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: 1795103
Sex: M
Age: 54
State: LA

Vax Date: 09/13/2021
Onset Date: 10/01/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: BP 164/103 on 10/13/2021

Allergies: NKDA

Symptom List: Dysphagia, Epiglottitis

Symptoms: Development of hypertension , prior to vaccine patient with well controlled HTN (stage1), after vaccine, rapidly progressive HTN to stage 3, with need of increasing of HTN medication.

Other Meds: Irbesartan

Current Illness: Rhinovirus

ID: 1795104
Sex: F
Age: 94
State:

Vax Date: 02/03/2021
Onset Date: 10/08/2021
Rec V Date: 10/18/2021
Hospital: Y

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

Lab Data: COVID + 10/8/2021

Allergies: latex, penicillins

Symptom List: Anxiety, Dyspnoea

Symptoms: Breakthrough COVID first vaccine 1/6/21. Sent due to positive COVID and shortness of breath/dyspnea on exertion. Patient has had progressive shortness of breath for approximately 3-4 weeks. It appears that her shortness of breath per minute her from going to the dining hall at night. According to the daughter, patient's shortness of breath has gotten progressively fever worse over the past 2 days. Patient was checked for COVID today and she reportedly was positive. Due to her positivity and shortness of breath she was sent to the ED for further evaluation. Once in the ED, patient was found to have a saturation of 90-92% at rest. Patient denied fever, chills, cough.

Other Meds:

Current Illness:

ID: 1795105
Sex: F
Age: 45
State: MD

Vax Date: 04/05/2021
Onset Date: 04/07/2021
Rec V Date: 10/18/2021
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: Xrays ordered by pain specialist June 2021 diagnosed with bulging muscles from mri no broken bones

Allergies: Percocet

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

Symptoms: Excruciating panic in muscles on right side of body unable to walk sit lay down sleep with out pain 2 days after shot Urgent care and X-ray treatment and bulging muscles in back muscles which moved into my wrist Hips legs ankles shoulders and body pain meds have helped and at home therapy and care for it still ongoing pain and inflammation in my muscles/ joints

Other Meds: One a day woman, ambian,clonipin,pantropazole.lasics, inflmab,glucosamine vitamins

Current Illness: Sarcoidosis,osteoporosis,neurological sarcoidosis

ID: 1795106
Sex: M
Age: 36
State: IN

Vax Date: 09/25/2021
Onset Date: 10/01/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: N/A

Allergies: N/A

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Exacerbation of eczema, increased dandruff, lethargy, bumps on body, cold chills

Other Meds: Vyvanse 30 mg capsule 1 PO SID, Vyvanse 20 mg capsule 1 PO SID

Current Illness: N/A

ID: 1795107
Sex: M
Age: 40
State: OR

Vax Date: 04/12/2021
Onset Date: 10/07/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: Telehealth visit on Oct. 11 COVID test on Oct. 11 (result was negative)

Allergies: Allergic to penicillin as a baby

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

Symptoms: Headache with vertigo. Treatment is ibuprofen. Headache is lasting more than 1 week (approximately 10 days). COVID test was negative. No history of headaches lasting more than 1 day until now.

Other Meds: None

Current Illness: None

ID: 1795108
Sex: M
Age: 40
State: NC

Vax Date: 03/01/2021
Onset Date: 08/01/2021
Rec V Date: 10/18/2021
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: Tested Positive for COVID-19

Other Meds: Creon, Vyvanse, escitalopram

Current Illness:

ID: 1795109
Sex: F
Age: 47
State: PA

Vax Date: 09/29/2021
Onset Date: 10/06/2021
Rec V Date: 10/18/2021
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: N/A

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Frequent daily muscle spasms at injection site occurring multiple time every day.

