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: 1771157
Sex: M
Age: 19
State: MO

Vax Date: 09/20/2021
Onset Date: 09/22/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: His gums began to ooze/bleed; This spontaneous case was reported by a nurse and describes the occurrence of GINGIVAL BLEEDING (His gums began to ooze/bleed) in a 19-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 20-Sep-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 22-Sep-2021, the patient experienced GINGIVAL BLEEDING (His gums began to ooze/bleed). At the time of the report, GINGIVAL BLEEDING (His gums began to ooze/bleed) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. No concomitant medications provided. No treatment medications provided.

Other Meds:

Current Illness:

ID: 1771158
Sex: F
Age: 48
State: NY

Vax Date: 02/08/2021
Onset Date:
Rec V Date: 10/08/2021
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:

Symptom List: Anxiety, Dyspnoea

Symptoms: frozen shoulder; can't lift my arm all the way up; very restricted in motion; very sore shoulder where she had the vaccine; This spontaneous case was reported by a consumer and describes the occurrence of PERIARTHRITIS (frozen shoulder), HYPOKINESIA (can't lift my arm all the way up), MOBILITY DECREASED (very restricted in motion) and VACCINATION SITE PAIN (very sore shoulder where she had the vaccine) in a 49-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 001A21A and 039K20A) for COVID-19 vaccination. No medical history was provided by the reporter. On 08-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 11-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced PERIARTHRITIS (frozen shoulder), HYPOKINESIA (can't lift my arm all the way up), MOBILITY DECREASED (very restricted in motion) and VACCINATION SITE PAIN (very sore shoulder where she had the vaccine). The patient was treated with Physical therapy for Vaccination site pain. At the time of the report, PERIARTHRITIS (frozen shoulder), HYPOKINESIA (can't lift my arm all the way up), MOBILITY DECREASED (very restricted in motion) and VACCINATION SITE PAIN (very sore shoulder where she had the vaccine) outcome was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medication included unspecified cholesterol medication Treatment included physical therapy for pain and inflammation.; Sender's Comments: This case concerns a 49-year-old female patient with no relevant medical history, who experienced the unexpected non-serious events of periarthritis, hypokinesia and mobility decreased and the expected non-serious event of vaccination site pain. The events occurred on unknown days after the second dose of mRNA- 1273 vaccine / Moderna COVID-19 Vaccine. The rechallenge was not applicable, as the events were reported after the second dose and no additional dosing will be given. The benefit-risk relationship of vaccine is not affected by this report

Other Meds:

Current Illness:

ID: 1771159
Sex: M
Age: 21
State: CO

Vax Date: 03/01/2021
Onset Date: 09/29/2021
Rec V Date: 10/08/2021
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: Test Date: 202109; Test Name: Body temperature; Result Unstructured Data: 100.7 degrees Farenheight,

Allergies:

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

Symptoms: Sore left arm; Low grade fever , 100.7 degrees Farenheight; Slight headache; Generalized weakness; This spontaneous case was reported by a consumer and describes the occurrence of ASTHENIA (Generalized weakness), PAIN IN EXTREMITY (Sore left arm), PYREXIA (Low grade fever , 100.7 degrees Farenheight) and HEADACHE (Slight headache) in a 21-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 003B21A and 025A21A) for COVID-19 vaccination. Co-suspect product included non-company product INFLUENZA VACCINE (FLU) for an unknown indication. Concurrent medical conditions included Arthritis and Immunocompromised. Concomitant products included METHOTREXATE for an unknown indication. On 01-Mar-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 29-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 29-Sep-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 29-Sep-2021, the patient started INFLUENZA VACCINE (FLU) (unknown route) at an unspecified dose. On 29-Sep-2021, the patient experienced ASTHENIA (Generalized weakness), PYREXIA (Low grade fever , 100.7 degrees Farenheight) and HEADACHE (Slight headache). On an unknown date, the patient experienced PAIN IN EXTREMITY (Sore left arm). At the time of the report, ASTHENIA (Generalized weakness), PAIN IN EXTREMITY (Sore left arm), PYREXIA (Low grade fever , 100.7 degrees Farenheight) and HEADACHE (Slight headache) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In September 2021, Body temperature: 100.7 (High) 100.7 degrees Farenheight. The patient received his flu shot at the same time that he received his third dose of Moderna Covid-19 vaccine. The side effects were generalized weakness, low grade fever of 100.7 degrees Fahrenheit and a slight headache. Patient also reported a sore left arm. Treatment information was not provided. This case was linked to MOD-2021-339370, MOD-2021-339390 (Patient Link).

