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: 1760028
Sex: M
Age: 49
State: CA

Vax Date: 08/18/2021
Onset Date: 09/01/2021
Rec V Date: 10/04/2021
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: none

Symptom List: Dysphagia, Epiglottitis

Symptoms: I have never had any issues with memory, short term memory or cognitive function. Over the past month I am DAILY unable to recall familiar names multiple times a day and find myself searching for words. I feel like a bit of a fog has set in at times. (note: upon receiving the first shot, I had sharp tingling and prickling sensation in my lips for approx. 12-15 hours)

Other Meds: none

Current Illness: none

ID: 1760029
Sex: M
Age: 35
State: CA

Vax Date: 06/09/2021
Onset Date: 06/26/2021
Rec V Date: 10/04/2021
Hospital: Y

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

Lab Data: X ray and Bloodwork from Dr. And then a plethora or ER/ICU/Telemetry tests. I was hospitalized over 2 weeks.

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: First shot 6/9/21, started noticing symptoms by 6/26/21, day I helped someone move and was feeling lightheaded/tired/weird. Got second shot 7/1, severe onset of symptoms started setting in a couple weeks later. I had what felt like gas, pressure in my abdomen, fatigue, anxiety. By the beginning of August I could not walk up the stairs without being out of breath. Third week in August I was waking up in the middle of the night and couldn't breathe. Assumed these were panic attacks and that I was just sick with something. I spent the following three weeks doing very little, bedridden waiting for it to pass. The last week in August I was getting bruising all over. The first week in September I swelled up, swollen feet, calves, and thighs. I finally went to the Dr., ordered x ray and blood work. She called me an hour later and told me to immediately go to the ER.

Other Meds: Multiviatmin

Current Illness: None

ID: 1760031
Sex: F
Age: 41
State: WA

Vax Date: 09/11/2021
Onset Date: 09/12/2021
Rec V Date: 10/04/2021
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: heavy metals

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

Symptoms: left eye twitching for a month, tightness in chest and back

Other Meds:

Current Illness:

ID: 1760033
Sex: F
Age: 43
State: MO

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

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

Lab Data: None

Allergies: Shellfish, ivp dye, doxycycline, sulfa

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Rash, itching and swelling of my arm from my neck to my elbow. Slight tongue swelling and mouth itch.

Other Meds: Ozempic, humira, Metformin, Zoloft, Val asaetan hctz, pantoprazole

Current Illness: Bronchitis, intestinal infection, uti

ID: 1760034
Sex: F
Age: 34
State: OH

Vax Date: 09/09/2021
Onset Date: 09/17/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data:

Allergies: Augmentin

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

Symptoms: - Three red spots on arm - all different in size ranging from 1/2 inch to 1 1/4 inch - very warm to the touch and itchy - went and saw doctor and was put on Famotidine for 5 days - Spots went away after a couple days and came back again a couple days later as a red line formed around the three spots previously - very warm to the touch and itchy as before - Went away after a day or so and got what seemed to be hives in a couple different spots (back of right leg, right side of back, right hand, small area on left wrist) - very itchy and went away after a few hours - Lasted about a week from onset of initial symptoms

Other Meds: Yaz Valcyclovir

Current Illness:

ID: 1760035
Sex: F
Age: 19
State: TX

Vax Date: 10/02/2021
Onset Date: 10/04/2021
Rec V Date: 10/04/2021
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: Severe lower abdominal pain. Vomiting due to the severity of the pain. Went to the ER and was discharged shortly after.

