/2021
Rec V Date: 10/03/2021
Hospital: Y

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

Lab Data: Blood, urine, and Covid (both PCR and slower test)

Allergies: gluten, penicillen, NSAIDS, pineapple, lactose

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

Symptoms: Severe chills/rigors, fevers up to 102.8, extreme weakness during the night. Unable to stand or walk the next day. via ambulance to ER on afternoon of 9/9/2021. Four days in hospital.

Other Meds: levothyroxin 150 mg

Current Illness: None

ID: 1757462
Sex: M
Age: 23
State: CA

Vax Date: 10/03/2021
Onset Date: 10/03/2021
Rec V Date: 10/03/2021
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: None

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

Symptoms: About 5 minutes after pt got his 1st Moderna shot, he lost consciousness and got a seizure. He turned red and both his arms stiffened up, one of his hands curled and he almost slipped out of his chair; when he regained consciousness about 1 - 2 minutes later he didn't remember what had happened. Gave the patient some water and also called an ambulance for him to check up just in case, kept him seated in the pharmacy waiting area.

Other Meds: Not that I'm aware of, nothing on patient profile and he just moved into town.

Current Illness: None that I am aware of.

ID: 1757463
Sex: F
Age: 60
State: IN

Vax Date: 10/01/2021
Onset Date: 10/03/2021
Rec V Date: 10/03/2021
Hospital:

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

Lab Data:

Allergies: Inderal Contrast dye

Symptom List: Unevaluable event

Symptoms: Hives on neck and chest. It is 6:10 pm, and the hives have not gone away.

Other Meds: None

Current Illness: COVID-19

ID: 1757464
Sex: F
Age: 34
State: NC

Vax Date: 10/02/2021
Onset Date: 10/02/2021
Rec V Date: 10/03/2021
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 as of yet

Allergies: none reported

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

Symptoms: patient called to report she had chest pain on left side about 4:30pm on 10/2/21 after receiving the vaccine at 11:32am, and on 10/3/21 she woke in the morning with red swollen cheeks

Other Meds:

Current Illness:

ID: 1757465
Sex: F
Age: 30
State: WI

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 10/03/2021
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: sulfa

Symptom List: Injection site pain, Pain

Symptoms: Same night of vaccination (9/30) I had fever, chills, heart pounding, muscle aches, joints aching, extreme fatigue. Next day (10/1) I had muscle aches, joints aching, extreme fatigue, heart pounding, feeling of depression and anxiety. I also had very vivid nightmares that woke me up at night. Day after that (10/2) I woke up with several pimples (I haven't had acne since I was a teenager). This acne won't go away and is getting worse each day. I also had severe depression and anxiety and my heart was skipping a beat. I had severe fatigue again. Today 10/3 my acne has gotten worse, I feel like my menstrual cycle was affected and I have severe depression and anxiety and my heart is still skipping a beat.

Other Meds: bupropion

Current Illness:

ID: 1757466
Sex: M
Age: 25
State: MO

Vax Date: 09/20/2021
Onset Date: 09/21/2021
Rec V Date: 10/03/2021
Hospital:

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

Lab Data: none

Allergies: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Approximately 18 hours after the second shot. Pain in left arm was low. motor functions with left arm were good. This was interrupted with an abrupt high fever and numbness in torso and both arms (for about 45-60 minutes). Rapid shallow breathing (for about 15 minutes) Treatment: Ice pack and time. This was a single occurrence.

Other Meds: None

Current Illness: None

ID: 1757467
Sex: F
Age: 18
State: TX

Vax Date: 09/03/2021
Onset Date: 09/04/2021
Rec V Date: 10/03/2021
Hospital:

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

Lab Data: 9-31-2021 covid test-negative 9-08-2021 covid test-negative 9-10-2021 covid test-negative 9-13-2021covid test-negative 9-17-2021 covid test-negative 9-20-2021 covid test-negative 9-27-2021 covid test-negative

Allergies: Penicillin

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

Symptoms: I woke up on 9/2 and was congested so on 9/5 I decided to go get an iv at an iv bar just to help get me over what I was thinking was a cold or allergies. Then on 9/5 I went and got my first dose of the covid vaccine and on 9/6 I woke up with no smell and no taste at all. For the next week I was congested, it was hard to breathe and I was very fatigue. I did get covid tested since I lost my taste and smell and I was negative on all 4 of them in the next 12 days. Now, it is time for my second dose and I still have no smell or taste at all so the doctors don't know if I should or should not get my second dose.

