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: 1768818
Sex: M
Age: 47
State: FL

Vax Date: 09/24/2021
Onset Date: 09/25/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: N/A

Allergies: PCN

Symptom List: Dysphagia, Epiglottitis

Symptoms: Vomiting

Other Meds: PANTOPRAZOLE 40MG in the am CITALOPRAM 40MG AM RISPERIDONE 4MG AT BEDTIME TRAZODONE 100MG 2 AT BEDTIME INVEGA TRENZA 819MG IM INJECTION 1x every 3 months ANGOGEL 1.62% 4 PUMPS (81 MG) IN AM ASPRIN 81MG AM ATORVASTATIN 10MG AT BEDTIME B12 50

Current Illness: None

ID: 1768819
Sex: M
Age: 96
State: IL

Vax Date: 10/05/2021
Onset Date: 10/05/2021
Rec V Date: 10/07/2021
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: UNKNOWN

Allergies: NO ALLERGIES TO FOOD, MEDICATIONS, PET OR ENVIRONMENTAL ALLERGIES INDICATED ON CONSENT FORM.

Symptom List: Anxiety, Dyspnoea

Symptoms: PATIENT HAD ADVERSE REACTION TO PNEUMOVAX 23 AND FLUZONE HD VACCINE; FOUND UNRESPONSIVE IN ROOM APPROXIMATELY 11 HOURS LATER; EMS NOTIFIED AND PATIENT TRANSFERRED TO HOSPITAL FOR WEAKNESS DUE TO VACCINE ADMINISTRATION.

Other Meds: UNKNOWN; NOT INDICATED ON VACCINATION CONSENT FORM

Current Illness: PATIENT REPORTED FEELING WELL ON CONSENT FORM

ID: 1768820
Sex: F
Age: 49
State: NM

Vax Date: 03/12/2021
Onset Date: 03/01/2021
Rec V Date: 10/07/2021
Hospital: Y

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: 09/06/2021 CT scan- gallbladder was gangrened

Allergies: None

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

Symptoms: After the first shot, my left breast was very painful. So painful. The nipple was excruciating painful. I have never had breast pain like that before. When I touched my breast, it was not hard or lumpy, it was just super painful. After I had the second shot on 04/07/2021 (lot number 016B21M), it was not much the pain in my left breast, but it was now in my right breast. It was so sore. It was really sore under my armpit as well. On the side underneath my armpit, like 3 inches, the under breast was so painful. It lasted for a couple of weeks. My right breast was also so heavy. It was very swollen, like if I was lactating but nothing was coming out of it. On my social media I have a number of friends that were complaining of the same breast pain. I even messaged one of my daughter's cousins because she also had the Moderna and she was having the same symptoms. I did research and I found that I should not have a mammogram because those symptoms were similar to breast cancer. I noticed women that have estrogen were kind of having more problems. After that I was having more pain in my belly on the right side. A week before 09/06/2021 I was feeling really sick. On 09/06/2021 I was throwing up, I could not even drink water. I could not keep anything down. I threw up nonstop for 6 and a half hours. I went to the ER. They did a CT scan. I had emergency surgery to take my gallbladder out. My gallbladder was gangrened. I had dead tissue inside. I was in the hospital for 3 days.

Other Meds: None

Current Illness: None

ID: 1768821
Sex: F
Age: 34
State: PA

Vax Date: 09/13/2021
Onset Date: 09/13/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: Head CT scan lab testing

Allergies: Bactrim

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: headache, dizziness, nausea, diarrhea, numbness in her left leg ( ?heaviness?).

Other Meds:

Current Illness:

ID: 1768822
Sex: F
Age: 47
State: HI

Vax Date: 09/01/2021
Onset Date: 09/20/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data:

Allergies: Penicillin Amoxicillin All fin fish

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

Symptoms: My thyroid condition ramped way up. My heart was in constant flutter for three days. My body temperature was all over the place. I lost 7 pounds in 48 hrs. I couldn?t sleep for three days. These are common symptoms of my thyroid acting up but it was extreme. Even for when it does this. It went away after three days but still hasn?t returned to normal.