Other Meds:

Current Illness:

ID: 1760037
Sex: M
Age: 58
State: MD

Vax Date: 07/01/2021
Onset Date: 07/01/2021
Rec V Date: 10/04/2021
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: NONE

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Ongoing x 2.5 months left deltoid pain radiating into left shoulder joint

Other Meds: MVI

Current Illness: NONE

ID: 1760230
Sex: F
Age: 34
State: PA

Vax Date: 01/08/2021
Onset Date: 01/09/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data: EMG, skin biopsy, QSART, tilt table testing

Allergies: none

Symptom List: Pharyngeal swelling

Symptoms: This is an update to my 2 previous regulatory authority reports. I have been diagnosed with vaccine induced, immune mediated, small fiber neuropathy and Dysautonomia. I am also currently undergoing evaluation for mast cell activation syndrome as well.

Other Meds: none

Current Illness: none

ID: 1760231
Sex: M
Age: 47
State: MI

Vax Date: 05/18/2021
Onset Date: 05/19/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data: Dehydration and fatigue

Allergies: Losartan, Lisinopril, amlodipine, peanut, PEG, polyethylene

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Sore arm with a dark round bruise where the shot was given, Swollen node under right arm pit. glucose level rise. felt very weak and dizzy. Hard to breath at times.

Other Meds: Metformin, Astrovan, Aspirin, Naproxen

Current Illness: Diabetes, High blood pressure, Alopecia Universalis

ID: 1760232
Sex: F
Age: 69
State: CO

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

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

Lab Data: EKG, BP, Blood sugar.

Allergies: hornets, wasps and yellow jacket, iodine, sulfur, avonex, interferon based products, statins,

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Vaccine administered at 12:15 pm on 9/10/2021 Approximately around 12:30 pm patient felt stinging sensation in arm at injection site. Had a feeling of being flushed. and warm. Went home : About 2 hours later- felt faint and arm started to burn even more. Looked like her arm was scorched color of red apple and swollen the size of baseball. Swelling and redness lasted 10 days in left arm. That evening- felt dizzy, weak, nausea, headache. Did not sleep all night. On Saturday, attended son's (coach) high school football game. At game, she felt faint and then fainted on the bleachers. Banged hand on bleachers. Paramedics were called and found that your Blood Pressure was 100/60 and then dropped to 100/58. Blood Sugar okay, Pulse was weak/slow. Paramedics monitored for 45 minutes+ on the field sidelines. Completed Portable EKG. Nothing was found. Patient went home and to bed and rested/feeling ill for 3 days. Then symptoms improved except for left arm which stayed swollen for 10 days. Patient states the injection was given very low in her arm. About 3 inches above the elbow. Different from previous two doses.

Other Meds: None at time of vaccination. In the evening- Zanaflex, neurotin, liquid tylenol at bedtime.

Current Illness: No illnesses

ID: 1760233
Sex: M
Age: 38
State: CT

Vax Date: 04/18/2021
Onset Date: 04/18/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data: small fiber neuropathy via skin biopsy, SFN, sept 2021 bilateral ulnar neuropathy EMG, june 2021 white mater lesions in brain mri supratentorial. june 2021 blood tests ... many

Allergies:

