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: 1793908
Sex: F
Age: 48
State: FL

Vax Date: 07/01/2021
Onset Date: 09/07/2021
Rec V Date: 10/16/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Dysphagia, Epiglottitis

Symptoms: Shingles outbreak

Other Meds: Cevimeline Hydroxychloroquin Tizanidine Ibuprofen Montelukast Zinc Vit d Magnesium Calcium Vit c

Current Illness: None

ID: 1793909
Sex: U
Age:
State:

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

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

Lab Data: On 10/6/2021 I had a chest x-ray, blood work, and an EKG done at the ER after I was admitted.

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: The day after I got the shot about 3:30 I had just taken a hot bath and gotten out and started to profusely sweat, felt nauseated and so I went to get a drink of water and then I felt sick trying to cool down by getting under a fan and sipping water and then a few minutes later my hands and arms went tingly and numb and my hands closed and I could not open them for approximately 3 to 5 minutes after that I felt fine and then the next day about 5:30 in the afternoon I was resting on the couch after I got home from work and Started having chest pains and got up and thought if I moved around it would go away but it didn't and then I felt the pain going up into my neck and right jaw so I went and called my sister and took my blood pressure and it was 169/93 and that is when I thought I should go in and get checked out at the emergency. The emergency doctor ran bloodwork and did a chest x-ray and EKG and everything came back OK. I have a stress test scheduled for October 20th.

Other Meds:

Current Illness:

ID: 1793910
Sex: F
Age: 81
State: IN

Vax Date: 10/01/2021
Onset Date: 10/15/2021
Rec V Date: 10/16/2021
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: I have not sought medical treatment.

Allergies: None that I know of.

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

Symptoms: I do not know which flu shot I received. My symptoms are as follows. I received both shots about a half inch apart on my left arm. There was a sensation going up my neck on the left side and across my upper chest for a few seconds. I experienced fatigue for 2 days. My upper left arm has been swollen for 3 days and is slowly getting better. It looked like a large, red hive around the shot area. The red, swollen area is hot to the touch. I had soreness at the shot site for 2 days. I have used Cortaid on the site the last day or so and it seems to be improving.

Other Meds: Simvastatin, 40mg; Atenolol, 25mg; Lisinopril/Hctz, 10/12.5mg; Centrum Silver for Women; Tylenol for Arthritis; Aspirin, 81mg.

Current Illness: None

ID: 1793911
Sex: F
Age: 25
State: SC

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/16/2021
Hospital:

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

Lab Data: All performed 10/15/2021 EKG-tachycardia Chest x-ray?normal Troponin?normal CMP/CBC?normal MD suspected pleurisy or pleuritis related to vaccine dose. Second adverse event, first adverse event similar to reaction experienced with second dose; however, this adverse reaction to 3rd dose was significantly worse.

Allergies: Clindamycin

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Cheat pain?substernal pain radiating to back of chest, chest tightening and feeling of sandpaper scratching behind sternum Shortness of breath?both at rest and upon exertion Tachycardia?at rest, measured at 130 BPM Syncope/ feeling of faintness All occurred at the same time, chest pain still present 24 hours post vaccine

Other Meds: Prenatal vitamins?vitafusion gummies Zoloft Wellbutrin Zyrtec

Current Illness: NA

ID: 1793912
Sex: F
Age: 30
State: WV

Vax Date: 03/26/2021
Onset Date: 08/23/2021
Rec V Date: 10/16/2021
Hospital:

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

Lab Data: Gynecologist ruled out cysts and pap smear came back normal.

Allergies: N/A

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

Symptoms: Severe cramping during regular menstrual periods on 8/23/21, 9/19/21, & 10/16/21.

Other Meds: Fluoxetine 20mg

Current Illness: N/A

ID: 1793913
Sex: F
Age: 3
State: MD

Vax Date: 10/14/2021
Onset Date: 10/16/2021
Rec V Date: 10/16/2021
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: None

Allergies: Poison ivy

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

Symptoms: Daughter developed diffuse pruritic maculopapular rash on face, with isolated red patches on right arm and right leg as well. The index patch was on right leg; it developed within 24 hours of the flu shot administration. The next patch was on her right arm (within 36 hours). 48 hours after the shot, I discovered she had the facial rash when I woke her up that morning. She is currently being treated with oral antihistamines and Rx-strength topical corticosteroids. I recall that she had a similar reaction to another vaccine at approximately 1 year of age, though I cannot remember which vaccine precipitated the reaction. I submitted a VAERS report then as well, temporary ID was 167498.