Other Meds: N/A

Current Illness: N/A

ID: 1795110
Sex: M
Age: 45
State: DC

Vax Date: 04/09/2021
Onset Date: 08/24/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: Covid Test- positive (8/27/2021) Hearing Test- loss of hearing in left ear (9/15/2021) Hearing Test- loss of hearing in right ear(10/1/2021) Hearing Test- hearing has improved in both ears (10/13/2021)

Allergies: Penicillin

Symptom List: Pharyngeal swelling

Symptoms: On 8/24/2021 I had a tickle feeling in my throat. I couldn't clear my throat. On 8/26-8/27 I had chills and a fever. Those symptoms lasted through 8/30/2021. On 8/30/2021 I had congestion and ringing in my left ear that lasted up to 9/15/2021. On 9/15/2021 I saw the doctor for the ringing in my left ear. I was diagnosed with hearing loss in my left ear. I was prescribed triamterene 25mg 1xday for it. On 9/29/2021 my right eardrum clogged and popped. On 10/1/2021 I went back to the doctor. The doctor recognized hearing loss in my right ear as well and started me a prescription for prednisone 9xday for 4 days, then 6xday for 4 days, then 3xday for 4 days, then 1xday over a period of 2 weeks. On 10/13/2021 I went to see the doctor again and my hearing loss has improved in both ears since the last visit.

Other Meds: none

Current Illness: none

ID: 1795111
Sex: M
Age: 69
State: IN

Vax Date: 10/12/2021
Onset Date: 10/13/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: none

Allergies: no

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Shot bled at time of injection (10:30am) Bruise appeared almost immediately. Shot was given high on the arm. Arm became stiff and pain developed early evening (6pm). Pain radiated across back of neck and down arm causing inability to use arm or sleep that night and the following day. Tylenol helped by the end of the second day pain subsided. Bruise is still very apparent today, day 7.

Other Meds: multivitamine

Current Illness: no

ID: 1795112
Sex: M
Age: 41
State:

Vax Date: 09/02/2021
Onset Date: 09/03/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: Blood draw for cardiac event 09/09/2021

Allergies: None.

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Within 1 week of receiving the vaccine, I had cardiac arrhythmias that required me to see a doctor. I have also had headaches every day since receiving the vaccine.

Other Meds: Multivitamins.

Current Illness: None.

ID: 1795113
Sex: F
Age: 46
State: IN

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/18/2021
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: Expired COVID vaccine - Janssen administered.

Other Meds:

Current Illness:

ID: 1795114
Sex: F
Age: 2
State: IA

Vax Date: 10/07/2021
Onset Date: 10/08/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: N/A

Allergies: Allergies to eggs; seasonal allergies

Symptom List: Rash, Urticaria

Symptoms: Had shot after daycareThursday night 10/7. She woke up early that morning on Friday 10/8 and I went to change her clothing for daycare and she had large hives with raised outsides all over torso area and upper thighs, there was a few under her chin. We called her pediatrician office as allergist was not open at the time. They advised to give her 5 ML Childrens Benadryl every 4-6 hours and also give her the normal dose of zyrtec she takes in the morning. We started this that morning and continued every 4 hours with Benadryl for that day. Her last dose that evening was at 7:30 p.m. She woke up on Saturday morning with small red dots with no raised edge but looking much better. We called the pediatrician office again to verify that if they were looking better to continue the Benadryl. We continued through the day with Benadryl and the spots were completely gone except for faint area on upper thighs. Last dose of the Benadryl and some Motrin were given around 6:30 p.m. Saturday night (10/9). She woke up at 6:00 a.m. and I checked her - this is where she had large hives all over her entire body and her face was swollen on her right side with eyes also being swollen. I gave her a dose of Benadryl, about 10 minutes later gave her Motrin to help with swelling and then gave her the Zyrtec she normally gets. Her breathing was ok so I waited for urgent care to open and took her there to hopefully get a steriod. Dr. prescribed the 5 days of Prednisolone (5ML) (Location Urgent Care). She immediately started getting better and looked much better by end of the day on Sunday 10/10. We saw the allergist on Wednesday 10/20 and he did not believe the reaction could have been due to her egg allergy. He will ensure she does not receive this same brand of flu shot next year and we will complete in office.

Other Meds: Children's Zyrtec Daily; Multi-vitamin (flintstone) daily

Current Illness: None at the time of vaccination; had Ear tubes put in 9/27/21

ID: 1795115
Sex: F
Age: 74
State: MD

Vax Date: 10/07/2021
Onset Date: 10/07/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data:

Allergies: Codeine.

