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: 1765673
Sex: M
Age: 17
State: WA

Vax Date: 09/03/2021
Onset Date: 09/06/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data: blood urin testing, came back goo. Seeing a urologist now

Allergies: none

Symptom List: Dysphagia, Epiglottitis

Symptoms: Unrinated a lot of blood almost passing out.

Other Meds: none

Current Illness: none

ID: 1765674
Sex: M
Age: 18
State: CA

Vax Date: 09/29/2021
Onset Date: 09/29/2021
Rec V Date: 10/06/2021
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: unknown

Symptom List: Anxiety, Dyspnoea

Symptoms: About 5 minutes after patient was vaccinated with COVID-19 vaccine, he complained of feeling dizzy and lightheaded while still seated at the vaccination station. Patient was moved to floor and assessed. Lungs were clear, A x O x 3, pulse regular and steady. EMS was already present from responding to another emergency so patient was assessed by them. Pulse 80, RR 16. Patient likely had vasovagal reaction as per mother he had similar symptoms when he underwent an MRI in the past. Patient had resolution of symptoms and ambulated out of clinic in stable condition with his parents. No hospital transport.

Other Meds: unknown

Current Illness: unknown

ID: 1765675
Sex: M
Age: 40
State: IL

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/06/2021
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: Patient complaint of dizziness 15 mins after vaccine. He was given fluids. Vitals: B/P 133/93, HR 108, temp 97.3, resp 20 and SpO2 100%. Patient rested in chair for another 15 mins, feeling dizzy. After further questioning, he complained of itching and throat tightness. Patient seemed anxious, but otherwise breathing unlabored. No sign of rash and SpO2 100% on vital recheck. Ambulance called at 1651 and arrived at 1700. Patient taken to nearest hospital for evaluation and monitoring.

Other Meds:

Current Illness:

ID: 1765676
Sex: M
Age: 25
State: AZ

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

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Syncope

Other Meds:

Current Illness:

ID: 1765677
Sex: M
Age: 81
State: GA

Vax Date: 09/19/2021
Onset Date: 09/28/2021
Rec V Date: 10/06/2021
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: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1765678
Sex: M
Age: 71
State: MA

Vax Date: 02/09/2021
Onset Date: 03/18/2021
Rec V Date: 10/06/2021
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: 3/18/21 and 3/20/21 - COVID positive PCR

Allergies: amoxicillin, Cimetidine

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

Symptoms: Pt by EMS with worsening SOB, reports being sick for 10 days, tested positive for COVID on day prior to admission. R/A sat 82, improved with oxygen. Hx lung CA. lobectomy. Cardiac stent. Subjective fevers. Patient had second COVID vaccine 1 month ago. He started to have increasing dyspnea and oxygen requirements beginning 2 weeks ago. He has baseline poor lung function due to COPD. His oxygen requirement is generally 2 liters at night. His oxygen saturations, which are generally in the 90s, were noted to be in mid 80s at home. Also of note, COVID labs were as follows: ESR-22, CRP- 15.6, CK-27, Trop- 20, ferritin - 68, BNP-1119. (Chest CT was done on 3/17 which showed growth of RLL nodular opacity, increased consolidation and GGO around the opacity, unchanged existing pulmonary nodules, and unchanged left hilar LAD). Repeated COVID test had a cycle threshold 18. He was given a dose of prednisone 50 mg and increased his oxygen in the ED with good effect. His oxygen saturations were 96% on 3L at time of transfer to the floor. Given supplemental O2 via NC with goal SpO2 88-92%. Continued his home COPD inhalers. Completed 5 days remdesivir (3/19-3/23). Patient was given prednisone 50 mg at outside clinic on 3/19 which was changed to dexamethasone 6mg x 6 days (3/19-3/25); steroids discontinued on 3/25 due to continued HTN, lower extremity edema (non-cardiogenic), and agitation. His mental status returned to baseline off dexamethasone. Discharged home with baseline nocturnal oxygen. He continued to require 0.5-1 liter with activity to maintain sat >90%. VNA will help to wean this at home.

Other Meds: Anoro ellipta, aspirin, atorvastatin, azithromycin, coreg, clopidogrel, flonax, lorazepam, nitro SL, sildenafil, symbicord, tamsulosin, omeprazole,

Current Illness: Unknown.