Other Meds: None

Current Illness: Moderate poison ivy rash one month prior, treated with oral antihistamines and prescription strength topical steroids

ID: 1793914
Sex: F
Age: 29
State: NC

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/16/2021
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 known

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: I am having an adverse reaction to the COVID vaccine. It has been 10 days and I still have a welt that?s roughly 2 inches x 2.5 inches at the injection site. The welt is raised, itches, tender, and is warm to touch.

Other Meds: N/A

Current Illness: None

ID: 1793915
Sex: F
Age: 55
State: AZ

Vax Date: 09/22/2021
Onset Date: 09/23/2021
Rec V Date: 10/16/2021
Hospital:

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

Lab Data: blood work cat scan

Allergies: Lycria Gabapention Lidicaine

Symptom List: Pharyngeal swelling

Symptoms: Severe Abdominal pain that over the counter medication did not help severe headaches. Now they are treating me for ulcers and saying ulcerative colitis which ive never had before. They kept taking my blood over and over stating it was drawn too fast.

Other Meds: Geodon Lamictial Topamax Klonopin ropinril Abuterol Duclera Tylenol

Current Illness: None

ID: 1793916
Sex: F
Age: 42
State: AZ

Vax Date: 10/13/2021
Onset Date: 10/13/2021
Rec V Date: 10/16/2021
Hospital:

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

Lab Data: We did flu, covid, cbc and UA

Allergies: None

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Fever of 103, fatigue, urinary, frequency, body aches x48 hours after vaccine

Other Meds: None

Current Illness: None

ID: 1793917
Sex: F
Age: 68
State: NM

Vax Date: 10/16/2021
Onset Date: 10/16/2021
Rec V Date: 10/16/2021
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: A couple came in to receive their flu shots. The woman was supposed to get Fluad and the husband was to get Fluvax. The intern administered the vaccinations and got them mixed up so administered Fluad to the gentleman (58 years old) and the Fluvax to the woman.

Other Meds:

Current Illness:

ID: 1793918
Sex: F
Age: 55
State: UT

Vax Date: 06/19/2021
Onset Date: 06/21/2021
Rec V Date: 10/16/2021
Hospital:

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

Lab Data:

Allergies: acetaminophen

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

Symptoms: Patient had rash all over body for several days. Patient did not see a doctor and didn't tell me about it until much later.

Other Meds: Unknown

Current Illness:

ID: 1793920
Sex: M
Age: 33
State: KY

Vax Date: 10/15/2021
Onset Date: 10/15/2021
Rec V Date: 10/16/2021
Hospital:

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

Lab Data: ECG 12-LEADOrdered by MD, MDOct 15, 2021 Lab RAINBOW DRAWOrdered by MD, MDOct 15, 2021 Lab CBC WITH DIFFERENTIALOrdered by MD, MDOct 15, 2021 Lab COMPREHENSIVE METABOLIC PANELOrdered by , MD, MDOct 15, 2021 Lab MAGNESIUMOrdered by , MD, MDOct 15, 2021 Lab TROPONIN IOrdered by , MD, MDOct 15, 2021 Lab DK GREEN TOPOrdered by , MD, MDOct 15, 2021 Lab LAVENDER TOPOrdered by , MD, MDOct 15, 2021 Lab GOLD TOP - SSTOrdered by , MD, MDOct 15, 2021 Lab LIGHT BLUE TOPOrdered by , MD, MDOct 15, 2021 Lab CBC W/ AUTO DIFFERENTIALOrdered by , MD, MDOct 15, 2021