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

Symptoms: Temp of 103, arm of injection site began to swell.

Other Meds:

Current Illness:

ID: 1795116
Sex: F
Age: 14
State: AZ

Vax Date: 09/22/2021
Onset Date: 09/22/2021
Rec V Date: 10/18/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data: None.

Allergies: None

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

Symptoms: The patient should have received Pfizer dose #1. Multiple attempts have been made to reach this patient via phone about this vaccine error. No return phone call from this patient and patient has not reported any adverse reactions to receiving this dose.

Other Meds: Unknown

Current Illness: None

ID: 1795117
Sex: F
Age: 32
State:

Vax Date: 10/17/2021
Onset Date: 10/18/2021
Rec V Date: 10/18/2021
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: codeine, shellfish, dairy

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

Symptoms: the patient had a fainting spell after receiving the vaccination, she was also nauseous and vomiting

Other Meds: unknown

Current Illness: unknown

ID: 1795118
Sex: M
Age: 49
State: TN

Vax Date: 10/18/2021
Onset Date: 10/18/2021
Rec V Date: 10/18/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Patient reports feeling very hot and throwing up twice two hours after his vaccine. He had not eaten anything today and he was safely at home. When he called the pharmacy, he was feeling better. The pharmacist guided him on next steps.

Other Meds: Spiriva

Current Illness: None

ID: 1795119
Sex: F
Age: 54
State: NY

Vax Date: 10/15/2021
Onset Date: 10/16/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: pending a doctor's visit today regarding this matter.

Allergies: none

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

Symptoms: I received the vaccine on Friday, 10-15-21 around 2:30 pm. I have had pain on the injection site ever since. On 10-16-21 I woke up with swelling on both the left side of my posterior cervical area and on my underarm lymph nodes. Tremendous itch and pain on the underarm area and neck. I also feel a throbbing sensation under the arm area with I have swelling. I am unable to press my arm against my body.

Other Meds: Tylenol

Current Illness: none

ID: 1795120
Sex: M
Age: 64
State:

Vax Date: 10/05/2021
Onset Date: 10/05/2021
Rec V Date: 10/18/2021
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: High dose was given and he is under 65.

Other Meds:

Current Illness:

ID: 1795121
Sex: M
Age: 52
State: IA

Vax Date: 07/02/2021
Onset Date: 07/14/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: None

Allergies: Allergic to sulfa drugs; no food allergies

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: 12 days after my first dose, I had significant upper lip swelling,without any other symptoms of an allergic reaction. It took about 18 hours for the swelling to subside. Since then, every 5-14 days I have either my upper or lower lip swell for 6-18 hours, without any other signs or symptoms of an allergic reaction.

Other Meds: Multi-vitamin, Vitamin C, probiotic, organic sulfur

Current Illness: None

ID: 1795122
Sex: F
Age: 63
State: AZ

Vax Date: 03/09/2021
Onset Date: 03/17/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data:

Allergies: Latex

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

Symptoms: Ringing in both ears, 1 week after 1st shot. It's been over 6 months and I still have constant Ringing.

Other Meds:

Current Illness:

ID: 1795123
Sex: F
Age: 62
State: FL

Vax Date: 10/09/2021
Onset Date: 10/09/2021
Rec V Date: 10/18/2021
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: Strep throat: negative COVID: negative

Allergies: Medication Allergies Sulfa ? hives Darvon -- ? Penicillin ? vomiting Talwin ? hallucinations Zantac ? Hives Prilosec ? feeling out of it Phenergan ? vomiting Codeine ? severe itching Biaxin ? itching Codeine ? throat closing, asthma Zovirax ? itching Food Allergies Oranges Peanuts Environmental Allergies Molds Ragweed Cats Dust Trees

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

Symptoms: After receiving COVID booster vaccine reports 10 minutes after administration developed sever itching. States she took a Benadryl prior to Booster due to itching after second vaccine of COVID. Reports after she went home, the itching continued. Patient states she went to Urgent Care Saturday evening on 10/09/21 and was prescribed a Medrol dose Pak. Reports itching did not improve and she returned to Urgent Care on Wednesday 10/11/2021 for ongoing itching, and development of sore throat, and flu like symptoms was given Steroid IM injection, prescribed Pepcid, and instructed to continue to take Benadryl. Reports she was also tested for strep throat and COVID- both tests were negative. Patient states sore throat and flu like symptoms improved, but she continues to have itching. States she continues to take Benadryl and Pepcid as instructed by Urgent Care.

