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: 1776660
Sex: M
Age: 72
State: FL

Vax Date: 02/26/2021
Onset Date: 03/03/2021
Rec V Date: 10/11/2021
Hospital: Y

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

Lab Data: CT Scan of the brain; MRI; Ultrasound of carotid arteries; Bubble test; Ultrasound of the heart; Repeated cognitive tests.

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: What I initially noticed was some problems with my vision. After trying to narrow it down, I was able to figure out that in the upper left quadrant of my field of vision, I had to blank areas. This persisted for about 15-20 mins and then it began to get better. After 30 mins, I was completely recovered. The blank areas were visible with both eyes, so I knew it wasn't a problem with the eyes. It was a brain problem. I went to the ER and they immediately took me in to run tests and observation. By that time, nothing showed up in the tests. They kept me all that day in the ER and then I spent the night on a bed in the ER. They kept me until early afternoon the next day. They moved me up to a hospital room. Finally they discharged me about 6:30PM.

Other Meds: Levothyroxine; Alopurinol; Tamsulosin; Lovastatin; Therelux XR

Current Illness:

ID: 1776661
Sex: M
Age: 32
State: FL

Vax Date: 10/10/2021
Onset Date: 10/10/2021
Rec V Date: 10/11/2021
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: Systemic: Confusion-Severe, Systemic: Dizziness/Lightheadedness-Severe, Systemic: Fainting/Unresponsive-Severe, Systemic: Flushed/Sweating-Medium, Additional Details: The patient received shot and was waiting in resting area. His wife received her shot. When we opened the door to exit vaccine room, he had fallen and was trying to get up. He had carpet burns on his nose and bruise above right eye. The NP form minute clinic came over took his vitals, heart rate which were normal. She advised he let us call an ambulance to have him checked out for concussion since no one say him fall but patient refused. After 30 minutes patient was able to leave on his own.

Other Meds:

Current Illness:

ID: 1776663
Sex: F
Age: 63
State: NY

Vax Date: 04/22/2021
Onset Date: 06/01/2021
Rec V Date: 10/11/2021
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: Blood Work 06/2021

Allergies: N/A

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

Symptoms: Pt. states that after receiving the 2nd dose of Phizer 04/22/2021, started experiencing symptoms 06/2021 of constant fatigue, headaches, loose stool, dry coughing, sneezing, and mild irritation. Primary visit 06/2021 Blood Work checked, recommendation for Antibiotics continue use seems to subside the symptoms but expiration of use Symptoms Return. ENT specialist seen with no recommendations.

Other Meds: Operimate, Kepra, Speriva

Current Illness: N/A

ID: 1776664
Sex: F
Age: 32
State: OH

Vax Date: 04/01/2021
Onset Date: 09/15/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data: Positive COVID-19 PCR test on 09/17/2021, chest x-ray on 09/21/2021

Allergies: Amoxicillin, penicillin

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Breakthrough case of COVID-19 at 26 weeks pregnant including fever of 103+ for four days, fatigue/exhaustion, congestion, severe cough lasting over 3 weeks, reduced oxygen saturation, diarrhea, headache, loss of taste & smell, tinnitus (still unresolved nearly a month later). Treated with oral and inhaled steroids and monoclonal antibody infusion.

Other Meds: Prenatal vitamin

Current Illness: None

ID: 1776665
Sex: M
Age: 50
State: TN

Vax Date: 01/30/2021
Onset Date: 09/25/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data: PSA 3.8

Allergies: none

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

Symptoms: diagnosed with prostate cancer after PSA doubled in 1 year after vaccination

Other Meds: Avapro, Cymbalta

Current Illness: none

ID: 1776666
Sex: F
Age: 56
State: VA

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

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Systemic: Abdominal Pain-Medium, Systemic: Body Aches Generalized-Severe, Systemic: Chills-Severe, Systemic: Confusion-Medium, Systemic: Diarrhea-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Medium, Systemic: Fainting / Unresponsive-Severe, Systemic: Fever-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Headache-Medium, Systemic: Nausea-Medium, Systemic: Unable to Sleep-Severe, Additional Details: Severe Palpitation