Other Meds: Birth control

Current Illness: I have an overactive thyroid

ID: 1768823
Sex: M
Age: 62
State: KS

Vax Date: 10/05/2021
Onset Date: 10/05/2021
Rec V Date: 10/07/2021
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: No e

Allergies: None

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

Symptoms: Fever pain headache loss of appetite lethargy stomach cramps

Other Meds: Vitamin D magnesium lysinopril hydrclorothiazide

Current Illness: None

ID: 1768825
Sex: M
Age: 14
State: NY

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: NONE

Allergies: NONE

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient was given a Moderna Vaccine (first dose) during a time when this vaccine has not been approved for population under 18 years of age. No adverse reactions have been reported

Other Meds: NONE

Current Illness: NONE

Date Died: 07/15/2021

ID: 1768827
Sex: M
Age: 72
State: WA

Vax Date: 04/01/2021
Onset Date: 06/16/2021
Rec V Date: 10/07/2021
Hospital: Y

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

Lab Data: Hospital

Allergies: None

Symptom List: Pharyngeal swelling

Symptoms: He had a heart attack two months after receiving the shot. They had to put a stent in. He had blood clots they didn't know where they were coming from. One month later, July 12, he had another heart attack that killed him. They put him on a ventilator and after they removed that he was doing fine. Then they put him on rendezevere. It filled his lungs with fluid and he was gone in 12 hours. They murdered him.

Other Meds: None

Current Illness: None

ID: 1768828
Sex: M
Age: 30
State: TN

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/07/2021
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: No known allergies

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: After patient received his Janssen (J&J) vaccine, he was directed to sit for 15 minutes in front of our pharmacy area. Within the first minute of sitting down, another patient of the pharmacy who was standing by saw him and said he "didn't look good" and grabbed my attention. He fainted while in the chair for a few seconds, then regained consciousness. When I was next to the patient, I asked if he could hear me and feel my touch when I grabbed his hand, and he said yes. He began (and continued) sweating profusely. He said he had chills but was able to breathe normally. He began to turn a pale yellow/white in color. He lost consciousness a second time and began seizing for roughly 10 seconds. After regaining consciousness again, he was very flushed in the face with a faster pulse. He asked if he could lay down. I gave him ice for his neck to cool him down and had him lay down on the floor until paramedics arrived (verified this was okay with operator on the phone). He said that made him feel a lot better. I was informed he was not allowed to eat or drink anything per operator. Paramedics arrived and took him to the nearest hospital. Time course of roughly 30 minutes or less.

Other Meds: Unknown

Current Illness: N/A

ID: 1768829
Sex: F
Age: 35
State: CA

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

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

Lab Data:

Allergies: Penicillin

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Body/muscle aches. Headache. Fever. Hands trembling. Body trembling. Nausea

Other Meds: None

Current Illness: None

ID: 1768830
Sex: F
Age: 36
State: NC

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

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

Lab Data: Resistent and reflex tests, possibly blood work

Allergies: None.

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

Symptoms: I remember at the pharmacy, immediately when he did injection I felt a cooling and tingling sensation that went down my arm and I could feel it from injection site down to fingers. It felt very odd. I remember thinking it must be something different because I've never had that before. I asked the person administering vaccine about it and she seemed to think I was nuts. I sat in waiting area to be monitored for 10-15 minutes so I sat and my fingers felt numb and tingly like they were asleep or like I hit a nerve and it didn't go away. I was just sitting there in the waiting area and shaking my arm and rubbing it to see what the sensation was. Pharmacist noticed me and I described to him the sensation I was having and he said it was normal and while I was sitting there I googled it and I found nothing on there. I didn't have anything else happen and I drove home and told my husband and he said he was sure it would go away. I got home and sat on the couch and it took about 2-2 ? hours for the feeling to start to fade. Around same time frame I started feeling kind of a pain in my left side above shoulder in-between neck and shoulder by shoulder blade and hadn't exerted myself or changed positions or anything. I felt pain in back as I was sitting there and it was growing in intensity and it felt like a muscle pulled or contraction as I was sitting there. It was pretty miserable by the time I went to bed and I thought I would feel better in the morning and I was hoping it was all normal and I tried not to think about it. The next morning I did have typical arm pain at injection site but the pain from shoulder had radiated into arm and upper arm and shoulder into neck and I couldn't move that side of my body and couldn't turn my head or arm without pain. It was enough pain that I was in tears trying to sit up and move. I was nursing at the time and so I was trying to avoid inflammatory medicine and I was trying to go unmedicated but the pain was intense. I may have taken some medicine the following night. The pain was enough to keep me from sitting up and moving and carrying child and I couldn't really function well. I waited a couple days and it didn't subside or get better so I reached out to my Doctor and he thought it was strange so he did a video call with me and wanted me to come in to be examined. I went and described what I was feeling and he checked reflexes and motions and said that he didn't know what would be causing it but to keep an eye on it. It took about a week for it to start to dwindle down and 3-4 weeks until I could move comfortably.