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

Symptoms: diagnosed with small fiber neuropathy via skin biopsy, SFN, bilateral ulnar neuropathy, white mater lesions in brain mri supratentorial. Symptom onset: 4/18/21 - Received pfizer vaccine in left deltoid: 6 hours after injection, had an episode of racing heart, nausea, lightheaded, breathing difficulties, felt like I was going to pass out. This resolved the following day; high injection site pain lasted 2 days then decreased. Day 10 deltoid pain is high, fasciculation twitching begin at injection site. Day 20 pain is spread to elbow and wrist inflammation, sick feeling for days. Day 25 fingers 4 and 5 are numb, forearm nerve spasming. Rash appears on stomach. Daily progression of all fingers and full hand now numb, nerve shooting pains, hand swells red with white spots in extreme pain elbow and hands, forearm, weakness, Bicep in pain. Nerve running through shoulder and down scapula is in extreme pain. 5/21/21 - numbness spread to left face, then scalp and entire body numbness,twitching, weakness. Other arm now mirrors injection arm red swelling and nerve pain. Symptoms progress to ?brain zaps?, full body neuropathy, epeleptic like episodes. vibration everywhere, throat swelling shut. Sleep paralysis, fully numb arms, body loss, unable to walk, insomnia, jolts, swollen lymph in armpit, neck, elbows.Tinnitus begins after the brain shock episodes and still remains. Symptoms continued as of september 2021: Numbness in all hands, fingers, feet, and toes. Ulnar nerve fingers continue to be the most numb, ulnar neuropathy on EMG Extreme pain and weakness in arms, hands, and bicep. Hands swell red with white spots, cannot make fist or grip, throb in extreme pain. Hands and fingers inflame, feel like blood pooling or string tied around fingers. Burning pain on the skin all over Bicep nerve feel seized Lymph nodes in elbows swollen and painful, tied to hand pain Intermittently unable to lift arms Neuromuscular connections in arms and legs malfunction, like a TENS unit is on them. Extreme Weakness arms hands forearms Weakness in legs, full body weakness. Intermittently unable to walk properly. Extreme calf weakness Brains zaps, like an electrical shock to the head, but not as intense as initial episode. Tremors full body Twitching full body, both fasciculation and involuntary limb movement Intermittent trouble breathing with erratic heart rate spikes. Becoming lightheaded. Pots like episodes that come and go. 24/7 Tinnitus, brain fog/confusion depersonalization Vertigo Vision comprehension is like a strobe light, but vision itself is clear. Adrenaline jolts anxiety jolts/rushes Insomnia in the beginning was resolved. All symptoms vary greatly in intensity throughout the day

Other Meds: ibuprofen

Current Illness:

ID: 1760234
Sex: F
Age: 38
State: OH

Vax Date: 04/27/2021
Onset Date: 09/21/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data: N/A

Allergies: Penicillin, sulfa drugs, pineapple, banana

Symptom List: Rash, Urticaria

Symptoms: Severe fatigue, chills, fever, inability to remain upright, headache, sore throat, sinus pain and coughing. Severe fatigue for 7 days. Lingering cold-like symptoms for 10 days and counting.

Other Meds: Zyrtec, Advair, Zoloft, Albuterol, Centrum Women's Multivitamin, Ortho Tri-Cyclen, Vitamin D, Vitamin C

Current Illness: None

ID: 1760235
Sex: F
Age: 41
State: CA

Vax Date: 09/30/2021
Onset Date: 10/01/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data:

Allergies: Pnut?s, almonds and other outside things

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

Symptoms: Loss of taste for a few hours

Other Meds: Hum log, losartan,hctz, cholesterol meds,asthma meds

Current Illness: None

ID: 1760236
Sex: M
Age: 19
State:

Vax Date: 09/28/2021
Onset Date: 09/28/2021
Rec V Date: 10/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Patient received a Moderna Covid-19 Vaccine shot on 19 JUL 2021, and was deployed in support of care. Due to the risk of working with vulnerable, communicable risk of congregate living facilities; this patient was given a dose of the Pfizer Vaccine for his second shot as it was the only vaccine available at the time. No adverse reactions were reported.

Other Meds:

Current Illness:

ID: 1760237
Sex: M
Age: 40
State: VA

Vax Date: 08/09/2021
Onset Date: 09/01/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data: Went to Patient First on 09/16/2021 and had the M.D. look at my arm. Had bloodwork done lab venipucnture test results were in normal range from what I was told

Allergies: None

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

Symptoms: Adenopathy, swollen lymph gland in left armpit area about the size of bean bag. It started after first dose small at first about the size of a pea then 2 days after second dose it got considerably larger lasted for 6 days swelling decreased for about 5 days then swelling returned for another 8 days then went down again still hasn't fully went away but swelling is down to a tolerable state.