ID: 1765679
Sex: F
Age: 41
State: CO

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/06/2021
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: Amox, banana, sesame, Moderna covid vac

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Pt said throat felt irritated "like a ball stuck in there." Sx progressed to thrat and inner ears feeling itchy, throat felt tight, seeing "star flies", few hives noted on neck and continuously clearing throat. )2 2 L initiated and Epipen 0.3 mg adiministered and within 1 min pt states she was feel better. Pt transported for observation.

Other Meds: Losarten, Trazadone, Bupropion

Current Illness:

ID: 1765680
Sex: M
Age: 34
State: CA

Vax Date: 04/07/2021
Onset Date: 04/28/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data: In May I had MRI's done for my heart (Cardiac MRI), Cervical, Lumbar, Brain, Thorasic MRI's done. With bloodwork, EKG, Neurological test, and Echocardiogram test. All the test came out negative.

Allergies: Haldol

Symptom List: Pharyngeal swelling

Symptoms: 3 weeks after the second covid shot I started getting abnormal heart beats with heavy palpitations. As weeks progressed symptoms changed. I started getting chest pain, stinging and burning senstations throughout my body. Leg pain and numbness in my legs, arms, and hands. As months progressed I started getting burning sensations in my head, with weird neurological headaches. I also wasn't able to swallow at times and my mouth would get dry. I would also get brain fog and hard to focus at times. I would get dissy if I turned and focused. Almost 6 months in and I'm still not recovered. I still have heart palpitations, and abnormal heart beats. Weird headaches and burning sensations througout my body with chest pain at times.

Other Meds: No

Current Illness: None

ID: 1765681
Sex: M
Age: 79
State: ID

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

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: The covid vaccine vial was reconstituted with normal saline not with the diluent coming with the covid vaccine the one with pink top. This was not the right one. So the manufacturer stated that this is not valid and pt should do another dose in 6 months. Pt was receiving covid booster vaccine at that time.

Other Meds:

Current Illness:

ID: 1765682
Sex: F
Age: 45
State: WA

Vax Date: 03/31/2021
Onset Date: 03/31/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data: Asthma doctor - tried antibiotics to see if it was infection - antibiotics and steroids - they made me go 10 weeks (with inhalers) - just finishing that. Cough is not responding to these medications. He is also going to have me come in and do another breathing test because I am not able to take deep breaths as well. I'm still in the middle of it all now since I didn't respond to the 10 weeks of meds.

Allergies: Aspirin; Demerol; Doladid; Doxycycline; Gabapentin; Reglan; Certriline Contra indicated to my disease: Propofol; Lactated Ringers Solution (IV solution)

Symptom List: Diarrhoea, Nasal congestion

Symptoms: About 8 hours after the shot, the fever started; body aches; 103 temperature and really bad headache (worst I have ever had). It lasted two days straight (the symptoms) and the third day I felt okay. I had arm pain and swollen and very sore. Then I didn't have anything except off and on waves of fatigue that would come and go every couple of weeks. I could tell something was different. I almost felt like I was getting sick but didn't get sick - that beginning feeling of getting sick. July, I started having issues with my breathing. I started having swallowing difficulties and then by August, I started having a cough that doesn't go away. The only way I can make it go away is that if I lay down and my heart rate goes down. My lungs sound good. I am waiting to see a new pulmonologist (my other one has moved). The lungs sound good though so they aren't sure what it is. I have never experienced anything like this before. My normal asthma is induced by sickness or exercise and this is different. I can't walk very far right now.

Other Meds: My normal meds: Singular 10 mg once a day; Synthroid - 150 mcg; Prep medications for the shot- so I would not have an anaphylaxis reaction to vaccine: Prednisone/Claritin/Famotidine - extreme high dose of everything that I took every two ho

Current Illness: no

ID: 1765683
Sex: F
Age: 67
State: MN

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 10/06/2021
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: Sulfa drugs, amoxicillin, erythromycin

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

Symptoms: Slight rash and itching at and below injection site; injection site pain, redness and slight swelling; tiredness; headache; muscle and joint pain in injection arm; slight nausea; feeling unwell Symptoms began about 6-7 hours after injection, progressively became worse over the first 24-48 hours , but were mostly gone by 60 hours after the injection.