Other Meds: METHOTREXATE

Current Illness: Arthritis; Immunocompromised

ID: 1771160
Sex: F
Age:
State: AZ

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

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

Lab Data: Test Date: 202110; Test Name: EKG; Result Unstructured Data: normal

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Chest pain; This spontaneous case was reported by a consumer and describes the occurrence of CHEST PAIN (Chest pain) in a 26-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 01-Oct-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 01-Oct-2021, the patient experienced CHEST PAIN (Chest pain). At the time of the report, CHEST PAIN (Chest pain) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In October 2021, Electrocardiogram: normal (normal) normal. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Concomitant medication information was not provided by the reporter. Treatment information was not provided by the reporter.

Other Meds:

Current Illness:

ID: 1771161
Sex: F
Age: 54
State: FL

Vax Date: 12/31/2020
Onset Date:
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: Test Name: Body temperature; Result Unstructured Data: ELEVATED

Allergies:

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

Symptoms: sore arm; This spontaneous case was reported by a consumer and describes the occurrence of PAIN IN EXTREMITY (sore arm) in a 25-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 039K20A) for COVID-19 vaccination. No Medical History information was reported. On 31-Dec-2020, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced PAIN IN EXTREMITY (sore arm). The patient was treated with PARACETAMOL (TYLENOL) at an unspecified dose and frequency. At the time of the report, PAIN IN EXTREMITY (sore arm) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Body temperature: elevated (High) ELEVATED. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. NO Concomitant medication was reported This case was linked to MOD-2021-339433 (Patient Link).

Other Meds:

Current Illness:

ID: 1771162
Sex: M
Age:
State: NY

Vax Date: 01/01/2021
Onset Date: 06/01/2021
Rec V Date: 10/08/2021
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: Test Date: 202106; Test Name: SARS-CoV-2 test; Test Result: Positive ; Result Unstructured Data: Positive

Allergies:

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

Symptoms: Tested positive for COVID-19 disease; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 03-Oct-2021 and was forwarded to Moderna on 03-Oct-2021. This spontaneous case was reported by a consumer and describes the occurrence of COVID-19 (Tested positive for COVID-19 disease) in a 69-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. In January 2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. In June 2021, the patient experienced COVID-19 (Tested positive for COVID-19 disease). At the time of the report, COVID-19 (Tested positive for COVID-19 disease) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): In June 2021, SARS-CoV-2 test: positive (Positive) Positive. No concomitant medications are provided. No treatment medications are provided.; Sender's Comments: This case concerns a 69-year-old male patient with no relevant medical history reported, who experienced non serious unexpected event of special interest COVID-19. The event occurred approximately 5 months after the second dose of Spikevax however, the exact time to onset was unknown. Rechallenge was not applicable since the event occurred after the second dose. The benefit-risk relationship of drug is not affected by this report. Although the time between the second dose and the event was more than15 days, Lack of efficacy not captured since there are no exact vaccination dates and time between doses.

Other Meds:

Current Illness:

ID: 1771163
Sex: F
Age: 50
State: NJ

Vax Date: 04/05/2021
Onset Date: 09/30/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Received the 4th dose; This spontaneous case was reported by a nurse and describes the occurrence of INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Received the 4th dose) in a 50-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 058E21A, 019B21A, 048B21A and 017B21A) for COVID-19 vaccination. No Medical History information was reported. On 05-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 07-May-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 03-Sep-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 30-Sep-2021, received fourth dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 30-Sep-2021, after starting mRNA-1273 (Moderna COVID-19 Vaccine), the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Received the 4th dose). On 30-Sep-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Received the 4th dose) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Concomitant product use was not provided by the reporter. Treatment information was not provided by the reporter.