Allergies: N/A

Symptom List: Rash, Urticaria

Symptoms: I had burning at the injection site 20 minutes after administration, but no concerns since I?ve had many vaccines before with no adverse reaction. At 35 minutes after the injection, I suddenly felt an intense deep aching pain in my left arm. Seconds after feeling the pain my heart fluttered. My palms and body began to sweat. The heart flutter made me stagger and feel off balance. I had another heart flutter. After that my vision closed in. I lost all depth perception. The next thing I knew I was on the floor. My wife caught me on my fall, so I didn't hit my head. She also called 911 and kept me talking to remain alert, but I was having a hard time focusing on anything but my breathing. When I became aware of my surroundings again, I had to concentrate hard on my breathing to remain conscious. My left arm all the way from my shoulder down to my fingertips was painful to the point of being unable to make a fist or support any of my body weight on it. The EMT/ ambulance showed up at 1:43pm. I was then transported to the emergency room, where I was checked in at 2:19pm. At 5:31pm I began getting what felt like a hot poker in my heart on the left side of my chest and some dizziness while sitting down. I was discharged at 7:30pm. Since then, I have had one episode where I was standing and became as dizzy as when I first passed out. I got sweaty and my heart started racing, but I didn?t have any flutters. It eventually passed when I focused on my breathing. I have been extremely tired and unable to do any gentle activities, including standing and walking around the house without the potential of becoming lightheaded and dizzy.

Other Meds: N/A

Current Illness: N/A

ID: 1793921
Sex: M
Age: 76
State: NV

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

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

Lab Data: CBC: all within normal limits except WBC slightly elevated at 10.72 BMP and troponin: all within normal limits CT head without contrast: Impression: No CT evidence of acute intracranial pathology, mild cerebral atrophy which is most pronounced involving the frontal lobes, mild chronic small vessel ischemic changes involving the periventricular white matter, mild chronic left mastoiditis. CTA: No CTA evidence of acute intracranial thrombosis, heavy calcific plaquing within the proximal portion of the right internal carotid artery results in approximately 85% diameter stenosis, mild calcific plaquing of the left carotid artery bifurcation with no significant stenosis, both vertebral arteries are patent throughout their course.

Allergies: No allergies

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

Symptoms: Patient had sudden onset of vertigo that started at 11 AM, associated with nausea and vomiting.

Other Meds: Atorvastatin, enalapril, isosorbide mononitrate, metoprolol succinate, nitroglycerin, zetia, xarelto (2.5 mg twice daily), multivitamin, aspirin 81 mg, synthroid 125 mcg, coq10, vitamin d3, vitamin b12

Current Illness: None

ID: 1793922
Sex: F
Age: 12
State: CA

Vax Date: 10/16/2021
Onset Date: 10/16/2021
Rec V Date: 10/16/2021
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: 10/16/2021. patient return back with mom with prednisone prescription 40 mg qd and was given in the hospital as well.

Allergies: no

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

Symptoms: Patients throat feels tight and swelling, lips has a small swelling bump, patient was scared and cried and shaking afraid she is dying. Give patient 25 mg diphenhydramine (10 cc of the 12.5/5 ml) with mom consent. Have patient sit down. I have a medic on site site to do vaccination. We continue monitor her symptoms access the condition and trying to calm the patient. Her BP was 125/99 HR 125. She was very nervous. AFter 10 minutes, paitnet feel a little better, I give her another 25 mg Benadryl with mother consent. Explain to mom the situation and she want her daughter to be seen at the hospital. Patients left with mom to the nearest hospital.

Other Meds: unknown

Current Illness: unknown

ID: 1793923
Sex: F
Age: 60
State: FL

Vax Date: 05/21/2021
Onset Date: 09/03/2021
Rec V Date: 10/16/2021
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: 09/03/2021 to 09/06/2021. EKG, CT scan, chest x-ray. Blood tests. Urine tests and culture Only abnormal results: high white blood count. high lactic acid

Allergies: None

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

Symptoms: Distorted vision, muscle weakness, unable to walk unaided, low blood pressure, low respiration rate, low body temperature, cold sweat, vomiting and loss of consciousness. Extreme fatigue. Vertigo and loss of balance.

Other Meds: Prescription Vitamin D. OTC Calcium

Current Illness: None

ID: 1793924
Sex: F
Age: 39
State: MD

Vax Date: 03/16/2021
Onset Date: 09/08/2021
Rec V Date: 10/16/2021
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: Vitiligo on my left arm and an indentation in my arm at the vaccination area.