Other Meds: Escitalopram, Clonazepam

Current Illness: None

ID: 1760238
Sex: F
Age: 54
State: CA

Vax Date: 09/07/2021
Onset Date: 09/09/2021
Rec V Date: 10/04/2021
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: Patient reported large bruise of groin with no trauma. labs completed and normal. bruise improved with time. she also was found with a false positive HIV antibody screen on 9/9/2021. unclear if related to vaccine.

Other Meds: oral antihistamine

Current Illness: none

ID: 1760239
Sex: F
Age: 46
State: CT

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/04/2021
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: unknown

Allergies: erythromycin, penicillin

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

Symptoms: patient called in the afternoon of 10/4 stating that she was experiencing pain and numbness in her lower extremities and was unable to easily move. I asked her when this started and she said shortly after she returned home from receiving her flu shot from us on 10/1. I advised her to contact her provider or emergency services. Later in the evening I called her and she said that she was in the hospital but was unable to give more info as to her condition just that they were evaluating a problem with her legs.

Other Meds: zolpidem, alprazolam, fluoxetine, medroxyprogesterone, divalproex

Current Illness:

ID: 1760240
Sex: F
Age: 25
State:

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

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 101.9 fever, body aches, fatigue, dizziness, migraines, vomiting, shaking

Other Meds:

Current Illness:

ID: 1760241
Sex: M
Age: 41
State: OH

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

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Pt stated that they never received a COVID vaccine and marked as such on their paperwork. Explained everything to patient who discussed vaccine hesitance about this first vaccine he was receiving. When the vaccination was billed, insurance showed previous history. shows they received the Pfizer vaccine 08/05/21 at a different site.

Other Meds:

Current Illness:

ID: 1760242
Sex: M
Age: 80
State: MI

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

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

Lab Data: None

Allergies: None.

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

Symptoms: Hives distributed only on injected arm. Duration has been at least 45 hours. Spots are about 5-7mm diameter and in groups of 4 to 8.

Other Meds: Atorvastatin-40mg, Pantoprasol-40 mg, Brilinta-90 mg, aspirin-81mg, CoQ10-200 mg, fish oil-200mg,

Current Illness: None.

ID: 1760243
Sex: F
Age: 76
State: WA

Vax Date: 06/11/2021
Onset Date: 10/02/2021
Rec V Date: 10/04/2021
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: COVID status positive on 10/2/21.

Allergies: NKDA

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

Symptoms: Patient received Pfizer COVID vaccine on 5/14/21 and 6/11/21. Patient admitted to our facility on 9/29/21 s/p a mechanical fall down 2-3 concrete steps with RIGHT distal radius and ulna styloid fracture and LEFT comminuted patella fracture. Pt underwent ORIF of the RIGHT distal radius and ulna fracture and ORIF of the LEFT patella on 9/30/21. On 10/2/21, patient tested positive for COVID but asymptomatic. As of 10/4/21, patient is still admitted in the med/surg unit post ORIF.

Other Meds: vitamin C, atorvastatin, vitamin B complex, vitamin D3, carvedilol, clopidogrel, levothyroxine

Current Illness:

ID: 1760244
Sex: M
Age: 48
State: OR

Vax Date: 10/01/2021
Onset Date: 10/04/2021
Rec V Date: 10/04/2021
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: N/A

Symptom List: Unevaluable event

Symptoms: We had an Covid vaccine event at a low income apartment. We checked the database but miss read his birthday and gave him the shot. Patient wanted the shot so he could get the $150 gift card incentive.

Other Meds: Pt got one dose of Jand J on 05/28/2021; came back got another J and J dose on 10/01/2021 because of the incentive. I tried to call him, but it was a wrong person picking up the phone.

Current Illness: N/A

ID: 1760245
Sex: F
Age: 61
State: UT

Vax Date: 09/24/2021
Onset Date: 10/02/2021
Rec V Date: 10/04/2021
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:

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

Symptoms: Red itchy and swollen area over the injection site. It started 8 days after the vaccination and has been occuring for 3 days.