Other Meds:

Current Illness:

ID: 1771164
Sex: F
Age:
State: GA

Vax Date:
Onset Date:
Rec V Date: 10/08/2021
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: Pharyngeal swelling

Symptoms: met 2 people who are having issues after receiving the Moderna COVID-19; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of VACCINATION COMPLICATION (met 2 people who are having issues after receiving the Moderna COVID-19) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. Unknown) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced VACCINATION COMPLICATION (met 2 people who are having issues after receiving the Moderna COVID-19). At the time of the report, VACCINATION COMPLICATION (met 2 people who are having issues after receiving the Moderna COVID-19) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. Concomitant medications were not reported. Treatment details not provided.

Other Meds:

Current Illness:

ID: 1771165
Sex: U
Age: 63
State: CO

Vax Date: 08/02/2021
Onset Date: 08/02/2021
Rec V Date: 10/08/2021
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: itching really bad; arms, tights trunk, and everything except my head/itch; the itch went more to a tingling; never received the second dose of the Moderna COVID-19 Vaccine; This spontaneous case was reported by a consumer and describes the occurrence of PRURITUS (itching really bad), PRURITUS (arms, tights trunk, and everything except my head/itch), PARAESTHESIA (the itch went more to a tingling) and PRODUCT DOSE OMISSION ISSUE (never received the second dose of the Moderna COVID-19 Vaccine) in a 63-year-old patient of an unknown gender who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 048C21A) for COVID-19 vaccination. Concurrent medical conditions included Shellfish allergy. On 02-Aug-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 02-Aug-2021, the patient experienced PRODUCT DOSE OMISSION ISSUE (never received the second dose of the Moderna COVID-19 Vaccine). On an unknown date, the patient experienced PRURITUS (itching really bad), PRURITUS (arms, tights trunk, and everything except my head/itch) and PARAESTHESIA (the itch went more to a tingling). The patient was treated with DEXAMETHASONE for Itching, at an unspecified dose and frequency; HYDROCODONE for Itching, at an unspecified dose and frequency; METHYLPREDNISOLONE (MEDROL [METHYLPREDNISOLONE]) for Itching, at an unspecified dose and frequency and IVERMECTIN for Tingling, at an unspecified dose and frequency. On 02-Aug-2021, PRODUCT DOSE OMISSION ISSUE (never received the second dose of the Moderna COVID-19 Vaccine) had resolved. At the time of the report, PRURITUS (itching really bad), PRURITUS (arms, tights trunk, and everything except my head/itch) and PARAESTHESIA (the itch went more to a tingling) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. It was reported that the patient had experienced itching like bug bites on arms, tights trunk everywhere except head, went to urgent care on 21-Aug-2021, doctor suggested that the tingling and heat was internal not external, like a nerve issue. Patient did not received 2nd dose of Moderna COVID-19 vaccine as per the advise of the doctor. Treatment includes: V Vitamins and nerve support, And Antihistaminic drug. No concomitant medications were reported

Other Meds:

Current Illness: Shellfish allergy

ID: 1771166
Sex: M
Age: 24
State: MA

Vax Date: 04/21/2021
Onset Date: 08/10/2021
Rec V Date: 10/08/2021
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:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Had been out at sea for over 3 months and came to receive his second dose upon his arrival back on land; This spontaneous case was reported by an other health care professional and describes the occurrence of INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Had been out at sea for over 3 months and came to receive his second dose upon his arrival back on land) in a 25-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 003f21a and 001c1a) for COVID-19 vaccination. No Medical History information was reported. On 21-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 10-Aug-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On 10-Aug-2021, the patient experienced INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Had been out at sea for over 3 months and came to receive his second dose upon his arrival back on land). On 10-Aug-2021, INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (Had been out at sea for over 3 months and came to receive his second dose upon his arrival back on land) had resolved. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant medication of the patient was not reported. No treatment information was provided by the reporter. This case was linked to MOD-2021-281283 (Patient Link).

Other Meds:

Current Illness:

ID: 1771169
Sex: F
Age: 24
State: FL

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/08/2021
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: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1771170
Sex: F
Age: 65
State: NY

Vax Date: 10/05/2021
Onset Date: 10/06/2021
Rec V Date: 10/08/2021
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: Site: Swelling at Injection Site-Mild, Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Mild, Systemic: Abdominal Pain-Mild, Systemic: Body Aches Generalized-Mild, Systemic: Exhaustion / Lethargy-Mild, Systemic: Fainting / Unresponsive-Medium, Additional Details: patient also claimed to have a decrease in appetite post vaccination.