Other Meds: Hydrochlorothiazide-25 mg Pantoprazole Calcium with vitamin D3-600 mg

Current Illness: none

ID: 1765684
Sex: F
Age: 78
State: GA

Vax Date: 09/23/2021
Onset Date: 09/28/2021
Rec V Date: 10/06/2021
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: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1765685
Sex: M
Age: 74
State: NJ

Vax Date: 02/24/2021
Onset Date: 03/01/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data: MRI (08/05/2021), In house aspiration of cyst (09/10/2021), several months of physical therapy

Allergies: aspirin

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

Symptoms: Synovial cyst between L4/L5 was discovered after MRI on 08/5/2021. The MRI was prescribed after I had severe pain in left leg. the pain started on 02/29/2021. I have had back problems for 20+ years but this was the worst. I'm still being treated for the cyst.

Other Meds: multi-vitamins

Current Illness: none

ID: 1765686
Sex: F
Age: 72
State: MO

Vax Date: 09/22/2021
Onset Date: 09/23/2021
Rec V Date: 10/06/2021
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: none

Allergies: ibuprofen allergy

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

Symptoms: Patient said she has had a rash for 2 weeks

Other Meds: unknown

Current Illness: unknown

ID: 1765687
Sex: M
Age: 31
State: GA

Vax Date: 09/19/2021
Onset Date: 09/28/2021
Rec V Date: 10/06/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1765688
Sex: M
Age: 66
State: ID

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

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

Lab Data:

Allergies:

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

Symptoms: The covid vaccine vial was reconstituted with normal saline not with the diluent coming with the covid vaccine the one with pink top. This was not the right one. So the manufacturer stated that this is not valid and pt should do another dose in 6 months. Pt was receiving covid booster vaccine at that time.

Other Meds:

Current Illness:

ID: 1765689
Sex: F
Age: 26
State:

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

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

Lab Data:

Allergies:

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

Symptoms: First shot issued 9/14/2021 Pregnancy: Estimated delivery date 24 May 2022, miscarriage diagnosed 20 Sep 2021 Second shot issued 10/05/2021 Symptoms: Headache, nausea, swollen lymph node under injected arm's armpit, low grade fever, chills, excessive sweating, gastrointestinal issues including diarrhea, increased urination, muscle soreness/aches, chest pain.

Other Meds:

Current Illness:

Date Died: 05/02/2021

ID: 1765690
Sex: M
Age: 67
State: NE

Vax Date: 04/01/2021
Onset Date: 05/02/2021
Rec V Date: 10/06/2021
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: latex, penicillins, unsure of reaction milk weed #2 - anaphylactis

Symptom List: Ear pain, Hypoaesthesia

Symptoms: suspect patient death based on timing Patient was seen on 3/31 for lumbar back pain with leg pain. had follow up visit scheduled with regular PCP within a few days. had covid shot the next day. Then we noted he missed his appointment follow up with pcp and were told he had passed. noted his covid shot was the next day. sounds like he may have been found at home expired.

Other Meds: lipitor, vitd, jardiance, iron, folic acid, glipizide, lisinopril, ativan, metformin, multivitamin, prilosec, actos, risperidone, zoloft

Current Illness: lumbar back pain.

ID: 1765691
Sex: F
Age: 67
State: GA

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/06/2021
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: Patient signed up for a flu vaccine at the pharmacy. She filled out the consent form and was counseled by the pharmacist. After receving the vaccine, she stated that she also received the flu vaccine at her doctor's office 1 month ago. The patient's doctor was notified. No adverse reactions have been observed .

Other Meds:

Current Illness:

ID: 1765692
Sex: M
Age: 72
State: KS

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

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

Lab Data:

Allergies:

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

Symptoms: Moderna given as the first dose on 09/01/2021. Pfizer given as the second 10/06/2021.