Other Meds: Levothyroxin, Prevacid, Nystatin, Baclofen, Tymlos, Albuterol, Flonase, Meloxicam, Metronigazole gel, Tretinoin, Montelukast, Bupropion, Sudafed as needed, Pepcid, Vitamin B, Multivitamin, Vitamin C, Tums as needed, Tylenol as needed.

Current Illness: none

ID: 1795124
Sex: F
Age: 78
State: ME

Vax Date: 10/09/2021
Onset Date: 10/09/2021
Rec V Date: 10/18/2021
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: 2 hours after shot her left arm and arm pit had incredible pain that radiated thru to her left breast. Lymph nodes swollen, patient disorientated.

Other Meds: None

Current Illness: none

ID: 1795125
Sex: F
Age:
State: NJ

Vax Date: 04/08/2021
Onset Date: 04/22/2021
Rec V Date: 10/18/2021
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: 4/22/21 chest xray, 4/28/21? Cat scan of lungs with contrast. Found blood clot in my left lung. 5/4/21 echocardiogram, 5/19/21? Nuclear stress test, 5/24/21 lung function test dx with asthma. 08/18/21 blood work very low iron, 08/23/21 iron Infusion , 10/08/21 more blood work looking for iron levels and lupus

Allergies: Pcn

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

Symptoms: 2 weeks after this dose I had a blood clot in my lung.

Other Meds: B12, vit D, Adderall, Triaterene/Hctz, Buspirone, propranolol, xhance, advil

Current Illness: None

ID: 1795126
Sex: F
Age: 62
State: MT

Vax Date: 10/11/2021
Onset Date: 10/11/2021
Rec V Date: 10/18/2021
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: As in the previous two Pfizer Covid-19 vaccinations I received in 2020, the third, administered by Drugs store, within hours became very tired and over the course of four days, was too tired to do anything but sleep for about 18 hours a day. Site where shot administered has about a two-inch discolored (red) patch a week later.

Other Meds: Levothyroxine Aledronate Sodium Tablets

Current Illness: None

ID: 1795127
Sex: F
Age: 54
State: PA

Vax Date: 10/14/2021
Onset Date: 10/16/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: Not known to this reporter

Allergies: Not known to this reporter

Symptom List: Injection site pain, Menorrhagia

Symptoms: Syncopal event on 10-16. Individual was found unresponsive in the hallway. Emergency called. Assessed in ER and discharged that same day. with mild dehydration, hypoglycemia, syncope, and near syncope.

Other Meds: Not known to this reporter

Current Illness: Not known to this reporter

ID: 1795128
Sex: F
Age: 42
State: CT

Vax Date: 04/05/2021
Onset Date: 05/01/2021
Rec V Date: 10/18/2021
Hospital: Y

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

Lab Data:

Allergies: n/a

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

Symptoms: guillain bare syndrome.

Other Meds: lexapro losartan

Current Illness: n/a

ID: 1795129
Sex: M
Age: 26
State: NJ

Vax Date: 10/12/2021
Onset Date: 10/12/2021
Rec V Date: 10/18/2021
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: EKG, CBC, Metabolic panel, 10/12/2021

Allergies: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Tightness in chest eyes fluttering rolled back face turned red stiffened up then passed out. Pharmacist administered benadryl when came to then proceeded to vomit. Taken by ambulance to hospital

Other Meds: None

Current Illness: None

ID: 1795130
Sex: M
Age: 64
State:

Vax Date: 10/06/2021
Onset Date: 10/06/2021
Rec V Date: 10/18/2021
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: High dose was given to someone under 65.