Other Meds:

Current Illness:

ID: 1776667
Sex: M
Age: 33
State: WV

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

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

Lab Data:

Allergies: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Witnesses report that the patient made a snoring sound and was seizing in chair. This was approximately 5 minutes after the immunization while the patient was in the waiting area. Upon discovery of his situation by a witness, the patient fell out of his chair and lacerated his eye, broke a tooth, and injured his nose (resulting in blood spraying from the roof of his nose). The immunizing pharmacist, upon being notified by a witness had a staff member call 911 and the other pharmacist gloved up and stopped the bleeding with cotton balls and pressure. EMS arrived and evaluated the scene. The pt reported to them that he has "passed out" after an injection in college.

Other Meds: Unknown

Current Illness: Unknown

ID: 1776668
Sex: M
Age: 12
State: NH

Vax Date: 09/30/2021
Onset Date: 10/01/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data: 10/2 covid neg, 10/4 covid neg (all home tests)

Allergies: none

Symptom List: Pharyngeal swelling

Symptoms: developed itchy red welt like hives at injection site (L deltoid) from L shoulder to elbow. also c/o nausea. no breathing problems. this reaction occurred approx 17 hours after injection. child never had a reaction to flu or any vaccine in the past. no allergies to anything. 3/4 family members received their flu shot at this same clinic on different days/times. Mother was told day before due to her documented latex allergy that there is a rubber stopper in the vial, but Mother choose to proceed with vaccine. There was no mention of rubber stopper with her son, but he has no documented latex allergy. child went to school nurse at 11am on Fri 10/1 and had to be sent home due to symptoms. 10/2 child developed cold symptoms and was covid neg. child missed school 10/4 and 10/5 due to cold symptoms. child missed 2.5 days of school total.

Other Meds: Prozac 20mg, melatonin 3mg, multivitamin chewable Olly kids multi gummy worms

Current Illness: none

ID: 1776669
Sex: F
Age: 38
State:

Vax Date: 09/25/2021
Onset Date: 09/25/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data:

Allergies: Ofloxacin; Penicillin

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Vomiting; dizziness.

Other Meds: Syeda

Current Illness:

ID: 1776670
Sex: M
Age: 63
State:

Vax Date: 06/09/2021
Onset Date: 10/09/2021
Rec V Date: 10/11/2021
Hospital: Y

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: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series

Other Meds:

Current Illness:

ID: 1776671
Sex: F
Age: 34
State: WI

Vax Date: 09/11/2021
Onset Date: 09/11/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data: I was treated in Hospital ER 10/5/21 for Gastritis. I did not receive treatment for the abnormal menstration. I did miss work because of both incidents.

Allergies:

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

Symptoms: I started menstrating the night of my first dose. Menstration came 2 weeks early. It was the worst menstration cycle I have ever had in my life. I have been spotting daily since 9/11/21. My period did not come during it's usual week. Weekend of October 1 to 7 of 2021 I had a Gastritis flare up that has not occurred in 7 years. I did not have anything abnormal. It was the worst flare up I have experienced. I ended up in the ER at Hospital for relief.

Other Meds: sertraline

Current Illness:

ID: 1776672
Sex: F
Age: 19
State: AZ

Vax Date: 10/10/2021
Onset Date: 10/11/2021
Rec V Date: 10/11/2021
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: no

Symptom List: Rash, Urticaria

Symptoms: Chills, fever, fatigue, muscle soreness, headache, muscle pain, skin sensitivity

Other Meds: bc

Current Illness: no

Date Died: 10/08/2021

ID: 1776673
Sex: F
Age: 82
State: MI

Vax Date: 10/01/2021
Onset Date: 10/08/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data:

Allergies: knda

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

Symptoms: Patient was alert, ambulating in hallway. Patient a sudden, unexpected death in her sleep. Most likely suspect pulmonary embolis. However, patient has no pre-exisiting condition to explain this sudden death

Other Meds: Cymbalta Relafen

Current Illness: Dementia and urinary incontinence

ID: 1776674
Sex: F
Age: 52
State: KY

Vax Date: 04/29/2021
Onset Date: 08/25/2021
Rec V Date: 10/11/2021
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: COVID Antigen Positive 8/25/2021