Other Meds:

Current Illness:

ID: 1771171
Sex: F
Age: 37
State: IN

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

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

Lab Data:

Allergies:

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

Symptoms: Error: Wrong patient (documentation in EMR).

Other Meds:

Current Illness:

ID: 1771172
Sex: M
Age: 18
State: IL

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/08/2021
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: Systemic: Chills-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Shakiness-Medium

Other Meds:

Current Illness:

ID: 1771173
Sex: M
Age: 53
State: ME

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/08/2021
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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

Other Meds:

Current Illness:

ID: 1771174
Sex: F
Age: 38
State: NY

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/08/2021
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: Peanuts, coconuts, eggs, mangoes, wheat, pineapples

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

Symptoms: Complained of throat itching and dizziness

Other Meds: Symbicort, Albuterol

Current Illness: Asthma

ID: 1771175
Sex: M
Age: 73
State: IN

Vax Date: 10/06/2021
Onset Date: 10/07/2021
Rec V Date: 10/08/2021
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: pennicilan

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

Symptoms: Flu like symtoms, head ache and low fever.

Other Meds: Flomax, Miled blood pressuer

Current Illness: none

ID: 1771176
Sex: F
Age: 48
State: IL

Vax Date: 10/05/2021
Onset Date: 10/06/2021
Rec V Date: 10/08/2021
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: Systemic: Lymph Node Swelling-Mild

Other Meds:

Current Illness:

ID: 1771177
Sex: F
Age: 30
State: CA

Vax Date: 02/10/2021
Onset Date: 08/21/2021
Rec V Date: 10/08/2021
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: Irregular menstruation including 12-day period

Other Meds:

Current Illness:

ID: 1771178
Sex: M
Age: 38
State: NJ

Vax Date: 10/04/2021
Onset Date: 10/04/2021
Rec V Date: 10/08/2021
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: Systemic: Numbness (specify: facial area, extremities)-Medium

Other Meds:

Current Illness:

ID: 1771179
Sex: F
Age: 46
State: NC

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

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Systemic: Flushed/Sweating-Mild, Systemic: Hyperventilation-Medium.

Other Meds:

Current Illness:

ID: 1771180
Sex: M
Age: 57
State: IL

Vax Date: 04/11/2021
Onset Date: 04/11/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data:

Allergies: None.

Symptom List: Unevaluable event

Symptoms: TINNITUS.

Other Meds: Lisinopril; Rusastatin.

Current Illness: None.

ID: 1771181
Sex: F
Age: 57
State: GA

Vax Date: 10/04/2021
Onset Date: 10/05/2021
Rec V Date: 10/08/2021
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: Site: Bruising at Injection Site-Severe, Site: Pain at Injection Site-Severe, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium

Other Meds:

Current Illness:

ID: 1771182
Sex: F
Age: 36
State: TX

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

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Pain

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1771183
Sex: M
Age: 46
State: PR

Vax Date: 06/03/2021
Onset Date: 06/03/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: N/A

Allergies: Unknown

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient reports respiratory difficulty. Pt attended by emergency medical personnel. Pt is anxious, sweaty, he presented hypertension and then hypotension. VS 160/100, P 64, Sat 92% without o2 P62, 99% sat with 02 was performed and Pt will be transferred to Hospital.