Other Meds: Prenatal Vitamins.

Current Illness: None.

ID: 1768831
Sex: M
Age: 37
State: KS

Vax Date: 04/16/2021
Onset Date: 04/16/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: Patient motioned for help from this nurse and reported "I feel like I'm going to pass out." This nurse assisted patient to EMS room. Once seated on the cot, patient reports feeling better. He consumed water and snack during remainder of observation. patient reports doing well and assisted out of EMS room to exit.

Other Meds:

Current Illness:

ID: 1768832
Sex: M
Age: 52
State: TX

Vax Date: 10/04/2021
Onset Date: 10/05/2021
Rec V Date: 10/07/2021
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: No known

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

Symptoms: Fever, chills, nausea, diarrhea, vomiting started at 10 am the following morning. Another 12 hours and still having above-mentioned symptoms bit also one instance of passing out

Other Meds: Lisinopril, trazafobe, osteo-biflex

Current Illness: None

ID: 1768833
Sex: F
Age: 54
State: IL

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/07/2021
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: N/A

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

Symptoms: Initial 1st and 2nd dose were Moderna, 3rd dose given was Pfizer

Other Meds: None as stated by patient.

Current Illness: None as stated by patient.

ID: 1768834
Sex: F
Age: 76
State: GA

Vax Date: 09/19/2021
Onset Date: 09/28/2021
Rec V Date: 10/07/2021
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:

Date Died: 09/06/2021

ID: 1768835
Sex: M
Age: 87
State: GA

Vax Date: 02/16/2021
Onset Date: 08/23/2021
Rec V Date: 10/07/2021
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: MULTI SYSTEMS FAILURE, TRAUMATIC SUBDURAL HEMATOMA Death on 9/6/2021

Other Meds:

Current Illness:

ID: 1768836
Sex: F
Age: 70
State: IL

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

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

Lab Data: NONE

Allergies: NKA

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

Symptoms: PATIENT STATES INJECTION WAS VERY PAINFUL AND IT WAS GIVEN HIGH IN DELTOID; NOTICED IMMEDIATELY HER ARM HURT AND NOTICED AT HOME THAT IT WAS DIFFICULT TO LIFT HER ARM & WAS PAINFUL. THE PATIENT STATED SHE WENT TO SLEEP AND IT WAS IMPROVED THE NEXT DAY, WE CONTACTED HER AS SOON AS WE WERE AWARE OF THE ISSUE AND SHE WAS INSTRUCTED TO ICE THE AREA AND REPORT TO DOCTOR IF ANY SWELLING, WARMTH TO TOUCH, OR INCREASED PAIN. SHE WAS INSTRUCTED TO ICE THE AREA AND TAKE ANTI-INFLAMMATORIES IF WARRANTED AND SHE WILL RECEIVE A FOLLOW UP IN 3 DAYS.

Other Meds: N/A

Current Illness: N/A

ID: 1768837
Sex: F
Age: 27
State: TX

Vax Date: 10/06/2010
Onset Date: 10/06/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data:

Allergies: nkda

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Pt arrived to get her influenza vaccine and was given a 4 COVID vaccine. Patient reports feeling okay on the following day 10/7/21

Other Meds: none

Current Illness: no

ID: 1768838
Sex: F
Age: 73
State: GA

Vax Date: 09/18/2021
Onset Date: 09/28/2021
Rec V Date: 10/07/2021
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: 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: 1768839
Sex: F
Age: 71
State: IL

Vax Date: 02/15/2021
Onset Date: 02/22/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: MY TINNITUS IN BOTH EARS BECAME WORSE. THE LEFT EAR HAS MOSTLY SUBSIDED BUT MY RIGHT EAR IS NOW BOTHERSOME.