Other Meds:

Current Illness:

ID: 1795132
Sex: F
Age: 66
State: MA

Vax Date: 03/15/2021
Onset Date: 04/15/2021
Rec V Date: 10/18/2021
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: 9/7/2021 hearing test at CC ENT

Allergies: Vancomycin

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

Symptoms: I have been experiencing hearing loss in both ears, starting sometime in the spring, not really sure what the starting date is. The right ear has the more profound loss. I have been treated at CC ENT since 9/7. I have been on a course of prednisone, (20 mgs) for 1 week in September and I just finished a course in October for 5 days (20 mgs.) I have had only minimal success, because as soon as I stop the prednisone, the hearing loss returns. However, I don't think it is as bad as it was when I first experienced it in the spring. I also have been experiencing tendinitis in both ears on and off along with the hearing loss.

Other Meds: Zinc,calcium, mg, glucosamine and chondroitin, st. John's wort, ginko, sam-e, multi vit., milk thistle,

Current Illness: Common cold, knee replacement surgery.

ID: 1795133
Sex: F
Age: 63
State: TX

Vax Date: 10/15/2021
Onset Date: 10/17/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: None..

Allergies: Keflex antibiotics, aluminum in medications, peanuts

Symptom List: Nausea

Symptoms: Red rash with itching on upper torso.

Other Meds: Valsartan 320mg per day; Zyrtec OTC; Sudafed PE Sinus Congestion OTC

Current Illness: None

ID: 1795134
Sex: F
Age: 52
State: NY

Vax Date: 04/04/2021
Onset Date: 04/05/2021
Rec V Date: 10/18/2021
Hospital: Y

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

Lab Data: As above.

Allergies: NSAIDS.

Symptom List: Injection site pain

Symptoms: She got her vaccine, her arm was sore, she started feeling the pain on the left side of her shoulder, but it wasn't strong. She started at about 2:00 started to experience a slight headache and started to feel nauseous. Then, she took some Tylenol 650 ES and she was able to sleep for a few hours. When she woke up in the morning the headaches were getting worse as well as the nausea. She started feeling weak and the pain on the left side had spread throughout her body and felt like she was coming down with a cold. She read the instructions that she was given including the symptoms which was the flu-like symptoms, etc, so she felt that she was going to have this for a few days. By mid-afternoon the headaches were getting even worse and still feeling weak and taking Tylenol and resting. By early evening about 5-6 she started vomiting and by that time she was very weak. She was shivering with chills, had a fever and cold sweats and the headaches were even worse. She did her best not to go to the hospital. She was like this for a few days and continued to vomit and was loosing weight and was only on fluids due to the vomiting. This continued for 2 weeks, and had some periods were it was not so bad. After about a month she called her doctors office and scheduled an appointment as she was so weak and could not keep food down and still having the severe headaches. When she went to the doctor he informed her not to take the 2nd vaccine, and he sent her home and told her if it continued to see him again or go to the ER. He told her to see her neurologist for the headaches. She went to see her neurologist the next day who gave her magnesium intravenously, nerve block injections and explained to him that this was since 4/4/21. The following day she called him back as the nerve block and IV did not help as she was still weak and vomiting. She then called her PCP who told her to go to the hospital where she was admitted. She was given IV's. By that time when they weighed her she had lost 8#. She was in the hospital for 7 days and they finally submitted. When she was discharged she was still having nausea but she was feeling better, she was still having headaches, but not as severe. She waited so long as she felt that it was going to get better. When she was discharged she was still weak, still had the body aches, was not feeling like herself, and she did not have much appetite. She was having days about once a week or two weeks that she would vomit and continued with the nausea even with her favorite foods. She is a worship leader and was very busy with her church and had to take a leave as she was not able to sing and her throat was hurting a lot, which she contributed to the vomiting. She then scheduled to see a specialist, allergist who specialized in voice. She then had a scope done and he told her that she would not be able to sing for about a month and put her on medication. She was informed that due to the vomiting that she developed reflux which was in her voicebox, and also laryngitis. She also had periods when she would loose her voice completely. He put her on two different medications and continued to see him until she was better. When she last saw him she was told that the reflux was better, but her VM was still not right. She used to walk a lot, which is her choice of her exercise and now since the vaccine she can only walk 5 blocks and cannot due to the fatigue. She has tired that she is tired and can just sleep for long periods of time and lethargic. She also continues to have the headaches are mild, but different from her migraine headaches and feels that they are due to the vaccine. She does get migraines and has been admitted in the past as they have to be treated intravenously. Usually the magnesium and the nerve blocks work but not always. They headaches now come and go.