Other Meds:

Current Illness:

ID: 1765693
Sex: F
Age: 65
State: TX

Vax Date: 09/10/2021
Onset Date: 09/12/2021
Rec V Date: 10/06/2021
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: CT Scan EKG

Allergies: Tetracycline

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

Symptoms: The day after the third dose I felt unwell but on the second day I started to have trouble breathing and my heart rate got erratic. It would go up for no reason and then it went back down. I couldn't seem to get enough air. I checked my Oxygen and it was a little lower than normal between 92-94% when I usually run close to 100. I waited until the next day and my doctor told me to go to the ER. I was tested and the tests area negative. A couple of days after when The next day I knew my left arm was in trouble because my vein was enlarged and rock hard. It was very sore and a visible enlargement of the vein in my arm. I have had had infusions and problems in that arm before so I knew there was something wrong. I called my doctor and I was given a Doppler scan on my left arm. I was diagnosed with a superficial clot in my arm. I was prescribed Eliquis at a higher dose and then tapered off. The Eliquis was discontinued on 10/01/2021 to prepare for surgery. I am a current Cancer patient. The clot seems to have resolved and my breathing problems are better. I was not given any lot numbers or information about my shots.

Other Meds: Celexa; Xiidra eye drops; Multiple supplement

Current Illness: N/A

ID: 1765694
Sex: F
Age: 81
State: GA

Vax Date: 09/22/2021
Onset Date: 09/28/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: Vaccine error-vaccine was administered past its beyond use date. The vaccine had been stored in the freezer beyond the time frame recommended by the manufacturer.

Other Meds:

Current Illness:

ID: 1765695
Sex: F
Age: 43
State: FL

Vax Date: 10/03/2021
Onset Date: 10/05/2021
Rec V Date: 10/06/2021
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: Labs, EKG and COVID-19 test.

Allergies: Keflex

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

Symptoms: Dizziness; head spinning; gait issues; unable to focus or see straight; sharp pains in the back of my head. I was unable to walk straight or drive my vehicle. Dehydration and unable to think clearly.

Other Meds: None

Current Illness: None

ID: 1765696
Sex: M
Age: 40
State: GA

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

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

Lab Data: EKG, bloodwork, chest X-ray, monitored in ER for several hours. Ultimately determined to be severe heartburn. Never had this condition prior to COVID Vax.

Allergies: Bactrian

Symptom List: Injection site pain, Pain

Symptoms: Severe chest pains, ER visit following. No definitive cause determined. Possibly heartburn. Condition started after first shot and has continued ever since. Now on daily prescription heartburn medicine to control this new condition.

Other Meds: None

Current Illness: None

ID: 1765698
Sex: F
Age: 48
State: DC

Vax Date: 04/02/2021
Onset Date: 08/01/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data: I took the lab test on 09/03/2021 as a result of the adverse event., which was the previous lab result in August.

Allergies: shell fish

Symptom List: Injection site pain, Menorrhagia

Symptoms: My kidney results were stable in March. The next time I did the kidney labs on August 2nd, 2021 it had more than doubled. Clearly my disease was progressing. Then I did telehealth with Dr. on 08/11/2021. I changed my diet and took the test again. I dropped off my jug on 09/03/2021 in the morning, I received my 3rd Pfizer shot that afternoon.

Other Meds: hormone replacement-estradiol- 0.05 mg patch change it once a week prometrium 100 mg pill per day pravastatin 10 mg per day ezetimibe 10 mg pill per day losartan 75 mg per day/ 3 tablets fish oil pills 500 mg 3 pills per day vitamin E 80

Current Illness: no

ID: 1765699
Sex: F
Age: 72
State: CA

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/06/2021
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: Flagyl, Kenalog, Prednisone, Sulfa

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

Symptoms: Patient received a J&J shot around 11 am. She was in the observation area for a 1 hour observation per patient request due to her reaction to the Moderna vaccine in March (patient reported shortness of breath and throat swelling but did not seek emergency care). After about 40 minutes, she complained of dizziness and appeared pale and diaphoretic. She was lowered to the ground and legs were propped up on a chair. She did not lose consciousness. Patient was then assisted to a wheelchair and then over to the gurney. She complained of chest tightness that began when she was lying on the ground. Patient was advised to go to the ER for a workup due to cardiac history and chest tightness. She wanted to wait a while to see how she felt. She rested for another 20 minutes and said her chest tightness subsided a little but was still present and had moved to the left side of her chest. She agreed to go to the ER and was transported via wheelchair. VS: 142/78 HR 75 99% on RA.