Other Meds: 5 mg rosuvastin

Current Illness: none

ID: 1768840
Sex: F
Age: 36
State: CA

Vax Date: 08/24/2021
Onset Date: 08/24/2021
Rec V Date: 10/07/2021
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: Blood work

Allergies:

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

Symptoms: I experienced two swollen lymph nodes above my collar bone.

Other Meds:

Current Illness:

ID: 1768841
Sex: M
Age: 59
State: NJ

Vax Date: 05/04/2021
Onset Date: 05/08/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: Physical ear check by primary care. then a 10 day course of antibiotics. Issue has not gone away since a few days after the 2nd shot. There are days where the ringing has been very low, but never gone. Please note, I have never had ringing in my ear prior to a few days after the second covid shot. I have been putting up with this, hoping it would go away at some point. It has not.

Allergies: None

Symptom List: Unevaluable event

Symptoms: A few days after my 2nd Pfizer shot, I woke up to a ringing in my left ear. At first it was mild and hardly noticeable. After a week or two, the ringing increased, but at times would go away. I put up with this symptom for several weeks, perhaps even a month or more. Eventually, I went to my primary care doctor who looked into the ear, and felt I could be at the start of an ear infection. I was prescribed a routine anti biotic for 10 days. It seemed to improve slightly but returned after a few weeks. I have been putting up with a mild ringing ever since. In the past 2 weeks, the loudness of the ringing has increased. This has prompted me to fill out this form, just in case you have any suggestions.

Other Meds: Levoxyl, Fosinopril, Eloquis, Metoprolol, Atorvastatin, Panpropozol, Daily Vitamin

Current Illness: None

ID: 1768842
Sex: F
Age: 32
State: MI

Vax Date: 09/30/2021
Onset Date: 10/03/2021
Rec V Date: 10/07/2021
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: Full audiogram Auditory MRI scheduled for 10-25-2021

Allergies: NKDA

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

Symptoms: Vertigo and sudden onset complete neurosensorial hearing loss of right ear. Sent to ENT for evaluation and Transtympanic steroid injection. Confirmation by audiology of hearing loss. Onset of symptoms 3 days after vaccine. Currently in treatment no improvement as of this date

Other Meds: taking Multivitamin

Current Illness: None

ID: 1768843
Sex: F
Age: 64
State: CA

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: N/A

Allergies: N/A

Symptom List: Injection site pain, Pain

Symptoms: PT WAS REQUESTING FLU SHOT, BUT LVN-OUTSIDE CONTRACTOR MISTAKENLY GIVEN PFIZER COVID SHOT INSTEAD. PT ENDED UP GETTING BOTH FLU SHOT (AND PFIZER ON THE SAME ARM-PREFERRED BY PT). PT FIRST 2 SHOTS RECEIVED MODERNA (2ND SHOT ON 3/8/21).

Other Meds: N/A

Current Illness: N/A

ID: 1768844
Sex: F
Age: 73
State: GA

Vax Date: 09/22/2021
Onset Date: 09/28/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

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: 1768845
Sex: F
Age: 38
State: MN

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/07/2021
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: 65+ dose administered to 38 year old employee Heart palpitations following that night for a few hours

Other Meds:

Current Illness:

ID: 1768846
Sex: F
Age: 43
State: NY

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/07/2021
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: HR: 130, R 20, BP 130/80 , SAT 99%

Allergies: lasix, zithromycin, bacitracin.

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Patient complained of numbness and tingling bilateral lower extremities, dry mouth, lethargic, headache, shortness of breath, numbness of lower lips, light headed. patient presented with clammy skin, slurred speech, dry mouth, tachycardia, n/v x2.

Other Meds: n/a

Current Illness: n/a

ID: 1768847
Sex: M
Age: 57
State: IL

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Initial 2 doses were Moderna, 3rd dose given was Pfizer.