Other Meds: Prednisone, hydroxychloroquine, Brea inhaler, Albuterol as needed. Essential 1 vitamin.

Current Illness: None.

ID: 1795135
Sex: M
Age: 33
State: TX

Vax Date: 10/11/2021
Onset Date: 10/13/2021
Rec V Date: 10/18/2021
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: My second pfizer vaccine was administered to me on Monday October 11th. On Wednesday October 13th I started to notice vision impairment issues with my right eye which got progressively and noticeably worse on Friday October 15th. The vision in my right eye seems to be deteriorating - noticeable vision loss compared to my left eye. My right eye is extremely blurry and has a yellowish tint.

Other Meds:

Current Illness:

ID: 1795136
Sex: F
Age: 46
State: WI

Vax Date: 10/14/2021
Onset Date: 10/16/2021
Rec V Date: 10/18/2021
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: Amoxicillin sulfa vancomycin

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

Symptoms: extreme muscle pain in the arm/shoulder/neck area. this could have been contributed to recent increase in weight lifting. however then by 10/17/21, lymph nodes in arm pit were swelling. on morning of 10/18/21 the entire arm pit area, part of right breast and chest, down into the right side around the breast were quite swollen, sore. little warmth to touch of the arm area where injection was given.

Other Meds: Meloxicam 15 mg probiotic loratadine 10 mg

Current Illness: none

ID: 1795137
Sex: F
Age: 68
State: CA

Vax Date: 04/13/2021
Onset Date: 04/13/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: Blood work, Urinalysis, GFI scale was normal

Allergies: Flagyl; NSAIDs; Keflex; amoxicillin; Depakote

Symptom List: Tremor

Symptoms: 04/13/2021 First day I had fatigue, I felt dizzy, it turned into vertigo, going to the right, I was cold, body aches, nauseous, weak, heart beat became irregular. I went to bed. I slept ok but the next morning around 4 am, I had chest and heart pressure pain. On 04/14/2021 I called my friend and they took me to the ER. They put me on heart monitor but did not see life threatening symptoms, no fever.

Other Meds: Calcitriol; amlodipine; losartan; Spiriva; Restasis; biotin; vitamin B; C complex; vitamin D3; glutathione; tart cherry extract

Current Illness: No

ID: 1795138
Sex: M
Age: 41
State: OH

Vax Date: 03/13/2021
Onset Date: 10/01/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: PCR collected 10-9-2021, resulted positive 10-9-2021

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Fever, feeling feverish, chills, muscle aches, cough, shortness of breath, chest pain, nausea, vomiting, headache, fatigue, abdominal pain, loss of taste and smell

Other Meds:

Current Illness:

ID: 1795139
Sex: M
Age: 0
State: KY

Vax Date: 01/15/1943
Onset Date: 10/16/2021
Rec V Date: 10/18/2021
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:

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

Symptoms: hospital, supportive care. On room air, no steroids or remdesivir/actemra/ baricitinib.

Other Meds:

Current Illness:

ID: 1795140
Sex: F
Age: 36
State: CO

Vax Date: 09/29/2021
Onset Date: 10/01/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: CT, CMP, BMP

Allergies: None

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

Symptoms: Within 48 hours felt like I had COVID again, headache, body aches, fever, cough, congestion, chills, loss smell and taste for 12 hours, nausea, sore throat. By day 11 I was in the ED with diverticulitis

Other Meds: None

Current Illness: None

ID: 1795141
Sex: M
Age: 28
State: CO

Vax Date: 04/01/2021
Onset Date: 06/15/2021
Rec V Date: 10/18/2021
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: I'm sensitive to Motrin.