Other Meds:

Current Illness:

ID: 1765700
Sex: F
Age: 43
State: TX

Vax Date: 04/01/2021
Onset Date: 04/19/2021
Rec V Date: 10/06/2021
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: COVID test (2x)- negative

Allergies: no

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: The second shot my arm was swollen for maybe 5 days but it went away. Roughly about 3 weeks I had a fever and chills, went to the doctor and it was determined I had the flu. I was out of work for 5 days. I took medicine and stayed hydrated. The end of September I had sinus issues and really bad sinuses. I went to the doctor and COVID test came back negative, they told me I just had a sinus infection. I was prescribed amoxicillin. It has been 3 weeks, and I am still having sinus issues. I can breathe through my nose though. I feel like my body is reacting differently now with the sinus infection than it previously has reacted.

Other Meds: none

Current Illness: no

ID: 1765701
Sex: M
Age: 38
State: OR

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data: Physician check up and physical exam with primary care provider. PCR Covid test to rule out actually having Covid Recommendations and referral to a neurology specialist

Allergies: Morphine - Anaphylaxis Demerol Prednisone

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Altered taste and smelling things not present such as smoke. My taste and smell have been "off" since the evening or receiving the vaccine. Things don't taste right. I keep smelling things that are not present, and my normally sensitive smell is off. Sensory issues: Feelings of poky/stinging sensations in my arms, hands, shoulder, legs, and feet. Ears plugged up the day I received the shot. Now diagnosed with an ear infection. Winded and out of breath. Daily headaches General feeling of being unwell. Lethargy and fatigue.

Other Meds: Testosterone Gel - 2% Daily Methylphenidate - 20MG once daily Clonazepam - .5mg as needed (roughly once a week) Fish oil extract - 3600 MG daily Vitmin D3 - 7500mcg daily

Current Illness: None

ID: 1765702
Sex: F
Age: 26
State: CA

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/06/2021
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: NA

Allergies: Dog and Cat dander

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

Symptoms: Patient received a Covid Pfizer vaccine but was originally given Moderna (2 doses) and should not have received Pfizer dose

Other Meds: Yasmin Aldactone Prozac Albuterol Inhaler Flonase nasal spray

Current Illness: NA

ID: 1765703
Sex: F
Age: 69
State: AR

Vax Date: 09/22/2021
Onset Date: 09/25/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data: Ultrasound.

Allergies: Prednisone.

Symptom List: Nausea

Symptoms: On September 25th my leg started hurting really bad. I called Monday to make an appointment because I thought I might have done something to my muscle. I went Tuesday 09/28/2021 and I take blood thinner so my Doctor said he did not think I would have a blood clot, but they did an Ultrasound and I did have a blood clot in my leg. They put me on Eliquis and said I would need to be treated for three months.

Other Meds: Effient Blood Thinner (has other medications but doesn?t want to list them), Multaq for afib.

Current Illness: No.

ID: 1765704
Sex: F
Age: 53
State: KS

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

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Moderna given as first shot 09/01/2021. Pfizer given as second shot 10/06/2021.

Other Meds:

Current Illness:

ID: 1765705
Sex: F
Age: 74
State: CA

Vax Date: 09/30/2021
Onset Date: 09/30/2021
Rec V Date: 10/06/2021
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: RASH AND SWELLING AT INJECTION SITE SHORTLY AFTETR INJECTION ON 9/30/21. AS OF TODAY 10/6/21, SWELLING IS GONE, RASH IS STILL THERE

Other Meds: UNKWOWN

Current Illness: NONE

ID: 1765706
Sex: F
Age: 43
State: LA

Vax Date: 10/03/2021
Onset Date: 10/03/2021
Rec V Date: 10/06/2021
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: NKDA

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

Symptoms: Patient reported swelling of the throat after receiving first dose of Pfizer Vaccine. Per protocol, 50mg Diphenhydramine administered IM to Right Upper Quadrant- Gluteal. Lot #6123821 Exp date 03/22. Immediate response to Benadryl, no further medication administration required. Patient discharged 30 minutes post vaccination.