Other Meds:

Current Illness:

ID: 1768848
Sex: F
Age: 20
State: NY

Vax Date: 09/24/2021
Onset Date: 10/04/2021
Rec V Date: 10/07/2021
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: n/a

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

Symptoms: Extreme flare-up of eczema around eyes. The other day when I noticed it began I couldn't open my eyes when I first woke up; since then every morning I've had puffy eyes with a ring of eczema around both eyes. I currently have blurry and foggy vision. The last time I had eczema around my eyes was Fall 2016, but it was nowhere near as painful and prominent as this. I was mandated by my college to get the vaccine, to which I was very much personally against getting, even after my doctor wrote a letter to the college stating I do not need the vaccine, supporting my belief not to get the covid vaccine. The school did not agree with me, I was told to take a sort of leave of absence, or get vaccinated. I am not sure that the vaccine is directly responsible for this recent painful flare-up of eczema on my face, but it is the only thing recently that has been out of the ordinary. I am cautious with products I use, as I often get eczema on my hands. The eczema on my face currently is the worse case of eczema I have ever experienced.

Other Meds: Vitamin D supplement

Current Illness: n/a

ID: 1768849
Sex: F
Age: 39
State:

Vax Date: 12/30/2020
Onset Date: 10/04/2021
Rec V Date: 10/07/2021
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: PATIENT HAD PFIZER VACCINE ON 12/30/2020, and 01/20/2021, AND TESTED POSITIVE TO COVID.

Other Meds:

Current Illness:

ID: 1768850
Sex: F
Age: 72
State: GA

Vax Date: 09/18/2021
Onset Date: 09/28/2021
Rec V Date: 10/07/2021
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: 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: 1768851
Sex: F
Age: 65
State: IA

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/07/2021
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: Ceftin, Sulfa, Clindamycin, Erythromycin, Hydrocodone-acetaminophen, Tramadol, Prednisone, Cefuroxime Axetil, Penicillin G,

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

Symptoms: Patient was inadvertently given 0.3mL of Pfizer COVID undiluted

Other Meds: unknown

Current Illness: none

ID: 1768852
Sex: F
Age: 47
State: KS

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 10/07/2021
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: Patient has migraine and did not take medication this morning. Brought to EMS room for a quieter environment. Patient given 2nd vaccine in EMS room. patient became nauseated. Laid patient down. Cold pack and water given. Patient stayed in EMS room for approximately 45 minutes. Patient felt okay to leave once 45 minutes passed.

Other Meds:

Current Illness:

ID: 1768853
Sex: F
Age: 56
State: GA

Vax Date: 09/22/2021
Onset Date: 09/28/2021
Rec V Date: 10/07/2021
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: 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: 1768854
Sex: F
Age: 84
State: IA

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/07/2021
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: N/A

Symptom List: Erythema, Pruritus

Symptoms: PFIZER BOOSTER GIVEN AS 3RD SHOT. PATIENT HAD MODERNA FOR PREVIOUS 2 VACCINE.

Other Meds: N/A

Current Illness: N/A

ID: 1768855
Sex: F
Age: 30
State: MO

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/07/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies:

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

Symptoms: Headache Nose felt funny Left ear was hurting top throat itchy then bottom of throat was itchy 08:40 Inserted 24 gauge IV in Left AC Space 08:43 - Epi 0.5mg IM Left thigh 08:44 - Benadryl 50 mg administered via IV ear/nose/throat s/s improved Developed chest tightness, moved to floor elevated feet. EMS called. Transported via ambulance to ED.

Other Meds:

Current Illness:

Date Died: 09/08/2021

ID: 1768856
Sex: F
Age: 70
State: MO

Vax Date: 03/04/2021
Onset Date: 07/22/2021
Rec V Date: 10/07/2021
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: POSITIVE FOR COVID 19 ON 8/1/2021

Allergies: UNKNOWN

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

Symptoms: PATIENT DIED FROM COVID 19 AFTER BEING FULLY VACCINATED

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1768857
Sex: M
Age:
State: CA

Vax Date:
Onset Date:
Rec V Date: 10/07/2021
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: Tetanus

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Full body rash that started within 12 hours of injection and lasted another 36 hours General aches and chills and swelling at site of injection that lasted about 48 hours Painful Lymph node swelling under both arms, but the worst was under the right arm that started about 36 hours after injection and is still very sensitive, but the swelling is decreasing. 3 consecutive nights of night sweats, worst night was soaking bed clothes and sheets

Other Meds: None

Current Illness: None

ID: 1768858
Sex: F
Age: 16
State: MA

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

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

Lab Data:

Allergies: none

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

Symptoms: No adverse events occurred; however, the first dose of Moderna was an incorrect administration based on the patient's age; Provider noted incorrect administration of 1st dose realizing that Moderna's EUA had only approved administration of this vaccine for those 18 years old. The series was completed per CDC guidance for incorrect doses given to patients 16yo-17yo. The patient and guardian were informed and reported no side effects.