Other Meds: Unknown

Current Illness: Unknown

ID: 1771184
Sex: F
Age: 83
State: OK

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/08/2021
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: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

Other Meds:

Current Illness:

ID: 1771185
Sex: M
Age: 50
State: IN

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

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

Lab Data: None

Allergies: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Vomiting, diahreah and spinning effect

Other Meds: None

Current Illness: None

ID: 1771186
Sex: F
Age: 49
State: CA

Vax Date: 09/28/2021
Onset Date: 09/29/2021
Rec V Date: 10/08/2021
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: Site: Swelling at Injection Site-Severe, Systemic: lymph node/armpit area is tender and swollen-Severe, Systemic: Lymph Node Swelling-Severe, Systemic: Vomiting-Mild, Additional Details: extreme fatigue and extreme lymph node swelling and tenderness on same side of injection site

Other Meds:

Current Illness:

ID: 1771187
Sex: M
Age: 47
State: VA

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/08/2021
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: NA

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

Symptoms: extreme soreness at injection site, extended period of body chills, nausea, headache, chest pain/heartburn, low temperature(96 deg), joint pain - lower extremities All beginning 12 hours after shot. Took 200mg ibuprofen to relieve pain. At 20 hour mark body chills turned to sweating and other symptoms remain the same

Other Meds: NA

Current Illness: NA

ID: 1771188
Sex: F
Age: 41
State: OH

Vax Date: 03/22/2021
Onset Date: 05/01/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Nausea

Symptoms: Sudden cease of menstruation

Other Meds: N/A

Current Illness: N/A

ID: 1771189
Sex: F
Age: 76
State: FL

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/08/2021
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: Error: Incorrect reconstitution.

Other Meds:

Current Illness:

ID: 1771190
Sex: F
Age: 65
State: DC

Vax Date: 10/03/2021
Onset Date: 10/04/2021
Rec V Date: 10/08/2021
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 induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Site: Bruising at Injection Site-Medium, Site: Itching at Injection Site-Medium, Site: Pain at Injection Site-Medium, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium, Additional Details: Patient will be monitored by her provider and pharmacist

Other Meds:

Current Illness:

ID: 1771191
Sex: M
Age: 17
State: NY

Vax Date: 10/02/2021
Onset Date: 10/04/2021
Rec V Date: 10/08/2021
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: penicillin

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

Symptoms: Severe facial swelling (angioedema) reported 2 days after the vaccination, received vaccine Saturday 10/02/2021 without incident, reported back to pharmacy on Monday morning 10/04/2021 reportinf allergic reaction that started early mornin on 10/04/2021, reported to ER then to pharmacy to notify.

Other Meds: none

Current Illness: none

ID: 1771192
Sex: F
Age: 70
State: CA

Vax Date: 10/04/2021
Onset Date: 10/04/2021
Rec V Date: 10/08/2021
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: Site: Itching at Injection Site-Mild, Site: Redness at Injection Site-Medium, Site: Swelling at Injection Site-Medium

Other Meds:

Current Illness:

ID: 1771193
Sex: F
Age: 75
State: CA

Vax Date: 09/27/2021
Onset Date: 09/28/2021
Rec V Date: 10/08/2021
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: Systemic: Body Aches Generalized-Medium, Systemic: Chills-Medium, Systemic: Fever-Medium, Systemic: Headache-Severe

Other Meds:

Current Illness:

ID: 1771194
Sex: F
Age: 87
State: VA

Vax Date: 08/23/2021
Onset Date: 08/23/2021
Rec V Date: 10/08/2021
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: Systemic: Tingling (specify: facial area, extemities)-Medium, Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-, Additional Details: no taste. stomach issue

Other Meds:

Current Illness:

ID: 1771195
Sex: F
Age: 78
State: MO

Vax Date: 10/02/2021
Onset Date: 10/02/2021
Rec V Date: 10/08/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

Other Meds:

Current Illness:

ID: 1771196
Sex: F
Age: 30
State: IL

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

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

Lab Data:

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Pain in armpit/lymph node Feels tender to touch

Other Meds: DROSPIRENONE-EE 3-0.03 MG TAB TABLET OMEPRAZOLE-BICARB 20-1,100 CAP CAPS

Current Illness: None

ID: 1771197
Sex: M
Age: 65
State: CT

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

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

Lab Data:

Allergies:

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

Symptoms: Error: Shoulder Joint Injury (prolonged pain, tingling, etc.)-

Other Meds:

Current Illness:

ID: 1771199
Sex: F
Age: 78
State: KS

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

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Site: Bruising at Injection Site-Mild, Site: Pain at Injection Site-Mild, Site: Redness at Injection Site-Mild, Site: Swelling at Injection Site-Mild

Other Meds:

Current Illness:

ID: 1771200
Sex: F
Age: 24
State: PR

Vax Date: 06/03/2021
Onset Date: 06/03/2021
Rec V Date: 10/08/2021
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: Unknown

Symptom List: Pain in extremity

Symptoms: Observation Area Patient felt dizziness, desire to vomit and weakness in the body Paramedic gave him oxygen and took his vitals. Pt recovered.