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: In June I started with joint pain and swelling, to the point where I wasn't able to walk outside my apartment.

Other Meds: emtricitabine, andtenofovir-disoproxil-sumarate, Lactone, Estradiol, Progesterone's, Iron Supplement, Prednisone, Folic acid, Methotrexate.

Current Illness: N/A

ID: 1795142
Sex: F
Age: 70
State: FL

Vax Date: 03/03/2021
Onset Date: 08/15/2021
Rec V Date: 10/18/2021
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: see above.

Allergies: none

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

Symptoms: On 8/15/21 developed SOB and chest pain with inspiration worsening over 12 hours. On 8/16/21, developed rapid atrial fib, cardiac cath also done later that day. Had frequent episode of atrial fib with chest pain requiring several hospitalizations. On 09/03/21 RAF, ablation not tone due large pericaridal effusion requiring pericardial window, Other complications included, pulmonary embolus and pneumonia. I am still having pericarditis symptoms. Symptoms began approximately 5 months post 2nd vaccine.

Other Meds: B12, Vit C , tumeric, biotin, B complex, probiotic, eye support vitamins

Current Illness:

ID: 1795143
Sex: F
Age: 66
State: NV

Vax Date: 04/16/2021
Onset Date: 09/25/2021
Rec V Date: 10/18/2021
Hospital: Y

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: Two times to hospital - chest x-ray; CT scan; EKG and bloodwork - had these both times at the hospitals - shortness of breath and pneumonia.

Allergies: Penicillin; sulfa and codeine

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

Symptoms: The second shot - I didn't have hardly any side affects at all right after - just a tiny fever and achiness which lasted two days. Recent health event: Shortness of breath; pneumonia - I had it in August 4th -11th. and now again here in October 11th -14th. The first time I had ER visit and they admitted to Hospital. I was there three days. I was also hospitalized the second time: four days. They gave me IV antibiotics both times. The first time, they sent me home with a couple of days of antibiotics. This second time, they did not send me home with any medicine. I have a follow up visit on Wednesday with my oncologist.

Other Meds: Thyroid medicine- Levothyroxine; Prilosec - twice a day; Eliquis twice a day; Ruvastatin - cholesterol drug; Meloxicam; Singulair - pill; chemo pill - Pickrey; Calcium and Vit D at night; Flonase for my nose; I have a couple of inhalers -

Current Illness: no

ID: 1795144
Sex: M
Age: 70
State: NY

Vax Date: 10/11/2021
Onset Date: 10/18/2021
Rec V Date: 10/18/2021
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: Pain in extremity

Symptoms: None stated.

Other Meds: Tamsulosin HCL; Omega 3

Current Illness: Arthritis in neck and right shoulders

ID: 1795145
Sex: F
Age: 63
State: IL

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

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

Lab Data:

Allergies: None

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

Symptoms: After Moderna vaccine, I had feeling of heaviness in my chest, rapid irregular abnormal heart rhythms (arrhythmia), really fast heartbeat (tachycardia), heart palpitations, high heart rate, high BP, shortness of breath, dizziness, tinnitus, fatigue, body aches, tingling and twitching in the left foot with slight numbness and brain fog.

Other Meds: None

Current Illness: None

ID: 1795146
Sex: F
Age: 44
State: AZ

Vax Date: 01/15/2021
Onset Date: 01/15/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: BLOODWORK IM BENADRYL PEPCID Methylprednisolone

Allergies: ERYTHROMYCIN AMOXICILLIN CIPRO KEFLEX BACTRUM SHELLFISH

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

Symptoms: ABOUT 18 MIN AFTER DOSE PT BEGAN HAVING NUMBNESS IN TONGUE AND TIGHTNESS IN THROAT. FEELING LIKE THROAT WAS CLOSING AND SIMILAR TO FEELING OF SOMETHING STUCK IN THROAT. VERY SAME FEELING WHEN EATING SHELLFISH.