Other Meds:

Current Illness:

Date Died: 09/23/2021

ID: 1793925
Sex: M
Age: 77
State: GA

Vax Date: 05/01/2021
Onset Date: 05/01/2021
Rec V Date: 10/16/2021
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: Sulfur

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

Symptoms: Confused and not able to communicate, never clear thinking again

Other Meds: Flomax

Current Illness: Copd

ID: 1793926
Sex: M
Age: 23
State:

Vax Date: 05/03/2021
Onset Date: 05/04/2021
Rec V Date: 10/16/2021
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: Acute fever 101 degrees and headache the night after vaccination that resolved after 2 days Chronic pain at the injections site 2/10, dull, aching pain

Other Meds:

Current Illness:

ID: 1793927
Sex: F
Age: 28
State: AL

Vax Date: 10/08/2021
Onset Date: 10/09/2021
Rec V Date: 10/16/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Low-grade fever (100.5) 24 hours following the shot which lasted about 12 hours and took Ibprophran to keep the fever down. Arm soreness at the injection site and underarm swollen and sore under the arm of the injection site for the following three days and took Ibprophran to relieve pain and discomfort. Muscle weakness in hands. A rash across the chest appeared five days after the shot and is slowly going away.

Other Meds: Jaimiess 0.15, 0.03, 0.01 mg, Spironolactone 25 mg

Current Illness: None

ID: 1793928
Sex: M
Age: 37
State: CA

Vax Date: 09/30/2021
Onset Date: 10/01/2021
Rec V Date: 10/16/2021
Hospital:

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

Lab Data: Spoke with nurse over the phone on Saturday October 16th. Recommended ice. Scheduled Doctor appointment on October 29th.

Allergies: Cat dander, dust mites

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

Symptoms: Significant and worsening pain in my upper left shoulder. I am unable to rotate or lift my arm above my head without significant pain. I have contacted my healthcare provider but have not been see due to lack of appointments. I am taking over-the-counter pain medication and icing constantly with little to no relief.

Other Meds: None

Current Illness: None

ID: 1793929
Sex: M
Age: 14
State:

Vax Date: 10/15/2021
Onset Date: 10/16/2021
Rec V Date: 10/16/2021
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: X-ray, physical exam, ekg

Allergies:

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

Symptoms: Chest pain, rapid heart beat were treated at urgent care. The diagnosis was costochondritis or inflammation of the rib cage.

Other Meds: Abilify 2mg

Current Illness:

ID: 1793930
Sex: F
Age: 36
State: UT

Vax Date: 06/11/2021
Onset Date: 09/19/2021
Rec V Date: 10/16/2021
Hospital: Y

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

Lab Data: I had two ultrasounds to diagnose polyhydramnios (9/13/2021 and 9/19/2021). My son has had multiple ultrasounds, X-rays, and lab tests -- too many to provide dates. Results of his tests show TEF/EA with no apparent VACTERL association. He had surgery to correct TEF/EA on 9/21/2021.

Allergies: None

Symptom List: Unevaluable event

Symptoms: I was due 11/17/2021. I was diagnosed with polyhydramnios on 9/13/2021. I went into labor after my water broke on the evening of 9/19/2021. My son was born on 9/20/2021 at 10:44 AM; he was 30 weeks and 5 days gestation. He weighed 3 lbs and 12 oz, and he was 17.5 inches long. After delivery, he was diagnosed with esophageal atresia with tracheoesophageal fistula.

Other Meds: Prenatal vitamins

Current Illness: None

ID: 1793931
Sex: F
Age: 52
State: WA

Vax Date: 10/07/2021
Onset Date: 10/13/2021
Rec V Date: 10/16/2021
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: Levoquin opioids

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

Symptoms: No treatment as medical people dismiss anything related to the vaccine. ? it can?t be vaccine related ?

Other Meds: Started as a feeling of swelling or lump in my throat that I couldn?t clear with swallowing and couldn?t clear my lungs. Coughing to the extent I would bend over but still couldn?t clear my lungs.

Current Illness: None absolutely none

ID: 1793932
Sex: M
Age: 47
State: CA

Vax Date: 03/13/2021
Onset Date: 03/13/2021
Rec V Date: 10/16/2021
Hospital:

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

Lab Data: None

Allergies: None

Symptom List: Injection site pain, Pain

Symptoms: Several hours after the injection, I began feeling light-headed and weak. When I woke up the next morning, I was feverish, extremely weak, suffering painful headaches and experiencing feelings of vertigo. It was very difficult for me to stand without become unsteady and fearing that I would fall. These strong symptoms persisted for a week, during which I was confined to bed rest, rising only to eat and use the bathroom. The strong symptoms began to diminish into the second week after the vaccination. By the end of the second week, I still felt a bit weak, but the fever, headaches and feelings of vertigo had mostly subsided and I was able to return to a normal routine.