Other Meds:

Current Illness:

ID: 1760246
Sex: F
Age: 36
State: FL

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

Symptom List: Injection site pain, Pain

Symptoms: I received the first shot with no problems on August 13, 2021. My second vaccine was on September 3, 2021 did not have a reaction till the following day I had extreme head pain throbbing pressure and still continuous fast irregular heartbeats that wake me while sleeping almost everynight. I have a pulse oximeter and my heart rates is in 100 to 120 range while sleeping. Sometimes takes my breath away.

Other Meds:

Current Illness:

ID: 1760247
Sex: F
Age: 51
State: CO

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data: Unknown

Allergies: Eggs, penicillin

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient received Flucelvax flu vaccine on 10/1/21 at our off-site clinic for Casinos. She had hives, headache, sore arm, and a large swollen lymph node under her arm. Prior to receiving the vaccine she stated that she is allergic to eggs and she also wrote the same on her consent form. I received an email from the HR representative for the clinic relaying the information about her adverse reaction as they believed that we failed to give her an egg-free vaccine. I called the patient and she states that she has been taking Benadryl nonstop over the last few days and most symptoms have subsided with the exception of her sore arm. I did let her know that the Flucelvax she received this year as well as last year is egg-free and preservative free, but that she should follow up with her physician as well and take ibuprofen and use an ice pack for her sore arm and continue taking Benadryl as needed. She had to miss work due to her allergic reaction.

Other Meds: Unknown

Current Illness: unknown

ID: 1760249
Sex: M
Age: 36
State: TX

Vax Date: 06/09/2021
Onset Date: 06/12/2021
Rec V Date: 10/04/2021
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:

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

Symptoms: 3 days after shot, heart rate went to 100 bpm for another three days. Doctors dismissed it at my body producing antibodies. After second shot, similar issue. Now, I?m September, having serious issues with random spikes in blood pressure and heart rate. They make me completely out of it, sick and like I?m having a heart attack. I?ve had tons of blood work, echocardiogram, stress test, etc and docs cannot pinpoint a cause. All this started after the vaccine. It is keeping me from working, just filed short term disability.

Other Meds:

Current Illness:

ID: 1760250
Sex: F
Age: 31
State: NJ

Vax Date: 05/01/2021
Onset Date: 05/01/2021
Rec V Date: 10/04/2021
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:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Thyroid levels decreased to alarming levels. Thyroid medication had to change and be monitored for a month. RA symptoms of joint pain and soreness, as well as fatigue and flu like symptoms, affected my overall functioning. The worst of these adverse affects lasted 2 months, with some of these effects still present today.

Other Meds: Quetiapine fumare

Current Illness:

ID: 1760252
Sex: M
Age: 52
State: NC

Vax Date: 09/30/2021
Onset Date: 10/02/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data: None

Allergies: penicillin

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Covid Arm at the injection site. Rash at least 6 inches in length and 5 in width. Swollen lymph nodes at the axillary and supraclavicular. Huge lump on my neck. All very painful and sore to the touch. Muscle twitching (all over my body) that lasted for 7 hours, that started 9 hours after the injection.

Other Meds: multi-vitamin

Current Illness: none

ID: 1760253
Sex: F
Age: 61
State: MN

Vax Date: 04/16/2021
Onset Date: 09/25/2021
Rec V Date: 10/04/2021
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: cough, diarrhea, cold symptoms starting on 9/25/21, son tested positive same day she did, recently attended wedding

Other Meds: Adderall, Fluticasone; Benefiber; Alevel Mupirocin; Lexapro

Current Illness: none

ID: 1760254
Sex: F
Age: 41
State: WV

Vax Date: 08/01/2021
Onset Date: 08/27/2021
Rec V Date: 10/04/2021
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: Chest pain, tachycardia greater than 125 at rest, irregular heart beat, dizziness at rest.