Allergies:

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

Symptoms: Breakthrough case after Covid vaccination. Dose #1 4/1/2021 Dose #2 4/29/2021. C/O muscle aches, runny nose, fatigue, and cough, onset 8/25/2021

Other Meds:

Current Illness:

ID: 1776676
Sex: F
Age: 16
State: GA

Vax Date: 10/05/2021
Onset Date: 10/07/2021
Rec V Date: 10/11/2021
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: Systemic: Allergic: Rash (specify: facial area, extremeties)-Mild, Systemic: Numbness (specify: facial area, extremities)-Mild, Additional Details: extremeties

Other Meds:

Current Illness:

ID: 1776677
Sex: F
Age: 57
State: AL

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 10/11/2021
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: High fever, headache, body aches, vomiting 4 weeks later -episode of severe dizziness and SOB

Other Meds:

Current Illness: none

ID: 1776678
Sex: F
Age: 45
State: IN

Vax Date: 04/06/2021
Onset Date: 04/07/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data: Lung X-ray 6/11/2021 ECHO 6/16/2021 ECG 6/23/2021 Bloodwork 6/30/2021 Cardiac Mri with stress test 7/21/2021 Stress treadmill test 8/9/2021 Bloodwork 8/13/2021

Allergies: None

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

Symptoms: The day following my second vaccine I started having chest pain on the right side of my chest where my lung is. I felt it was my lung so I assumed it was because of my asthma and me having been outside a lot the day prior. It persisted so I made an appointment with my primary health provider, but I couldn?t get an appointment for a month. The chest pain lasted the entire month and occurred every day, but wasn?t constant. Besides the chest pain I could breath fine except I felt like I couldn?t fully empty my lungs. She listened to my lungs and they sounded fine, but ordered an X-ray. The X-ray showed just a little fluid in them so she ordered an ECHO. The echo showed cardiomyopathy so she referred me to a cardiologist. All my bloodwork is fine. Dr said I had significant heart failure with EF less than 30% alone with the cardiomyopathy with mild enlargement of left ventricle. I don?t have high cholesterol and my BP is only mildly elevated when I go to the dr, but at home it tests fine. I am obese. I had a cardiac MRI a month later (was the earliest they could get me in). The mri already showed EF improvement to 45% and nothing was enlarged. I had a stress test a couple weeks later and it showed no blockages. The cardiologist has put me on Entresto for the heart failure and a beta blocker to slow my heart to give it time to heal. She put me on these right after I had the ECHO.

Other Meds: Albuterol, vitamin d, singulair, Zyrtec, omeprazole, ibuprofen

Current Illness: None

ID: 1776679
Sex: F
Age: 66
State: FL

Vax Date: 10/09/2021
Onset Date: 10/09/2021
Rec V Date: 10/11/2021
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: Site: Bruising at Injection Site-Mild, Site: Swelling at Injection Site-Mild, Additional Details: The needle initially did not go in easily (only the point) so I changed the needle. During 2nd attempt, needle went in fine, I administerd the vaccine, upon removal of the syringe, there was slight bleeding and I used a cotton ball and it stopped bleeding. Afterwards I noticed swelling at the injection site the size of a nickle. Pt had no other reaction.

Other Meds:

Current Illness:

ID: 1776680
Sex: M
Age: 83
State:

Vax Date: 02/12/2021
Onset Date: 09/21/2021
Rec V Date: 10/11/2021
Hospital: Y

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

Lab Data: Rapid COVID test = positive

Allergies: NKDA

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient presents to the ED on 9/21/2021 with fatigue and sob x 2 days. He was started on oxygen (2L nasal cannula), dexamethasone, and remdesivir. While hospitalized, he received 5 days of remdesivir, 7 days of dexamethasone, was weaned off oxygen, and discharged to home on 9/28/2021.