Other Meds: None

Current Illness: None

ID: 1793934
Sex: F
Age: 31
State: KY

Vax Date: 10/15/2021
Onset Date: 10/16/2021
Rec V Date: 10/16/2021
Hospital:

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

Lab Data: None yet.

Allergies: Amoxicillin, TDAP vaccine, raw tomato.

Symptom List: Injection site pain, Menorrhagia

Symptoms: Diarrhea and vomiting. Severe pain in left arm. Started as hot sensation and itching in left ear. Led to left eye twitching for a few hours. Then had sudden onset of numbness and tingling in left side of face from where eye is twitching down left cheek and left side of neck, down to left shoulder.

Other Meds: N/A

Current Illness: N/A

ID: 1793935
Sex: F
Age: 36
State: CA

Vax Date: 10/05/2021
Onset Date: 10/05/2021
Rec V Date: 10/16/2021
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: Pcn Class, Sulfa

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

Symptoms: Pain at injection site and numbness in hand and arm immediately after injection. Uncontrollable shaking 6 hours after injection that lasted for one hour. Fever, muscle pain, headache, chills, and nausea 7 hours after injection.

Other Meds:

Current Illness:

ID: 1793936
Sex: F
Age: 43
State: DC

Vax Date: 05/17/2021
Onset Date: 05/17/2021
Rec V Date: 10/16/2021
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: Mammogram 10/1/2021; biopsy 10/5/2021 following primary care visit inquiring about the growing mass.

Allergies: No

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Took the 1st shot around 10:30am, I fainted and possible seizure at 8pm. By the time I received the 2nd shot I noticed a bump on my chest growing more than like a bite or pimple.

Other Meds: Milk thistle, vitamin b complex, vitamin c, vitamin d, elderberry

Current Illness: Hydradendanitis Superrativa, asthma, arthritis

ID: 1793938
Sex: F
Age: 29
State: AL

Vax Date: 10/12/2021
Onset Date: 10/13/2021
Rec V Date: 10/16/2021
Hospital:

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

Lab Data: None

Allergies: No

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Big red rash all over my torso and keep expanding towards my back and legs

Other Meds: No

Current Illness: No

ID: 1793939
Sex: F
Age: 72
State: IL

Vax Date: 10/12/2021
Onset Date: 10/13/2021
Rec V Date: 10/16/2021
Hospital:

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

Lab Data: None

Allergies: Lexapro, latex

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

Symptoms: pain/swelling/heat at site; low-grade temp (99.3), chills, joint and muscle aches, fatigue, headache. Treatment: slept entire day after the vaccine. Much improved by that night and symptoms gone the next morning (except for mild pain at vaccination site).

Other Meds: rosuvastatin, methotrexate, folic acid, Insolar (nicotinamide to reduce risk of skin cancer), gabapentin, hydroxychloroquine, Vitamin B-12, Vitamin D-3, Helioplex (reduce risk of skin cancer), buPROPion, multi-vitamin, melatonin

Current Illness:

ID: 1793940
Sex: M
Age: 52
State: CT

Vax Date: 04/10/2021
Onset Date: 09/06/2021
Rec V Date: 10/16/2021
Hospital:

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

Lab Data: Rapid test and PCR test on 09-06-21

Allergies: None

Symptom List: Nausea

Symptoms: Tested positive for COVID-19 on 09-06-21. Presented with a 102* fever (lasted for two days), loss of sense of taste and smell (ongoing), severe sinus congestion and related headache (congestion for a week however the headaches persist) continuing loss of energy and lethargic

Other Meds: Multi vitamin

Current Illness: None

ID: 1793941
Sex: F
Age: 29
State: OK

Vax Date: 08/05/2021
Onset Date: 08/18/2021
Rec V Date: 10/16/2021
Hospital: Y

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

Lab Data: CBC 8/18/2021

Allergies: No

Symptom List: Injection site pain

Symptoms: This was my first pregnancy. I was convinced to get the shot so I did on august 5, 2021. Two weeks later, before my 28 week appointment, I hemorrhaged blood. I was rushed to the hospital where the doctor on call determined that we needed to have an emergency cesarian due to the fact that my baby and I were losing so much blood. She was born at 27 weeks gestation, original due date was November 16, 2021. She weighed 2lbs 6.9oz, 14.96 inches long.