Other Meds: 50mcg Zinc, 1000mg vitamin C, 5000u vitamin D3, 0.5mg xanax as needed, breo.

Current Illness: Asthma

ID: 1760255
Sex: F
Age: 50
State: IL

Vax Date: 05/17/2021
Onset Date: 06/07/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data: I saw the dermatologist around 6/21. No testing, just prednisone.

Allergies: Latex and adhesive

Symptom List: Injection site pain

Symptoms: I developed a rash, dermatologist thinks reaction to bug bite, folliculitis, or vaccine. The rash is extensive, covers entire body, and itches. I was on Prednisone tapering dose twice, it still itches and I cannot get the inflammation to calm down. I developed blisters and open wounds from scratching the rash in my sleep and I now have cellulitis from one of the blisters and am antibiotics. I have used a variety of eczema and rash care products: so far CeraVe, Gold Bond Eczema, Aveeno Bath, Aveeno nighttime baby eczema relief, and goats milk soap with manuka honey, calamine lotion, and ice help calm my skin. The rash is still here, since early June, 4 months.

Other Meds: Lexapro 20 mg, Diclofenac Sodium 75mg, Singulair, albuterol inhaler, omeprazole 20 mg, Ropinrole 1 mg, Calcium Magnesium Zinc, extra strength magnesium, B12, B-complex, Vitamin C, Iron, Vitamin d3

Current Illness: asthma, fibromyalgia

ID: 1760256
Sex: M
Age: 29
State: WA

Vax Date: 09/29/2021
Onset Date: 09/30/2021
Rec V Date: 10/04/2021
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: Fever, headache, body aches, chills, nausea. Too ill to go to work. All children in the household also experienced fevers up to 102 degrees as well as body aches. Treated with ibuprofen and rest.

Other Meds: None

Current Illness: None

ID: 1760257
Sex: F
Age: 14
State: WV

Vax Date: 10/01/2021
Onset Date: 10/02/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Her vision started half black then progressed to full black and then she passed out in the shower, falling. When she came back to consciousness, her vision stayed black for several seconds.

Other Meds: None

Current Illness: None

ID: 1760258
Sex: F
Age: 51
State: CA

Vax Date: 09/15/2021
Onset Date: 09/15/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data: ECG 7/2/2021: Sinus bradycardia. CBC and CMP 14: All within normal limits.

Allergies: Tetanus Vaccine

Symptom List: Tremor

Symptoms: Initially injection pain and numbness to arm. From day 3 on to present: fatigue, malaise, elevated blood pressure, dizziness and facial flushing.

Other Meds: Linzess; Lisinopril/HCTZ 20/25mg; Estradiol; Vitamin D 50000IU; Verapamil ER 120mg; Xanax PRN

Current Illness: HTN; anxiety; HRT; irritable bowel syndrome

ID: 1760259
Sex: F
Age: 31
State: OH

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

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Pt received 2 doses of Pfizer, 6/12/21 and 7/3/21. Pt told us they had never received the vaccination and marked as such on their vaccine immunization form and confirmed when discussing side effects. Upon review in web application she had received Pfizer previously.

Other Meds:

Current Illness:

ID: 1760260
Sex: F
Age: 40
State: TX

Vax Date: 10/01/2021
Onset Date: 10/02/2021
Rec V Date: 10/04/2021
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: NA

Allergies: NA

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

Symptoms: I was sick with body aches, fever, sleepy, weak, headaches, the first shot was worse. Started feeling change in arm within 20 min of the first shot with symptoms lasting 48 hours. Second shot symptoms didn't start until the next morning and I had nausea and hive on my arm, still have some symptoms Monday.

Other Meds: Phentermine, synthetic thyroid taken mornong of shot and the following morning.

Current Illness: Cold/sinus

ID: 1760261
Sex: M
Age: 77
State: MO

Vax Date: 02/24/2021
Onset Date: 04/14/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data: Reported to my Primary Care Physician during checkup on May14, 2021 and again on August 2, 2021. No related tests have been made.