Other Meds: ADDERAL EFFEXOR IRON MULTIVITAMIN LORAZEPAM

Current Illness: N/A

ID: 1795147
Sex: M
Age: 39
State: TX

Vax Date: 10/08/2021
Onset Date: 10/09/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: Blood Work 10/9/2021 everything with in normal range EKG 10/12/2021 and Blood Work everything with in normal range. 10/18/2021 blood work results Pending

Allergies: None

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

Symptoms: On 10/9/2021 the first night post vaccine, I awoke to my right leg completely asleep, pins and needles sensation and very little mobility. On 10/10/2021 the following night I awoke to the same symptom only not as pronounced. That night I want to the local emergency room to rule out anything serious such as a stroke blood clot exc. Blood was drawn with negative results for anything requiring emergency medical attention. I was allowed to leave. On Monday 10/12/2021 that evening I felt my heart racing and my left arm felt numb. I checked my self into the local Er and an EKG and blood was drawn everything came back ok and I was allowed to leave. The ER doctor prescribed me some pills for anxiety. The days prior I began to experience brain fog and twitching in my muscles.

Other Meds: None

Current Illness: None

ID: 1795148
Sex: M
Age: 58
State: CA

Vax Date: 04/05/2021
Onset Date: 04/20/2021
Rec V Date: 10/18/2021
Hospital: Y

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

Lab Data: Both the blood routine test shows the blood clots with low platelets at 08/01/2021 and 09/23/2021

Allergies:

Symptom List: Vomiting

Symptoms: Regards to Janssen COVID-19 Vaccine EUA Injection? The adverse events ( e. g., Fainted vertigo/ Local bruise/Gum bleeding was hard to stop ) are began approximately two weeks after the vaccination. Due to lack of understanding of the side effect, he went back home on 07/23/2021, and then the blood routine test shows the blood clots with low platelets(25) at 08/01/2021. So far there are no further medical treatment are taken.

Other Meds:

Current Illness:

ID: 1795149
Sex: M
Age: 60
State: PA

Vax Date: 03/04/2021
Onset Date: 03/29/2021
Rec V Date: 10/18/2021
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: no

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: I have an almost continious ringing in my ear.

Other Meds: Trulicty, Floanse, Advair, glyburide/metformin, lipitor, hydrochlorothiazide, invokana, baby asorin, zyrtec, lisenpril, trazadone

Current Illness: none

ID: 1795150
Sex: F
Age: 59
State: SC

Vax Date: 04/14/2021
Onset Date: 08/20/2021
Rec V Date: 10/18/2021
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: Stress test 10-6-21, ECHO 10-11-21, cardiac cath to be done 10-20-21

Allergies: Sulfa, z-pack, ace inhibitors

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

Symptoms: Ventricular tachycardia. Atenolol stopped. Cavedilol started.

Other Meds: Metformin, potassium, atenolol, losartan/hctz, aspirin, norvasc, Xanax, Allegra, pantoprazole, lantus, ozempic

Current Illness: None

ID: 1795151
Sex: F
Age: 88
State: KY

Vax Date: 03/18/2021
Onset Date: 10/16/2021
Rec V Date: 10/18/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: On dexamethasone and remdesivir, on supplemental oxygen

Other Meds:

Current Illness:

ID: 1795152
Sex: M
Age: 23
State: MO

Vax Date: 10/14/2021
Onset Date: 10/14/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: None

Allergies: NKDA

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

Symptoms: Administered 0.3 ml of vaccine from a vial that had been punctured 21 hours prior. Staff member made an error of not checking status of open vial.

Other Meds: NONE

Current Illness: NONE

ID: 1795154
Sex: F
Age: 66
State: OR

Vax Date: 10/12/2021
Onset Date: 10/16/2021
Rec V Date: 10/18/2021
Hospital:

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

Lab Data: ct scan comprehensive metobolic

Allergies: no known allergies

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

Symptoms: pulmonary embolism in right left lower , middle lobe and left lobe and inflammation of left lobe

Other Meds: duloxetine, losartan, meloxicam, oxycodone/apap tylenol pm melatonin

Current Illness: factor V lieden possible not diagnosed per say

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am