Other Meds: Prenatal, levothyroxine

Current Illness: No

ID: 1793943
Sex: F
Age: 50
State: TX

Vax Date: 03/15/2021
Onset Date: 04/01/2021
Rec V Date: 10/16/2021
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: none

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

Symptoms: Started feeling numbness or faint pain on the area of vaccine right after the first vaccine. Its not continous pain, but sometimes after i lift anythingno matter how heavy or light. The pain is not always there but I i do feel it occassionally around the exact place that i got the vaccine. The pain feels like its in the muscle. I reported to my primary care physician who directed me to report here.

Other Meds: iron supplements B12 supplements

Current Illness: none

ID: 1793944
Sex: M
Age: 57
State: WA

Vax Date: 10/15/2021
Onset Date: 10/16/2021
Rec V Date: 10/16/2021
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: Patient received his booster COVID vaccination the day prior then woke up the next day with a swollen tongue (angioedema) and a sore throat. He was given a shot of epinephrine along w/ IV Solumedrol and sent emergently to the nearest ED

Other Meds: Losartan and Terbinafine

Current Illness:

ID: 1793945
Sex: F
Age: 46
State: IN

Vax Date: 10/14/2021
Onset Date: 10/15/2021
Rec V Date: 10/16/2021
Hospital:

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

Lab Data: Na

Allergies: Some

Symptom List: Tremor

Symptoms: Bumps, redness, itching, hard knot Red ring

Other Meds: Metoprolol 25 mg Armour thyroid 60 mg Vit B Vit D Slow release Iron 160 mg Montelukast 10 mg Xyzol

Current Illness: None

ID: 1793946
Sex: F
Age: 50
State: MN

Vax Date: 09/01/2021
Onset Date: 09/17/2021
Rec V Date: 10/16/2021
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: All Penicillin, Seland, most antibiotics

Symptom List: Erythema, Pruritus

Symptoms: Nausea, dizziness, light headed, hot flash, tingling and numbness in left arm, migraine

Other Meds: Hydro chlorothiazide, amitriptyline, Lunesta, Vitamin D

Current Illness:

ID: 1793947
Sex: F
Age: 21
State: MI

Vax Date: 10/14/2021
Onset Date: 10/15/2021
Rec V Date: 10/16/2021
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: None

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

Symptoms: At the time of the shot I was not due to start my period for 6 days. The next day I started it, 5 days early. I am extremely regular and every month have a 28 day cycle. The most it has ever varied is maybe late or early by a day, and even that is extremely rare. This period has been my most ever painful and heavy. I was worried and figured it had something to do with that the vaccine because I?m typically so regular. I searched the internet and there are a lot of other woman having the exact same thing, an earlier, heavier, and more painful period immediately after receiving the vaccine. This is concerning and should be looked into or at least made known to the public.

Other Meds: None

Current Illness: None

ID: 1793948
Sex: F
Age: 21
State: ME

Vax Date: 05/01/2021
Onset Date: 10/14/2021
Rec V Date: 10/16/2021
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: tree nuts

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

Symptoms: Began to get muscle pain at the injection site a few days ago (about 5 months ago). It has not gone away since I first noticed.

Other Meds: Wellbutrin, triprevifem

Current Illness: none

ID: 1793949
Sex: F
Age: 41
State: PA

Vax Date: 09/01/2021
Onset Date: 09/30/2021
Rec V Date: 10/16/2021
Hospital:

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

Lab Data: 2 MRIs and bloodwork

Allergies: Allergic to penicillins, eggs, dairy

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Swollen lymph nodes on left side for over a month. Pain shooting down left arm with tingling and numbness lasting over a month so far. Sometimes pain shoots up into neck and into armpit and left side of abdomen. Heart rate also seems to race at times.