Other Meds:

Current Illness:

ID: 1765707
Sex: M
Age: 29
State: AZ

Vax Date: 09/28/2021
Onset Date: 09/29/2021
Rec V Date: 10/06/2021
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: Tremor

Symptoms: 101.5 Fever, body aches, couldn't sleep or eat. Felt exactly like having COVID but more intense in a shorter time frame. Also felt numb and tingling in my arms and legs.

Other Meds: none

Current Illness: none

ID: 1765708
Sex: M
Age: 79
State: ID

Vax Date: 10/04/2021
Onset Date: 10/04/2021
Rec V Date: 10/06/2021
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: The covid vaccine vial was reconstituted with normal saline not with the diluent coming with the covid vaccine the one with pink top. This was not the right one. So the manufacturer stated that this is not valid and pt should do another dose in 6 months. Pt was receiving covid booster vaccine at that time.

Other Meds:

Current Illness:

ID: 1765709
Sex: F
Age: 47
State: SC

Vax Date: 09/14/2021
Onset Date: 09/20/2021
Rec V Date: 10/06/2021
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: none

Allergies: sulfa

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

Symptoms: skin rash over large areas - raised bumps - itching - seen by dr at yearly visit

Other Meds: xyzal,flonase,pepcid

Current Illness: seasonal allergies

ID: 1765710
Sex: F
Age: 68
State: SC

Vax Date: 10/04/2021
Onset Date: 10/05/2021
Rec V Date: 10/06/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: PATIENT PRESENTED WITH SWOLLEN RIGHT UPPER ARM BELOW THE DELTOID MUSCLE BUT ABOVE ELBOW. SHE HAD NOT TAKEN ANY TREATMENT, COUNSELLED TO TAKE SOME BENADRYL AND IF SYMPTOMS PERSIST SEEK MEDICAL ATTENTION.

Other Meds: TRAZODONE, ROPINIROLE, ANORO,GABAPENTIN,MELOXICAM

Current Illness:

ID: 1765712
Sex: F
Age: 47
State: WA

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

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Next day sore arm and numb. Unable to lift arm above head. Shortness of breath. Tightness in chest. Headache.

Other Meds:

Current Illness: None and unknown vaccination history

ID: 1765713
Sex: F
Age: 72
State: IN

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

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

Lab Data: None

Allergies: Allergic to sulfa, no other allergies

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

Symptoms: Headache, fever, fatigue, sore arm lasting 18 hours

Other Meds: No prescriptions, supplements: multi-vitamin, magnesium, calcium, vitamin E, vitamin C, low dose aspirin, cetirizine hydrochloride, oil of oregano

Current Illness: None

ID: 1765714
Sex: M
Age: 17
State: NY

Vax Date: 05/08/2021
Onset Date:
Rec V Date: 10/06/2021
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: N/A

Allergies: No

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

Symptoms: No adverse reaction

Other Meds: No

Current Illness: No

ID: 1765715
Sex: M
Age: 4
State: AZ

Vax Date: 10/05/2021
Onset Date: 10/06/2021
Rec V Date: 10/06/2021
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: n/a

Symptom List: Pain in extremity

Symptoms: swelling (size of a dime), redness, and warmth at the site of vaccination and surrounding area/shoulder, total area approx 3 inches

Other Meds: n/a

Current Illness: n/a

ID: 1765716
Sex: F
Age: 32
State:

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/06/2021
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: Patient arrived at vaccine site at approximately 1520 reporting that she had received dose 1 of the AstraZeneca COVID vaccine (lot 77673) in Mexico on 7/23/2021. She requested to receive the Pfizer COVID vaccine. PHN called PHN supervisor and the medical team. Dr from the medical team approved Pfizer vaccine series for the patient. Patient received dose 1 of the Pfizer COVID vaccine (lot 30145BA) at 1530. Patient waited in observation area, no report of adverse symptoms. Patient left walking at approximately 1548 with steady gait.