Other Meds:

Current Illness:

ID: 1776682
Sex: M
Age: 72
State: NC

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

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

Lab Data: NONE

Allergies: NKA

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

Symptoms: gave pt Pfizer Booster and he had previously received Moderna

Other Meds: Norvasc, insulin, Calcium, Coreg, Zyrtex, Cipro, Voltaren, Oxycontin,Viagra, Zocor,

Current Illness: DM, GERD, ERSRD,

ID: 1776684
Sex: F
Age: 75
State: NC

Vax Date: 10/05/2021
Onset Date: 10/06/2021
Rec V Date: 10/11/2021
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: None

Allergies: None

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

Symptoms: Red swollen knot.Tender and itchy.

Other Meds: Simvistatin,Irbesartan, Magnesium.

Current Illness: None

ID: 1776685
Sex: F
Age: 37
State: WA

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/11/2021
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: amitriptyline, hyedocodone-acetamonphen

Symptom List: Unevaluable event

Symptoms: Patient reported "very woozy", pain, nausea, and "felt faint" at time of injection. The following 3 days patient had, shoulder pain, pain while trying to move shoulder, redness, weakness in L arm, "clicking" in L shoulder

Other Meds: multi vitamin, sertraline

Current Illness: none

ID: 1776686
Sex: F
Age: 57
State: SC

Vax Date: 04/05/2021
Onset Date: 04/05/2021
Rec V Date: 10/11/2021
Hospital: Y

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

Lab Data: CT scan blood work

Allergies: Sulfa drugs, Sipro, bees

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

Symptoms: The ER stated I had a severe T-cell reaction. My arm, neck, face blow up four times the size. And I had fever and a lot of pain.

Other Meds: Yes

Current Illness: No

ID: 1776687
Sex: F
Age: 34
State: AR

Vax Date: 04/02/2021
Onset Date: 10/02/2021
Rec V Date: 10/11/2021
Hospital: Y

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

Lab Data:

Allergies: Iodine, latex, soy, adhesive tape, corn, peanut, porcine

Symptom List: Injection site pain, Pain

Symptoms: fully vaccinated for covid; hospitalized

Other Meds: unknown

Current Illness: unknown

ID: 1776688
Sex: M
Age: 64
State: MI

Vax Date: 04/21/2021
Onset Date: 10/08/2021
Rec V Date: 10/11/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: ***BREAKTHROUGH CASE*** Patient Covid - on 10/08/2021. Patient received Pfizer vaccine with 1st dose on 03/31/2021 and 2nd dose on 04/21/2021. Patient hospitalized. Per ED Note: History of Present Illness This is 64-year-old male past medical history of pulmonary fibrosis on home oxygen of 4 L as needed is presenting to the emergency department today with complaints of low oxygen level. States that he was diagnosed 2 days ago with Covid when he went to an urgent care because he had some nausea and vomiting. He overall has been having diffuse myalgias. He states that he tried to get up to make breakfast earlier today and felt increasingly short of breath anytime that he was trying to ambulate. He has been taking Tylenol for his headache which is mostly left-sided in nature nonradiating and described as a throbbing. Currently rated a 5 out of 10. Denies any fevers, chest pain, shortness of breath, pleuritic pain, numbness or tingling or weakness or dysuria.

Other Meds:

Current Illness:

ID: 1776689
Sex: M
Age: 81
State: KY

Vax Date: 02/01/2021
Onset Date: 08/16/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data: COVID 19 Antigen Positive 8/25/2021

Allergies:

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

Symptoms: Breakthrough case after Covid vaccination. Dose # 1 01/04/2021 Dose #2 02/01/2021. C/O runny nose, headache, and cough. Onset 8/16/2021

Other Meds:

Current Illness:

ID: 1776690
Sex: M
Age: 85
State:

Vax Date: 05/26/2021
Onset Date: 10/09/2021
Rec V Date: 10/11/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series

Other Meds:

Current Illness:

ID: 1776691
Sex: F
Age: 52
State: GA

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

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

Lab Data: None at this time

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Injection site reaction - redness greater than the size of a quarter, itching, sensation of being pricked around the site, injection site pain

Other Meds: Pantoprazole Sodium Augmentin 875 mg

Current Illness: None

ID: 1776692
Sex: F
Age: 37
State: TX

Vax Date: 09/10/2021
Onset Date: 09/10/2021
Rec V Date: 10/11/2021
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: Covid on 19 sep2021

Allergies: No

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

Symptoms: Fatigue and headache that evening at 8pm. Next day same. A week later after 9 nine days diagnosis Covid. 17 and 18 Sep - headache and congestion. On 19 urgent care and got tested. I deteriorated with fatigue and headache. By Wednesday, I had diarrhea and got 23Sep monoclonal infusion. After or 24Sep - my Covid symptoms were gone, Crohn's systems flared up again. 24Sep stared the steroids.