Allergies: None

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

Symptoms: Numbness in toes of both feet, from ball of foot forward.

Other Meds: Sotalol 160mg 2XDay Zetia(ezetimibe) 10mg Daily Hydrochodone/Acetaminophen 5/325mg 1-2/week Diltiazem HCL CD 180mg 2XDay Warfarin Sodium 4mg day Aspirin 81mg Daily Vitamin D3 2000u 1/day Vitamin B1 - Thiamine 100mg 1/day Folic Acid 1200mg 1

Current Illness: None

Date Died: 10/02/2021

ID: 1760262
Sex: F
Age: 74
State: KY

Vax Date: 03/12/2021
Onset Date: 10/02/2021
Rec V Date: 10/04/2021
Hospital: Y

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

Lab Data: 9/18/2021 tested positive for COVID-19 via PCR;

Allergies: unknown

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: 9/18/2021 tested positive for COVID-19 via PCR; developed pneumonia, fever, chills, myalgia, sore throat, headache, cough, dyspnea, abdominal pain, congestion, bloody stool, weakness;

Other Meds: pantoprazole; ibuprofen; HYDROcodone; cholecalciferol; simvastatin; loratadine; flunisolide; metoprolol tartrate;

Current Illness: unknown

ID: 1760263
Sex: F
Age: 49
State: MO

Vax Date: 06/05/2021
Onset Date: 06/06/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data: BLOOD WORK BY PRIMARY NERVE CONDUCTION TEST MRI OF BRAIN, NECK, BACK XRAYS FROM FALLING DUE TO THE DROP FOOT NUMEROUS TIMES,

Allergies: DOG, CATS, TREES AND GRASS, BETADINE, BENADRTY, ADHESIVE

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

Symptoms: LETHARGIC, MEMORY LOSS, DROP FOOT OCCURED 2 WEEKS AFTER SHOT, BALANCE OFF, FALLING, LOSS OF INTEREST IN DOING THINGS, NUMBNESS IN FINGERS ON BOTH HANDS AND TOP OF BACK, DROPPING THINGS, LOSS OF FEELING FEET, HANDS AND BACK,

Other Meds: HYOSCYAMUNE 0.125 MG , CLONAZEPZM 1MG, MNTELUKAST 10MG,

Current Illness: NONE

ID: 1760264
Sex: F
Age: 32
State: CA

Vax Date: 09/16/2021
Onset Date: 09/17/2021
Rec V Date: 10/04/2021
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: N/A

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

Symptoms: Fever, Nausea, Headache, Chills, Pain at injection site for 24 hours. Itchy bumps developed on right wrist & elbow. Formed into blisters. Shingles developed. Had chickenpox when younger.

Other Meds: N/A

Current Illness: N/A

ID: 1760265
Sex: M
Age: 76
State: AZ

Vax Date: 04/08/2021
Onset Date: 04/27/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data: none

Allergies: tetracycline.

Symptom List: Pain in extremity

Symptoms: Still have fatigue and nephropathy in right arm.

Other Meds: Vitamin C, Vitamin D & fiber gummies, Also take Tylenol for arthritis.

Current Illness: Arthritis.

ID: 1760266
Sex: M
Age: 40
State: OK

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

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

Lab Data: none yet

Allergies: NA

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

Symptoms: Burning sensation similar to shingles. Pain to the touch, this also happened shortly after my covid vaccine.

Other Meds: phentermine

Current Illness: none

ID: 1760267
Sex: M
Age: 70
State: TX

Vax Date: 02/04/2021
Onset Date: 07/19/2021
Rec V Date: 10/04/2021
Hospital: Y

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

Lab Data: They put a stent in.