Other Meds: Vitamin D-3, sambucocl, Xyzal

Current Illness:

ID: 1757468
Sex: F
Age: 41
State: MI

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/03/2021
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: n/a

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient received Moderna as her first two vaccines and got the Pfizer booster as her third vaccine. Patient did not have any adverse reactions to the booster and was told to contact us if she started experiencing any side effects.

Other Meds: n/a

Current Illness: n/a

ID: 1757469
Sex: M
Age: 12
State: GA

Vax Date: 08/13/2021
Onset Date: 08/13/2021
Rec V Date: 10/03/2021
Hospital:

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

Lab Data: There were no adverse reactions. No medication was administered.

Allergies: Amoxicillin

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: When my son was receiving his ?first? vaccination, the plunger was not pressed, and no medication was administered.

Other Meds: None

Current Illness: None

ID: 1757470
Sex: F
Age: 38
State: OH

Vax Date: 08/19/2021
Onset Date: 09/06/2021
Rec V Date: 10/03/2021
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: Retinal eye exam- normal ferritin blood test- low "dangerously low" at 9 acupuncturist muscle testing that showed low immune function and low blood function

Allergies: Predisone, Gluten/Wheat, Lentils, Garlic, Broccoli, most chemicals

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

Symptoms: 18 days after the first dose, I had a flurry of eye floaters, light sensitivity, headache and dry eye that made it difficult to work. My eye doctor said my eyes and retinas were normal and had no explanation for my symptoms. These symptoms continued until a few days ago, when I had acupuncture, which remedied most of the issues. The acupuncturists said the vaccine destroyed my immune and blood system, which was confirmed with a blood test which showed my ferritin levels at 9, which are considered "dangerously low". I've never had any issues with my eyes or iron levels prior to the vaccine, and now I have to live with some remaining eye floaters. After the second dose, I had immense fatigue that made me miss work for almost 4 weeks, along with continued eye floaters and eye problems.

Other Meds: Armour Thyroid, Adderall XR

Current Illness: none

ID: 1757471
Sex: F
Age: 58
State: IA

Vax Date: 09/23/2021
Onset Date: 09/25/2021
Rec V Date: 10/03/2021
Hospital:

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

Lab Data: None

Allergies: No known allergies

Symptom List: Nausea

Symptoms: I had the regular standard temperature for a couple of days but then my left arm started hurting and noticed it was raised red sore and feverish. Went to ER to have it looked at and it was cellulitis. Was put on Keflex four Per day for seven days

Other Meds: Amlodipine, vitamin D3, B12, potassium, metoprolol, Venlafaxine, Metformin, Triamterene/Hydrochlorothiazide, paroxetine, Atorvastatin, Multivitamin, fish oil, vitamin C, Hair skin and nails, calcium with magnesium and zinc Had taken Flu sh

Current Illness: None

ID: 1757472
Sex: M
Age: 60
State: MA

Vax Date: 04/21/2021
Onset Date: 04/22/2021
Rec V Date: 10/03/2021
Hospital: Y

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

Lab Data: 3/28/21 - Chest X-Ray - Diagnosis Pneumonia 4/1/21 -CT Scan 4/29/21 - CT Scan - Blood Clots - Put on Heparin drip in ICU ( Admitted to ICU) 8/11/21 - CT Scan - Blood clots cleared - Diagnosed with Moderate Emphysema. (COPD) 9/1/21 - Positive COVID Antibodies