Other Meds: Multivitamin; mercaptopurine; LEXAPRO

Current Illness: No

ID: 1776693
Sex: M
Age: 12
State: GA

Vax Date: 07/03/2021
Onset Date: 08/25/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data: EKG - normal The doctor said he may have experienced an inflammation in the heart.

Allergies: None

Symptom List: Nausea

Symptoms: Breathing problems Difficulty in taking a deep breath He was given Motrin by the doctor.

Other Meds: Motrin

Current Illness: None

ID: 1776694
Sex: F
Age: 58
State: AK

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

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

Lab Data: None, patient did not seek emergency care and declined f/u in clinic visit related to symptoms.

Allergies: NKA

Symptom List: Injection site pain

Symptoms: She reports a temp of up to 100.7, body aches, malaise, extreme chills, and reports her legs gave out and couldn't walk Friday night. She reports she had to crawl from the bathroom. She reports she felt "Punky" all weekend and does not feel "100%" today.

Other Meds: Vitamin D, calcium, albuterol, flonase

Current Illness: None per patient

ID: 1776695
Sex: F
Age: 27
State:

Vax Date: 10/08/2021
Onset Date: 10/08/2021
Rec V Date: 10/11/2021
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: 10/8, 5:00 pm: sweating, took shower, went to sleep 9:00 pm: sweating, temperature 100 degree f, took Tylenol, got very itchy 10/9, 1:00 am: took Benadryl for itching, did not help 1:00 pm: temperature 99.8, body aches, hands and feet with pins and needles sensation. 2:00 pm: took shower and notice hives on arms, chest, hands and feet, took Benadryl and Tylenol 10:00 pm: pins and needles sensation in hands and feet worsened, reddened finger tips and soles of feet 10/10: temperature 99.3, hives faded but still itchy, still have pins and needles sensation in hands and feet

Other Meds:

Current Illness:

ID: 1776696
Sex: F
Age: 15
State: PA

Vax Date: 09/01/2021
Onset Date: 09/04/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data: None

Allergies: None.

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

Symptoms: Patient's menstrual cycle is pretty regular til after the second shot.

Other Meds: Vyvanse, Sertraline, multi-vitamin.

Current Illness: Patient's menstrual cycle has been pretty regular until now. No illnesses to report.

ID: 1776697
Sex: F
Age: 70
State: VA

Vax Date: 10/09/2021
Onset Date: 10/10/2021
Rec V Date: 10/11/2021
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: Tremor

Symptoms: 10/092021 Fatigue and moderate pain at injection site 10/10/2021 Awakened at 4am with a pinching pain in armpit, same arm as injection site (left) Applied warm heating pad to armpit. Pain subsided, but needed to reapply several times throughout the day. Severely fatigued, slept several hours throughout the day, loss of appetite, and lo-grade fever (100 degreesF) 10/11/2021 Temperature normal (97 degrees F) Pinching pain in left armpit. Swelling in armpit is visible to the eye.

Other Meds: None

Current Illness: None

ID: 1776698
Sex: M
Age: 72
State: OH

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data: finger stick gluc 102 transferred to nearest ED,, I do not have the nearest ED records for his full labs or diagnostics during the time I am reporting this adverse event.

Allergies: NKDA

Symptom List: Erythema, Pruritus

Symptoms: Fifteen min after the infection; he states, " I can't breath". " I don't feel right". States, he feels like he cannot get his breath. c/o dizziness and lightheadedness. Denied chest pain. Facial flushing appreciated; vital signs included; his skin was clammy. 187/71 : HR 118 Pulse ox : 94% 02 placed at 2 liters per nc.