Other Meds: Multivitamin with calcium and minerals-folic acid; norgestimate-ethinyl estradioL, RETIN-A, polyethylene glycol, clindamycin phosphate, and ibuprofen

Current Illness: none

ID: 1768859
Sex: U
Age: 26
State: WA

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

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

Symptoms: Patient lost consciousness (twice) while sitting in the lobby and hit her head on the blood pressure machine. Small laceration and minor swelling was seen at the time. 911 was called and paramedics took the patient out of the building after checking her BP and blood glucose. Unknown if patient went to the hospital afterwards.

Other Meds: UNKNOWN

Current Illness: NONE

ID: 1768860
Sex: F
Age: 95
State: OH

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/07/2021
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: NKA

Symptom List: Pain in extremity

Symptoms: Resident previously received the Moderna series (2 vaccinations). She was given the Pfizer booster on 10/7/21 with no adverse reactions thus far. MD notified, family notified. Pharmacist administered the vaccine.

Other Meds: Carvedilol 6.25 mg po daily HCTZ 25 mg PO take 1/2 tab daily Tramadol 50 mg 2 tabs every 8 hours PRN pain Plaquenil 200 mg PO 2 tabs every M W F and one tab T Th Sa Su Amlodipine 5 mg PO daily ASA 81 mg PO daily Caltrate 600 with Vita

Current Illness: UNSTEADINESS ON FEET CHRONIC FATIGUE, UNSPECIFIED OTHER IRON DEFICIENCY ANEMIAS OTHER MALAISE ESSENTIAL (PRIMARY) HYPERTENSION ACQUIRED ABSENCE OF BOTH CERVIX AND UTERUS ACQUIRED ABSENCE OF OTHER SPECIFIED PARTS OF DIGESTIVE TRACT ACUTE APPENDICITIS WITH PERFORATION AND LOCALIZED PERITONITIS, WITH ABSCESS UNSPECIFIED CATARACT LOBULAR CARCINOMA IN SITU OF LEFT BREAST OTHER GIANT CELL ARTERITIS RHEUMATOID ARTHRITIS, UNSPECIFIED PAIN IN UNSPECIFIED JOINT HISTORY OF FALLING

ID: 1768861
Sex: F
Age: 87
State: CA

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

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

Lab Data:

Allergies: None

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

Symptoms: Chills, malaise/fatigue, GI nausea unable to eat, headache, cough, laryngitis. Severe arm soreness

Other Meds: Vitamin D, verapanil

Current Illness: None

ID: 1768862
Sex: F
Age: 50
State: NY

Vax Date: 08/25/2021
Onset Date: 08/26/2021
Rec V Date: 10/07/2021
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: Chocolate and opioid sensitivity

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

Symptoms: Migraines, extreme fatigue and joint pain, nausea and muscle cramps, much worse than on a daily basis

Other Meds: Venefexaline, Lynparza, Celebrex, magnesium, ginger, synthroid, atavastatin, and probiotic

Current Illness: I was exposed to mold while cleaning a family member?s house around the same time

ID: 1768863
Sex: F
Age: 18
State: KS

Vax Date: 08/13/2021
Onset Date: 08/13/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: N/A, I have aged out of my pediatrician and have been unable to find a new doctor

Allergies: Sulfa, Penicillin

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

Symptoms: After my first dose I began to experience severe shin pain and calf cramping within a few days as well as noticeable swelling and bloating all over my body. The night of the day I got my 2nd dose I very suddenly became horribly ill. I ran a 103 degree fever, was very fatigued and nauseous, had severe muscle pain, and horrible chills. These symptoms counited for about 5 days after words, with the added effect of severe swelling in my lymph nodes under my arms and by my groin. After my vaccine, I also had changes to my period. My period is now shorter, lighter, and farther apart than it was before. However, I get horrible bloating about a week and a half before my period and it lasts until my period is over. The bloating is uncomfortable and is almost enough to make me change clothing sizes and is all over my body, legs, hands, arms, belly, face, etc.