Other Meds: unknown

Current Illness: Unknown

ID: 1771201
Sex: M
Age: 38
State: MO

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/08/2021
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: Systemic: Fainting / Unresponsive-Mild, Systemic: Flushed / Sweating-Mild, Systemic: Hypertension-Mild, Additional Details: patient was given pfizer and flu shot, one on each arm. while waiting patient started coming to the pick up register and got dizzy and fainted. temperature was normal bp: 162/ 108 and hr: 104 bpm. Emergency serivces came in about 10 minutes to take a look at the patient and they cleared him stating his vitals were returning to normal. Pt stated for another 20-30 min and left stated he was feeling better.

Other Meds:

Current Illness:

ID: 1771202
Sex: F
Age: 65
State: NV

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/08/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: Error: Wrong Patient (documentation in EMR)-

Other Meds:

Current Illness:

ID: 1771203
Sex: F
Age: 43
State: RI

Vax Date: 09/26/2021
Onset Date: 09/26/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: None

Allergies: None

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

Symptoms: Headache almost every day since the vaccine Heartburn almost every day since the vaccine Bowel issues including constipation Fluttering in chest periodically Periods of overheating and lightheadedness None of these symptoms are normal for me

Other Meds: None

Current Illness: None

ID: 1771204
Sex: M
Age: 43
State: TX

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

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

Lab Data:

Allergies:

Symptom List: Vomiting

Symptoms: Error: Improper Storage (temperature)-

Other Meds:

Current Illness:

ID: 1771394
Sex: M
Age: 48
State: MO

Vax Date: 10/08/2021
Onset Date: 10/08/2021
Rec V Date: 10/08/2021
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: PCN

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Employee due for second COVID vaccination. Missed on his form that his first vaccination was Pfizer. We have primarily administered Moderna at our facility. When sitting down to document administration noted his prior immunization was Pfizer. Spoke with pharmacy director and advised to complete VEARs form. Employee with no adverse effects. He was monitor after immunization per protocol. Employee was notified of the error.

Other Meds:

Current Illness:

ID: 1771395
Sex: F
Age: 47
State:

Vax Date: 10/05/2021
Onset Date: 10/05/2021
Rec V Date: 10/08/2021
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: Itchy rash along arm

Other Meds:

Current Illness:

ID: 1771396
Sex: M
Age: 47
State: KY

Vax Date: 09/27/2021
Onset Date: 09/27/2021
Rec V Date: 10/08/2021
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 Known Allergies

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient arrived to receive their 3rd Pfizer COVID vaccine but was given a dose of the Moderna COVID vaccine.

Other Meds: None

Current Illness: None

ID: 1771397
Sex: F
Age: 62
State: CA

Vax Date: 03/30/2021
Onset Date: 06/28/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: She did a chest X-ray that looked normal . She ordered a cardiogram, I had not had yet due to waiting on a refferal. I had a echo to see was is cardiac related or respitory. I hadn't got the results yet.

Allergies: Yes. KEFLEX and azithromycin

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

Symptoms: I had a bad cough and shortness of breath. No fever. I was fatigued. It happened in late June after my husband brought home to me. I started getting sick.

Other Meds: LEXAPRO; trazodone; fenofibric acid; flax seed oil for dry eyes; multivitamins D and E and baby aspirin

Current Illness: NO

ID: 1771398
Sex: F
Age: 39
State: TX

Vax Date: 03/25/2021
Onset Date: 09/08/2021
Rec V Date: 10/08/2021
Hospital:

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

Lab Data: EEG - 10/05/2021 - Results pending MRI - 10/07/2021 - Results are clear (no signs of damage)

Allergies: None

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

Symptoms: Tingling headaches, tremors on left side of body (including face, shoulder, arm, leg, foot). Loss of sensation and muscle weakness on left side of body. Vertigo.

Other Meds: None

Current Illness: None

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am