Other Meds: Lovastatin, losartan, amlodipine, synthroid, loratidine, asa 81 mg, vit d,

Current Illness: none

ID: 1776699
Sex: M
Age: 69
State: MO

Vax Date: 03/27/2021
Onset Date: 10/06/2021
Rec V Date: 10/11/2021
Hospital: Y

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: unknown

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

Symptoms: developed COVID 10/06/2021 including myalgias, chills, and confusion. Admitted to hospital on 10/07/2021. Discharged to home on room air on 10/09/2021

Other Meds: unknown

Current Illness: unknown

ID: 1776700
Sex: M
Age: 17
State: WI

Vax Date: 04/13/2021
Onset Date: 04/16/2021
Rec V Date: 10/11/2021
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: Cough, Limb discomfort, Pain, SARS-CoV-2 test positive

Symptoms: He felt fine the day of the vaccine and then felt some mild flu symptoms the next day that lasted most of the day and he napped a bit. Then 3 days after the vaccine his hands were blue, and not like a fresh bruise but blue in a sense of a healing bruise (aqua blue). He had no other symptoms at the time and it cleared up within about 20 minutes it started to lessen and cleared up completely within the hour. He had no other areas of his body (lips, feet) that appeared blue, and he said it was just his hands. He was not overly concerned by it, but I was. I discussed it with the Doctor but by the time I got home there was nothing on him to examine. I do have some pictures.

Other Meds: None

Current Illness: None

ID: 1776701
Sex: F
Age: 75
State:

Vax Date: 10/09/2021
Onset Date: 10/10/2021
Rec V Date: 10/11/2021
Hospital: Y

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

Lab Data:

Allergies: Allergies Allergen Reactions ? Imipramine Hives ? Emetrol Unknown (See Comments) ? Fenofibrate Other (See Comments) Myalgias ? Flagyl [Metronidazole] Nausea And Vomiting and GI Intolerance ? Other Nausea And Vomiting and GI Intolerance steroids ? Phenergan [Promethazine Hcl] Nausea And Vomiting and GI Intolerance ? Prednisone Unknown (See Comments) ? Pristiq [Desvenlafaxine Succinate Er] ? Prochlorperazine Nausea Only Other reaction(s): Nausea Only ? Prochlorperazine Edisylate Nausea Only ? Rosuvastatin Calcium Itching ? Serzone [Nefazodone] ? Tofranil [Imipramine Hcl] ? Tramadol ? Wellbutrin [Bupropion] ? Metoclopramide Anxiety

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Pt presents to the ED c/o altered mental status noticed this morning by her husband. Last known normal was reportedly 2300 last night. She received her Covid booster shot yesterday. She does complain of fever today but presents to ER with 103.2. She denies headache. She denies chest pain, shortness of breath, nausea, vomiting, abdominal pain. She reports that she is having difficulty getting words out.

Other Meds: amLODIPine (NORVASC) 5 MG tablet Take 1 tablet by mouth Daily for 180 days. atorvastatin (LIPITOR) 20 MG tablet Take 1 tablet by mouth Daily. benztropine (COGENTIN) 0.5 MG tablet Take 0.5 mg by mouth Daily. carvedilol (COREG) 6.25 MG tab

Current Illness:

ID: 1776702
Sex: M
Age: 58
State:

Vax Date: 03/27/2021
Onset Date: 10/09/2021
Rec V Date: 10/11/2021
Hospital: Y

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: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series

Other Meds:

Current Illness:

ID: 1776703
Sex: F
Age: 76
State: TX

Vax Date: 02/06/2021
Onset Date: 02/10/2021
Rec V Date: 10/11/2021
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: EKG; Echocardiogram; Heart monitor; Heart catherization; Ablation