Other Meds: None

Current Illness: None

ID: 1793950
Sex: F
Age: 56
State: TX

Vax Date: 08/27/2021
Onset Date: 08/28/2021
Rec V Date: 10/16/2021
Hospital:

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

Lab Data: Doctor would not see me for 5 days said it needed to run its course

Allergies: Latex

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

Symptoms: Fever 104, body aches, congestion, could not get out of bed Lasted 3 days

Other Meds: None

Current Illness: None

ID: 1793951
Sex: F
Age: 67
State: OK

Vax Date: 01/13/2021
Onset Date: 10/16/2021
Rec V Date: 10/16/2021
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: Reported to primary care dr and kidney dr. Kidney dr ordered extensive immune blood tests all results were normal.

Allergies: None

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

Symptoms: Loud Static and cricket sounds in both ears. Continuous and still continues.

Other Meds: Premarin,Omeprazole, Allegra , calcium+D3, magnesium

Current Illness: None

ID: 1793952
Sex: M
Age: 13
State: TX

Vax Date: 08/27/2021
Onset Date: 08/28/2021
Rec V Date: 10/16/2021
Hospital:

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

Lab Data: Labs, X-ray August 31,2021

Allergies: None

Symptom List: Pain in extremity

Symptoms: Fever 102, congestion, URI, wheezing

Other Meds: None

Current Illness: None

ID: 1793953
Sex: F
Age: 33
State: VA

Vax Date: 03/23/2021
Onset Date: 06/15/2021
Rec V Date: 10/16/2021
Hospital:

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

Lab Data: I went to my OBGYN in early July, after experiencing bleeding for the first time in 4 years despite still being on the Nexplanon implant. She advised me to see if the irregular bleeding continued over the next 1-2 months. She also ordered a transvaginal ultrasound if I experience continued irregularity to rule out anything serious. After experiencing irregular menses in July and August, I scheduled a transvaginal ultrasound mid-August. The ultrasound didn't reveal anything serious. I had a follow up with my OBGYN on 1 September, during which she prescribed a course of Ibuprofen to see if anti-inflammatory medication would help. I did a course of the Ibruprofen and still experience bleeding and some irregularity. I was advised that I could request additional birth control pills to try to reset my menses. I have not yet explored this option. My menses are not painful, though I do experience PMS, i.e. swelling of breasts, tenderness, acne breakouts, and fatigue. I can live with having a period again, but it is a significant change, after 4 years of no period.

Allergies: n/a

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

Symptoms: Roughly a month after receiving the 2nd Pfizer COVID-19 dose (4/13/21), I started experiencing irregular menses. This was significant, as I am on the Nexplanon birth control implant, and have been for 4 years. During those 4 years, I have had essentially no periods, with some very irregular light spotting (roughly 1-3 days a year). Since June 2021, however, I started spotting for multiple days, and experiencing bleeding that seemed to be menses. The timing, however, was irregular. For example, I would bleed for 6 days with a normal menses flow, and then 9 days later, I experiences 4 days of light bleeding/spotting. Then 8 days later, I experienced two days of spotting. Then I experienced nothing for 3 weeks, after which I experienced 15 days of spotting/bleeding. I sought out medical attention in early July.

Other Meds: Flonase, Allegra. Nexplanon birth control implant, Vitamin D, Vitamin B-12

Current Illness: n/a

ID: 1793954
Sex: F
Age: 42
State: NY

Vax Date: 10/01/2021
Onset Date: 10/03/2021
Rec V Date: 10/16/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: On Day three of vaccine given Redness and swelling to left side of the face, headaches, tingling and numbness and pain to left face, pain left side of neck, followed by twitching and pressure of left eye,

Other Meds: None

Current Illness: Mild controlled Asthma

ID: 1793955
Sex: F
Age: 46
State: NY

Vax Date: 10/01/2021
Onset Date: 10/03/2021
Rec V Date: 10/16/2021
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: Allergic to Aleve/ Naproxen

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

Symptoms: Headaches with eye twitching started on day three. Persisting Headaches got worst with stabbing shooting pain Above right eye . Tingling and numbness On both side of face follow by pressure on right eye swelling off eyelid redness/rash and swelling face

Other Meds: None

Current Illness: Mild Asthma

ID: 1793956
Sex: M
Age: 60
State: WA

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

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

Lab Data: Just completed with a new round of Lab work, I'm scheduled for an MRI on my Brain for Monday October 18th

Allergies: none

Symptom List: Vomiting

Symptoms: cronic headache after 10-15 minutes after the injection...next day headache, lightheadedness and body agitation. These symptoms have NOT GONE AWAY TO DATE!