Allergies: None

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

Symptoms: heart attack caused by blood clot in heart. I am reporting this beacause the doctor said it was rare to see a heart attack of this type with so little plaque. I also had polycythemia (forgot to list it earlier)

Other Meds: Atorvastatin, Glipizide, Metformin, Tradjenta, Omeprezole, Jardiance, Trulicity, Olmesartan, Desveneflaxine, Cinnamon, Vitamin E, Fish Oil, Alegra, Potassium, Magnesium, Vitamin D3,

Current Illness: None

ID: 1760268
Sex: F
Age: 35
State: AR

Vax Date: 10/01/2021
Onset Date: 10/03/2021
Rec V Date: 10/04/2021
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: Swollen lymph node under arm, very tender and swollen

Other Meds: Vitamin B12, Vitamin C, Vitamin D, Icelandic Kelp, Probiotic Supplements, Algal Oil Supplement, Allegra Allergy, Mucinex (Allergy), Fluticasone/Triamcinolone Acetonide Nasal Spray (Allergy)

Current Illness: Seasonal Allergies

ID: 1760269
Sex: F
Age: 29
State: MN

Vax Date: 01/24/2021
Onset Date: 09/30/2021
Rec V Date: 10/04/2021
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: humira; remicade

Symptom List: Vomiting

Symptoms: headache, sore throat, productive cough at times, body aches, loss of taste, loss of smell, diarrhea not abnormal, sinus congestion, nasal congestion, post nasal drainage, chest tightness, sneezing, ear fullness, itchy eyes. starting 9/30/21

Other Meds: Cefuroxime; Vitamin D; Omeprazole; Oscella; Lialda; Biotin; Flonase

Current Illness: none

ID: 1760270
Sex: F
Age: 17
State: WI

Vax Date: 08/06/2021
Onset Date: 09/06/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data: None

Allergies: Cephalosporins

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: First Pfizer dose was 08/06/2021 of which was the last day of patients menstruation cycle. Second dose of Pfizer given 08/29/2021. Patient has not had a period since her last cycle 08/01/21-08/06/21

Other Meds: Spironolactone tabs, Clindamycin gel

Current Illness: None

ID: 1760271
Sex: F
Age: 72
State: VA

Vax Date: 09/30/2021
Onset Date: 10/01/2021
Rec V Date: 10/04/2021
Hospital:

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

Lab Data: None

Allergies: Shell Fish, Swimming Fish, Cantaloupe, Strawberries, Molds of any kind. Penicillin and Clindamycin.

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

Symptoms: Unable to get warm, severe aches in all muscles and joints, dry heaves (did not eat), headache worse than any migraine I?ve ever had, and an inability to maintain a standing position. My brain felt like jelly. This happened again on the two following days but has not come back since.

Other Meds: Lisinopril, Citalopram, Levothyroxine, Amlodipine, Rosuvastatin (new replacement for Pravastatin), Vitamins D3 and C, 81 aspirin.

Current Illness: None

ID: 1760272
Sex: M
Age: 38
State: MA

Vax Date: 06/01/2021
Onset Date: 09/22/2021
Rec V Date: 10/04/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: I had a seizure.

Other Meds: None

Current Illness: None

ID: 1760273
Sex: F
Age: 47
State: OR

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

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

Lab Data: N/A

Allergies: N/A

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

Symptoms: Pt had 2 moderna shots, gave her a pfizer booster shot. Pt is fine.

Other Meds: N/A

Current Illness: N/A

ID: 1760274
Sex: F
Age: 27
State: VA

Vax Date: 10/02/2021
Onset Date: 10/02/2021
Rec V Date: 10/04/2021
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 reported

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

Symptoms: Apprx 5 hrs after vaccination, developed burning sensation in face and eyes, awoke from sleep later that evening with very swollen eyelids. No other skin sxms, resp sxms, CP, GI or neuro sxms. Swelling resolved with cool compresses and OTC Benadryl over several hrs.

Other Meds: none reported

Current Illness: none reported

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am