Allergies: Sulfa

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

Symptoms: From the seventh day, fatigue continued. I just felt not well and then I realized that I felt pressure in my chest and heart and a loss of appetite. I barely got around each day. I had to ask neighbors to walk my dog because I didn't have the energy. I was finally able to see my cardiologist on Feb. 27th, I was in A-fib, he prescribed me Eloquis and Flexicide. He ordered an Echo and put me on a 2-week heart monitor. I went back a week later and they started me on another medication and changed the way I was taking Flexicide. I still feel crappy. I went in on March 16th, he looked at my background and Echo results and I had elevated pulmonary pressure and still in A-fib. He started me on Lasix and said he wanted to do a heart catherization. They found only one 80% blockage and put a stent in. My 2-week heart monitoring showed I was in A-fib the entire two weeks. I went back for follow up April 6th, I was still in A-fib and they sent me for an ablation. I went to the doctor for the ablation on April 27th. The ablation was successful but I had a slow recovery. It was the end of August before I started feeling normal again.

Other Meds: Yes

Current Illness: Chronic Lymphocytic Leukemia(CLL)

ID: 1776704
Sex: F
Age: 44
State: CA

Vax Date: 09/10/2021
Onset Date: 09/26/2021
Rec V Date: 10/11/2021
Hospital: Y

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

Lab Data: CT HEAD W/O CONTRAST Sep 28, 2021 TEE COMPLETE Sep 28, 2021 HOMOCYSTEINE Sep 28, 2021 ECHO COMPLETE Sep 27, 2021 US CAROTID DUPLEX Sep 27, 2021 US LOWER EXTREMITY VENOUS BILAT Sep 27, 2021 CT HEAD W/O CONTRAST Sep 27, 2021 CBC WITHOUT DIFFERENTIAL Sep 27, 2021 BASIC METABOLIC PANEL Sep 27, 2021 MAGNESIUM Sep 27, 2021 PHOSPHORUS Sep 27, 2021 PROTHROMBIN TIME Sep 27, 2021 ACTIVATED PARTIAL THROMBOPLA? Sep 27, 2021 MISC LAB - TYPE IN, BLOOD Sep 27, 2021 FACTOR II MUTATION BY PCR Sep 27, 2021 FACTOR V LEIDEN BY PCR Sep 27, 2021 CARDIOLIPIN ANTIBODIES, IGG & IGM Sep 27, 2021 ANTITHROMBIN III Sep 27, 2021 FACTOR VIII ASSAY Sep 27, 2021 ESTIMATED GLOMERULAR FILTRATI? Sep 27, 2021 LIPID PANEL Sep 27, 2021 COMPREHENSIVE METABOLIC PANEL Sep 27, 2021 COMPLETE BLOOD COUNT Sep 27, 2021 DIFFERENTIAL Sep 27, 2021 ESTIMATED GLOMERULAR FILTRATI? Sep 27, 2021 MRI BRAIN W/ AND W/O CONTRAST Sep 26, 2021 MRV BRAIN W/O CONTRAST Sep 26, 2021 POC URINALYSIS DIPSTICK Sep 26, 2021 XR CHEST 1 VIEW Sep 26, 2021 HEMOGLOBIN A1C Sep 26, 2021 C-REACTIVE PROTEIN, (CRP HS, CAR? Sep 26, 2021 HOMOCYSTEINE Sep 26, 2021 SEDIMENTATION RATE, WESTERGREN Sep 26, 2021 CT BRAIN PERFUSION Sep 26, 2021 CTA HEAD & NECK Sep 26, 2021 SARS-COV-2 MOLECULAR(RAPID-AB? Sep 26, 2021 CT HEAD W/O CONTRAST Sep 26, 2021 COMPLETE BLOOD COUNT Sep 26, 2021 ACTIVATED PARTIAL THROMBOPLA? Sep 26, 2021 PROTHROMBIN TIME Sep 26, 2021 TROPONIN I, HIGH-SENSITIVITY Sep 26, 2021 COMPREHENSIVE METABOLIC PANEL Sep 26, 2021 DIFFERENTIAL Sep 26, 2021 ESTIMATED GLOMERULAR FILTRATI? Sep 26, 2021 ECG ROUTINE 12 + LEADS Sep 26, 2021 POC GLUCOSE Unknown Provider Sep 26, 2021