Allergies: None

Symptom List: Injection site pain

Symptoms: I was sick most of March and was diagnosed with pneumonia on the 29th of March via an X-ray and CT scan at hospital. I tested negative for Covid and was put on an antibiotic. I was feeling OK when Dr (Primary Care Physician) said it was OK to get vaccinated. I was vaccinated with my first Pfizer vaccine on April 21st. After a week I could not breath and went to Emergency Room on April 29th. I was admitted to the ICU on the 29th and transferred to hospital as there were no beds in other hospital. I stayed 5 nights in ICU and was discharged from the hospital on the 6th of May. I had a significant amount of blood clots in my lungs and was put on Heparin in the hospital and was sent home on Eliquis. I am still taking the Eliquis. The clots were gone with a had my third CT scan on the 11 of August. I was then diagnosed with emphysema, and this is the reason I am seeing a pulmonologist. I was tested 6 or 7 times for Covid, but all were negative. I had an antibody test in September and was above 20

Other Meds: Ventolin HFA 180, Atorastatin 20mg, Metoprolol Succinate 20mg

Current Illness: Pneumonia diagnosed on March 28, 2012

ID: 1757473
Sex: F
Age: 74
State: FL

Vax Date: 09/30/2021
Onset Date: 10/01/2021
Rec V Date: 10/03/2021
Hospital:

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

Lab Data:

Allergies: NONE

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

Symptoms: THE NEXT DAY POST ADMINISTRATION PATIENT FELT THE ARM WAS VERY SORE TO THE PAIN SHE HAD TO TAKE A LOT OF TYLENOL. SHE WAS ALSO TIRED AND HAD LOW GRADE FEVER. AS OF 10/03/21 SHE SAID SHE ALSO HAD REDNESS AROUND THE INJECTION SITE.

Other Meds:

Current Illness:

ID: 1757474
Sex: M
Age: 30
State:

Vax Date: 10/03/2021
Onset Date: 10/03/2021
Rec V Date: 10/03/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: After receiving initial dose of Pfizer vaccine, patient reported feeling faint. Denied any other symptoms. Patient laid in supine position. Ice packs applied. Water and snacks provided. Vital signs stable. Patient monitored for a total of 35 minutes. Patient reported having no symptoms upon leaving.

Other Meds:

Current Illness:

ID: 1757475
Sex: F
Age: 14
State: KS

Vax Date: 10/03/2021
Onset Date: 10/03/2021
Rec V Date: 10/03/2021
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: Tremor

Symptoms: 2:56pm felt dizzy/was pale, vision in and out, ears ringing put head between legs, laid on back on floor with feet elevated on chair at 3 pm ice packs applied to forehead and wrists, 3:05pm color returned, ate a cereal bar and drank water, sat up at 3:10pm felt better

Other Meds:

Current Illness:

ID: 1757476
Sex: F
Age: 77
State: GA

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/03/2021
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 so far

Allergies: NKDA

Symptom List: Erythema, Pruritus

Symptoms: Redness, Swelling, Lump

Other Meds: no known

Current Illness: No known

ID: 1757477
Sex: F
Age: 16
State: VA

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 10/03/2021
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: no known allergies

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

Symptoms: Patient under 18 years old was administered Moderna vaccine on9/30/2021

Other Meds: unknown

Current Illness: unknown

ID: 1757478
Sex: M
Age: 54
State: ID

Vax Date: 08/06/2021
Onset Date: 09/06/2021
Rec V Date: 10/03/2021
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: Shellfish Lidocaine Pfizer Covid-19 Vaccine

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

Symptoms: 2nd episode of extreme facial adema. Swelling of lips, cheeks, the exterior of throat to up to 10X normal size. Feeling of tightness in the middle of lungs. Persisted for over 24 hours, with minor swelling up to a week later.