Other Meds: Zoloft (100mg) Fish Oil Women's Daily Iron (60mg) Melatonin (3mg) Probiotic complex

Current Illness: none

ID: 1768865
Sex: F
Age: 79
State: OK

Vax Date: 04/16/2021
Onset Date: 04/17/2021
Rec V Date: 10/07/2021
Hospital:

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

Lab Data: unremarkable workup. cbc, cmp, tsh, b12, vit d, iron/tibc/ferritin.

Allergies: nkda

Symptom List: Vomiting

Symptoms: fatigue ongoing for six months

Other Meds: tizanidine, naproxen, lisinopril, benadryl, klonopin, vitamin d OTC, norvasc

Current Illness: none

ID: 1768866
Sex: F
Age: 33
State: KS

Vax Date: 04/16/2021
Onset Date: 04/16/2021
Rec V Date: 10/07/2021
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:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient was sitting in observation. C/O itchiness to throat and neck. No redness or hives noted. States she is probably having a panic attack. No redness or hives noted. @2000 States itchiness to throat and neck has resolved. No complaints.

Other Meds:

Current Illness:

ID: 1768867
Sex: F
Age: 64
State: OH

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/07/2021
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: If I do not feel better within a day or so, will see my healthcare provider at Clinic.

Allergies: Laytex

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

Symptoms: Immediate pain in left arm Felt sinus opening up about 15 minutes in with ?medicine-like? taste in back of throat. 10:30 pm on day of vaccination began tingling sensation in extremities. Fingers were numb. 11:00 pm on day of vaccination I began to experience severe pain in knees, elbows, fingers, feet. Whole of body was achy. Began to have heart palpitations and fever shortly thereafter. Fever ran all night and next day at 101.4 degrees. Fever did not break until 6:00 pm next day. Feeling of tiredness and sore back muscles next day?like I was hit by a train.

Other Meds: None

Current Illness: None

ID: 1768868
Sex: M
Age: 68
State: AZ

Vax Date: 10/05/2021
Onset Date: 10/06/2021
Rec V Date: 10/07/2021
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: bee pollen

Symptom List: Injection site swelling, Limb discomfort

Symptoms: On 10.06.21 at 00:30 hours woke with headache, temperature of 101.4F, dry cough, legs aching, shortness of breath, O2 level 89 - 90,. Went to local clinic for Covid-19 test at 08:00 hours. PCP called around 13:00 hours who recommended go to hospital. After waiting 90 minutes only to find out that there were 40 patients ahead of us, went to urgent care. Put on O2, EKG taken. Was there about one hour.Sent to Medical Center by ambulance. Blood and urine samples taken. X-ray of lungs taken. Nothing was noted to be of concern. At hospital about 3 hours. Left at 19:00 hours.

Other Meds: Gabapentin Meloxicam Loratadine Melatonin D-3 Mature multivitamin

Current Illness: none

ID: 1768869
Sex: F
Age: 60
State: IN

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/07/2021
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: Morphine, codeine, diazipan

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

Symptoms: I waited the required 15 minutes and felt fine. At approximately 30 minutes post injection I started to itch. I realized I had hives on my legs. My lip was itchy, numb and my eyes felt swollen. I drove myself to the ER. There I received IV medications solumedraol, Pepcid, and Benadryl. After approx. 20 minutes the itching stopped. After approx. 40 minutes the hives had all dissapeared.

Other Meds: Dexilant, Trazodone, lisinopril, venlafaxin, synthroid, gabapentin, prednisone, Vitamin D w/vitamin K, asprin

Current Illness: Non

ID: 1768870
Sex: F
Age: 60
State: CA

Vax Date: 06/14/2021
Onset Date: 06/14/2021
Rec V Date: 10/07/2021
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:

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

Symptoms: CHOCKING SENSATION 30 MIN AFTER VACCINE MONTH AFTER HAS JOINT PAIN, MUSCLE IRRITATION AND EXTREMELY HIGH INFLAMMATORY MARKER PER PATIENT CRP OVER 70

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am