Other Meds:

Current Illness:

ID: 1765717
Sex: F
Age: 49
State: TX

Vax Date: 09/03/2021
Onset Date: 09/06/2021
Rec V Date: 10/06/2021
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: No known drug allergies

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

Symptoms: Patient reports intermittent generalized skin rash with blisters, "welts", and associated intermittent itching and "pins and needles" sensation. Occurs 4-5x per day and began 3 days after she received her first dose of Pfizer COVID-19 vaccine. Mainly occurs on her extremities and back but she also notices it on her face. Also reports her menstrual cycle is 2 days late and it is usually regular and always on time.

Other Meds: iron supplement over-the-counter

Current Illness: N/A

ID: 1765718
Sex: M
Age: 23
State: WA

Vax Date: 07/09/2021
Onset Date: 07/09/2021
Rec V Date: 10/06/2021
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: No known allergies. (food or meds) verified with patient. Allergic to tree pollen.

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

Symptoms: 2nd for vaccination in July. Since that time, day of the 2nd vaccine he has had intermittent ?hives". Describes a generalized rash "under the skin" happening a few times/week, lasting minutes to hours, itchy. History of hives as a child. Mother reports that this is similar to his hives as a child. Taking loratadine which has improved symptoms. When he forgets to take loratadine notices an outbreak of the rash. No rash today

Other Meds: Bupropion XL 300 mg. Gummy multi vitamins.

Current Illness: None

ID: 1765719
Sex: F
Age: 43
State: CA

Vax Date: 03/29/2021
Onset Date: 03/30/2021
Rec V Date: 10/06/2021
Hospital:

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

Lab Data: MRI, bloodwork

Allergies: none

Symptom List: Vomiting

Symptoms: Had L side shoulder and chest pain and L arm numbness. Later noticed worsening vision, diagnosed with stroke.

Other Meds: none

Current Illness: none

ID: 1765720
Sex: F
Age: 52
State: NY

Vax Date: 09/20/2021
Onset Date: 09/21/2021
Rec V Date: 10/06/2021
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: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Extremely emotional. Could not stop crying for 2 days. My period came 10 days earlier than expected and was heaviest in past 2 years.

Other Meds: multi vitamin, levothyroxine

Current Illness: none

ID: 1765721
Sex: F
Age: 22
State: NC

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/06/2021
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: Reporting a vaccine administration error. Patient was given a dose of Moderna vaccine that was expired at the time of administration. Vial that dose was drawn from was moved from freezer to fridge on 8/30/2021 at 8:45pm, starting a 30 day expiration per manufacturer. Error was discovered on 10/5/2021 after a subsequent vial from the same box was identified as being expired. Manufacturer was contacted on 10/6/2021 for guidance. Manufacturer indicated on 10/6/2021 that they will "conduct an analysis to determine if the vaccine administered past 30 days provided the necessary protection against a COVID-19 infection". Patient was contacted and informed of the vaccine administration error. Patient reports no AE's and is awaiting follow up guidance from manufacturer.

Other Meds:

Current Illness:

ID: 1765722
Sex: M
Age: 17
State: NY

Vax Date: 06/05/2021
Onset Date:
Rec V Date: 10/06/2021
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: No

Symptom List: Injection site swelling, Limb discomfort

Symptoms: None

Other Meds: No

Current Illness: No

ID: 1765723
Sex: F
Age: 71
State: LA

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

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

Lab Data:

Allergies: NKDA

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

Symptoms: Patient was seen on 10/5/21 for Pfizer Booster vaccine. Approximately 10 minutes into her post observation time she reported SOB and difficulty breathing. I was called into vaccine clinic where I assessed the patient and noted her labored breathing. Per WOG Emergency meds were pulled. 50 mg of Diphenhydramine was administered IM in upper right quadrant of gluteus. After 2 minutes patient was reassessed and declined needing further medication, no epinephrine was administered. Deep breathing practiced with the patient and within moments after the Benadryl injection patient reported feeling better. Her son was present, they denied needing further medical attention and opted to not take her in for further evaluation. I called to follow up with patient and her son today who reported she was doing well and only had mild discomfort at the injection site of her Covid vaccine.

Other Meds:

Current Illness:

ID: 1765724
Sex: F
Age: 62
State: UT

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

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

Lab Data: none

Allergies: none

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

Symptoms: none

Other Meds: none

Current Illness: none

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am