Allergies: none

Symptom List: Pain in extremity

Symptoms: Stroke; at 1:30 pm Sept.26 left arm became non-responsive; called 911; in ER left side of face began to feel numb and left leg was becoming weaker; doctors administered stroke medicine at 5pm after which left arm started responding, but fingers were still numb;

Other Meds: none

Current Illness: none

ID: 1776705
Sex: M
Age: 60
State: VA

Vax Date: 10/04/2021
Onset Date: 10/05/2021
Rec V Date: 10/11/2021
Hospital: Y

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

Lab Data: EKG 10-5 to 10-7, chest x-ray, 10-5 chest ultrasound 10-6, blood drawn

Allergies:

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

Symptoms: Afib/flutter with high heart rate

Other Meds: Zocor Eliquis daily vitamin, Vit C, D, black pepper, lysine, beet root, fish oil

Current Illness:

ID: 1776706
Sex: M
Age: 73
State:

Vax Date: 10/05/2021
Onset Date: 10/05/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data: N/A

Allergies: Coconut.

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

Symptoms: Arm was sore for a few days after injection, been less stable walking but with vaccine has gotten worse, extremely tired and less patient, a really big change on how well he could walk, Things that I was doing before I wasn't able to do, Vomiting his regular medication.

Other Meds: Lictulose, Amlodginebecyae, carbidopa-ladzpa, Vitamin B1, Donepezil, multi Vitamin Centrum.

Current Illness: N/A

ID: 1776707
Sex: F
Age: 72
State: NY

Vax Date: 10/11/2021
Onset Date: 10/11/2021
Rec V Date: 10/11/2021
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: None

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

Symptoms: Intense lower back pain the radiates up and down within 5 minutes of receiving vaccine. Patient had flushed features and felt lightheaded

Other Meds: None

Current Illness: None

ID: 1776708
Sex: F
Age: 33
State: KY

Vax Date: 03/05/2021
Onset Date: 08/24/2021
Rec V Date: 10/11/2021
Hospital:

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

Lab Data: COVID Antigen Positive on 8/25/2021

Allergies:

Symptom List: Vomiting

Symptoms: Breakthrough case after Covid vaccination. Dose #1 2/1/2021 Dose #2 3/5/2021. C/O nausea/vomiting and diarrhea onset 8/24/2021

Other Meds:

Current Illness:

ID: 1776709
Sex: F
Age: 87
State: MI

Vax Date: 02/25/2021
Onset Date: 04/13/2021
Rec V Date: 10/11/2021
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: sulfamethoxazole

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient developed shingles

Other Meds: Cranberry, Simvastatin, Pioglitazone, Aricept, Toprol XL, Multivitamin, aspirin, tylenol, probiotic, vitamin D, irbesaratan

Current Illness: none

ID: 1776710
Sex: F
Age: 75
State:

Vax Date: 02/22/2021
Onset Date: 10/10/2021
Rec V Date: 10/11/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Admitted to Hospital on Date of Adverse Event [recorded in VAERS] for treatment of Covid-19 Positive following completion of Covid Vaccine Series

Other Meds:

Current Illness:

ID: 1776711
Sex: M
Age: 20
State: CA

Vax Date: 09/20/2021
Onset Date: 09/24/2021
Rec V Date: 10/11/2021
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: Have not gone to doctor for this yet because I was hopping it would go away. I will be going to office soon to see if there is anything that can be done.

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Less than a week after the J&J shot I started getting a metallic taste in my mouth whenever I eat. It has progressed to being able to smell it when I eat. The symptom has not gone away at all and it has been 18days.

Other Meds: Vitamin C, Multivitamin, Vitamin D

Current Illness: None

ID: 1776712
Sex: F
Age: 66
State:

Vax Date: 10/11/2021
Onset Date: 10/11/2021
Rec V Date: 10/11/2021
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: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: Vaccine administered after being in fridge for 31 days. Patient remained in clinic for 15 min after injection. No reaction noted while in clinic.

Other Meds:

Current Illness:

ID: 1776713
Sex: F
Age: 92
State: MI

Vax Date: 03/10/2021
Onset Date: 10/09/2021
Rec V Date: 10/11/2021
Hospital: Y

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: positive covid test 10/09/21, SOB, PNA

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am