Other Meds: None

Current Illness:

ID: 1757479
Sex: F
Age: 49
State: PR

Vax Date: 09/17/2021
Onset Date: 09/17/2021
Rec V Date: 10/03/2021
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: Aspirin, Methylprednisolone, Prednisone

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Extremely heavy and sore left arm, heavy legs, swelling in left leg, sore throat, body pain to the touch, upset stomach, constipation, swelling in left armpit, breast pain, pain and throbbing in both eyes, palpitation and pain in fingers and toes as if they were going to explode, tickling or tingling in legs and feet. Rapid throbbing in chest, pain in hand and leg joints.

Other Meds: Multivitamins

Current Illness: None

ID: 1757480
Sex: F
Age: 25
State: AL

Vax Date: 10/02/2021
Onset Date: 10/02/2021
Rec V Date: 10/03/2021
Hospital:

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

Lab Data: on 10/2/21 paramedics checked her blood pressure,heart rate and heart rhythm and oxygen and said her vital signs appeared normal

Allergies: NO KNOWN ALLERGIES

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

Symptoms: on 10/2/21 at 553pm I gave the patient her 1st dose of pfizer vaccine and told her she would have to wait for 15 minutes after the shot was given along with the other 2 family members getting the 1st dose of the pfizer vaccine. At 630 pm her son who was the language interpreter said that she was not feeling well after getting the shot now and was complaining of trouble swallowing and breathing problems. I had her sit down in the vaccination booth and called 911 and described to the 911 assistant what the patient was complaining about and that i was going to give her an epipen injection because based on the symptom complaints i thought she was having an analphylatic reaction. I was concerned that her larynx was swelling and that was why she was having trouble swallowing . I explained to her that i would have to give her an epipen shot in her right upper thigh because i and the 911 assistant felt that she was having and analphylatic reaction to the vaccine and that she would have to be admitted to the hospital for further observation. she refused the epipen shot and going to the hospital. The paramedics then came and checked her blood pressure/heart rate/heart rhythm and oxygen and told her that based on their checking her vitals that everything appeared normal. One of the paramadics had her and her sign on his computer labtop a form refusing to be taken to the hospital. At 650pm the paramedics left and i contined to stay with her and her son. At 655pm she said she was okey and and left the pharmacy with her son. i feel that based on what the paramedics said that she had and anxiety attack and not an allergic reaction to the pfizer vaccine

Other Meds: NO

Current Illness: NO KNOWN ILLNESSES

ID: 1757481
Sex: M
Age: 67
State: PA

Vax Date: 09/30/2021
Onset Date: 10/01/2021
Rec V Date: 10/03/2021
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: Sever lower back pain

Allergies: Bactrim

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

Symptoms: None stated.

Other Meds: Call me if needed

Current Illness: None

ID: 1757482
Sex: M
Age: 58
State: NV

Vax Date: 03/26/2021
Onset Date: 04/10/2021
Rec V Date: 10/03/2021
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: Pain in extremity

Symptoms: Adverse effect started as a severe back pain, not like a pulled muscle or slipped disk, but deeper than that. It didn't hurt with lateral movement or bending. It really hurt if I was driving and hit a bump. After about 30 days the back pain went away but then my right knee started to hurt to the point that I couldn't bend it. After about 15 days it started to get better but then my left knee started to hurt to the point where I couldn't bend it. Doctor took x-rays and said I had early stages of arthritis. Gave me a shot of cortisone in my left knee (said it showed as worst in x-rays). Left Knee feels better now (3 days after shot) right need still has some pain. Never had any issues with my knees or back prior to the vaccine.

Other Meds: none

Current Illness: none

ID: 1757483
Sex: F
Age: 56
State: GA

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 10/03/2021
Hospital:

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

Lab Data: None

Allergies: NKDA

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

Symptoms: Swollen lymph nodes in left armpit and collar bone approximately 48 hours post vaccine.