Other Meds: prevacid 20mg, basic vitamin supplements, trazadone for the last 10 years

Current Illness: none

ID: 1793957
Sex: F
Age: 35
State: FL

Vax Date: 09/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/17/2021
Hospital:

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

Lab Data: 10/07 CT with contrast, full blood panel, urinalysis 10/10 CT, full blood panel with chemistry , urinalysis Nothing significant on CT.

Allergies: N/a

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: On 10/01 my urine was discolored it was a very intense yellow color that was very grainy, and I had the constant need to urinate. I was very lethargic and by end of day was running a low grade fever of 99.6. That evening I was also experiencing mild chest pains. Over the course of the next week I was having mild right flank pain, but on 10/07 the pain had intensified. I became very weak. I went to Urgent care who sent me to the ER. My blood tests had some elevated levels in my lymphocytes and white blood cell count. My urinalysis came back with minimal blood. I was started on antibiotics, doctors could not provide me with an answer to my pain, although UTI was suspected, there wasnt bacteria in my urine. On October 10th the pain was so intense in my back I went back to the ER, same tests were performed, same outcome, new antibiotic was prescribed. Still being very sick, I made appt with Regular Doctor and my blood pressure was very low. It had been low in the ER too, but I thought that was a misread. It is now October 17th, I still have the right flank pain, and still lethargic, and running a mild fever off and on. I am not on Cipro, the third antibiotic and have another urinalysis and blood test scheduled next week. The chest pain has not been addressed, but also still present.

Other Meds: Benicar, Amlodipine, buspar, metformin, xyzal, gnc multi vitamin, Acetazolamide

Current Illness: N/a

ID: 1793959
Sex: F
Age: 52
State: CA

Vax Date: 04/09/2021
Onset Date: 09/06/2021
Rec V Date: 10/17/2021
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: 9/11/2021 COVID-19 test. Tested negative

Allergies: None

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

Symptoms: Sinus infection due to bad air quality. Treated with antibiotics and over the counter meds

Other Meds:

Current Illness: None

ID: 1793961
Sex: F
Age: 53
State: WA

Vax Date: 10/09/2021
Onset Date: 10/10/2021
Rec V Date: 10/17/2021
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: Ekg bloodwork 10/12/2021 Ekg bloodwork chest xray 10/15/2021

Allergies: Cephlasporins, eggs, laytex, mushrooms, oats

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Swelling in heart. Went to my care provider on Tuesday had an ekg that wasn't good they took blood work that showed lots of swelling in my heart. My heart rate was going very high then low and I had chest pain. Went to ER on Friday and they redid tests and showed that it was heading back to normal. Still have slight chest pain a week later. Also had fever on Friday.

Other Meds: None

Current Illness: No

ID: 1793962
Sex: F
Age: 49
State: SC

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 10/17/2021
Hospital:

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

Lab Data:

Allergies: Tomatoes, strawberries, peaches

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

Symptoms: After 5-10 minutes, experienced tightness and burning in arm; after 15 minutes, inflammation began and heat was radiating off of arm, the doctor massaged arm to distribute medication and discharged me (patient). After 45 minutes entire left arm and hand was swollen, a small knot had developed at the injection site and I had a fever of 99.7 F with profuse sweating. I called the Clinic and was advised to take Tylenol. Over night, temperature increased to 101 F and stayed for the next 24+ hours, 100 mg Tylenol was taken every 6 hours. 72 hours after the injection, I still had a low grade fever and inflammation in my arm.

Other Meds:

Current Illness:

ID: 1793963
Sex: F
Age: 48
State: TX

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

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

Lab Data: none

Allergies: asprin, penicillin, latex, morphine, cipro

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

Symptoms: Sudden sever itching, then a dime sized raised liquid filled blister formed. after about 3 after applying green alcohol, the blister flattened to a quarter sized raised disk red in color, formed. it is hot to the touch and sore to the touch. it feels and looks like a blister that appears after a bad burn. there small indention in the center of the disk. It feels as though the body rejected the vaccine and pushed it from the muscle to sub Q under skin.

Other Meds:

Current Illness: obisity, high blood pressure, anxiety,

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am