Other Meds: Protonix Wellbutrin

Current Illness: None

ID: 1757485
Sex: M
Age: 43
State:

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/03/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Hip and knee pain, both legs, 2 days Chills and fever, 1 day, same day as shot Constipation, 3 days Loss of appetite, 2 days

Other Meds: None

Current Illness: None

ID: 1757486
Sex: F
Age: 39
State: CO

Vax Date: 09/13/2021
Onset Date: 10/01/2021
Rec V Date: 10/03/2021
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: Mold, grasses, animal dander

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

Symptoms: Extremely heavy onset of (on time) menstrual cycle, with bleeding 5X the volume of typical cycle.

Other Meds: None

Current Illness: None

ID: 1757487
Sex: M
Age: 72
State: NY

Vax Date: 10/01/2021
Onset Date: 08/01/2021
Rec V Date: 10/03/2021
Hospital: Y

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

Lab Data: Many tests were taken . I do not have all tests and dates on follow.

Allergies: No

Symptom List: Vomiting

Symptoms: Acute noon-ST elevation myocardial infarction CAD (cororary artery disease Bypass Graft Coronary Artery (None) (08-05-2021

Other Meds: Insulin Lispro (Humalog 100mg.Farixa 5mg. Cymbalta 60mg. Fenofribrate 145mg. Metoprolol 50 mg. Motrin, Tramadol 50mg. Fiask, Flomax,Rosuvastatin 40mg.

Current Illness: No

ID: 1757488
Sex: F
Age: 42
State: CA

Vax Date: 10/03/2021
Onset Date: 10/03/2021
Rec V Date: 10/03/2021
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: Anesthesia

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Client completed 15 minutes in the observation area and walked to the EMT station. EMt asked the client if she was feeling good. The client reported that she feels, " a little bit dizzy." RN Withers recommended the client stay in observation due to the dizziness. The client stated she wanted to go sit back in her seat. RN and EMT responded to the client at 1:49PM. The client said she felt, "A little bit lightheaded when I stood up." The client reported a history of low blood pressure. The client has a history of anaphylaxis related to anesthesia. The client reported a history of anxiety. Vitals obtained by EMT at 1:51PM were as follows: automatic BP 114/86, O2 99%, HR 74. The client denied any persistent symptoms. The client stated she has only consumed coffee and a cookie today. The client requested to leave the vaccination site against medical advice. RN provided education regarding s/s of anaphylaxis and when to seek EMS. The client voiced understanding of this education.

Other Meds: Unknown

Current Illness: Unknown

ID: 1757489
Sex: M
Age: 0
State: FL

Vax Date: 09/30/2021
Onset Date: 10/03/2021
Rec V Date: 10/03/2021
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:

Allergies: NONE KNOWN

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

Symptoms: SEIZURE AT 0800 AND 1200

Other Meds: NONE

Current Illness: HISTORY OF RSV

ID: 1757490
Sex: F
Age: 53
State: IL

Vax Date: 02/27/2021
Onset Date: 09/20/2021
Rec V Date: 10/03/2021
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: I have been getting vitamin infusions with B complex vitamin C and glutathione

Allergies: Shellfish,nuts,avacado,,aloe

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Sept 20 my facial muscles started to twitch and I had consistent migraines with lasting over 8 hours. Icing or taking medication only reduced the severity of migraine but it did not go away.

Other Meds: N/A

Current Illness: N/A

ID: 1757491
Sex: F
Age: 21
State: FL

Vax Date: 10/03/2021
Onset Date: 10/03/2021
Rec V Date: 10/03/2021
Hospital:

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

Lab Data:

Allergies: sulfa, kiwi

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

Symptoms: patient had seizure and was taken to hospital outcome unknown

Other Meds:

Current Illness: anemia

ID: 1757492
Sex: F
Age: 39
State: GA

Vax Date: 09/01/2021
Onset Date: 09/08/2021
Rec V Date: 10/03/2021
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: None

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

Symptoms: My heart is racing since the second shot and my heart rate doesn?t come down for hours after easy exercise like walking. Rapid heart rate even after a month. Left back pain, shoulder pain. No appetite and stomach pain. Digestion issues

Other Meds: Synthroid, vitamin D, buspar, Crestor

Current Illness: None

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am