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: 1801622
Sex: F
Age: 39
State: KY

Vax Date: 02/05/2021
Onset Date: 10/02/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: COVID19 test 10/2/2021

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Positive COVID19 test 10/2/2021

Other Meds:

Current Illness:

ID: 1801624
Sex: M
Age: 54
State: LA

Vax Date: 09/22/2021
Onset Date: 09/26/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: None. But have photographic evidence

Allergies: No

Symptom List: Anxiety, Dyspnoea

Symptoms: Largest, most aggressive Herpes Simplex-2 I?ve ever had or seen on anyone. Moreover, last time I had a cold sore was over 30 years ago. Also suffered headaches, fever & aches for most of the outbreak. Was completely fine before shot. FYI, I have had ocular herpes several times in adolescence & once after spending 5 days in ICU 14 years ago. I was asked if I had ever had shingles before they gave the shot, so I assume it is well known that Herpes outbreak is a common side effect. If it is, it was extremely dangerous & reckless to risk my vision over this vaccine. I was extremely lucky this time. However, people should be informed Herpes outbreaks are a common side effect if this is the case and I certainly believe it is after what I went through. Can send you a digital picture if you like.

Other Meds: Methedone, adderall

Current Illness: None

ID: 1801625
Sex: F
Age: 32
State: MN

Vax Date: 04/07/2021
Onset Date: 10/16/2021
Rec V Date: 10/20/2021
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: 10/2021 COVID Positive

Allergies:

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

Symptoms: Breakthrough COVID

Other Meds:

Current Illness:

ID: 1801626
Sex: F
Age: 44
State: MA

Vax Date: 09/30/2021
Onset Date: 10/01/2021
Rec V Date: 10/20/2021
Hospital: Y

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

Lab Data: EKG, labs 10/1 Echocardiogram 10/7 Exercise stress test 10/14 Coronary catheterization 10/15

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient reports chest pain, palpitations and dyspnea starting 1 day after vaccination with Pfizer vaccine. Chest pain and palpitations continued requiring ED visit on 10/1 and hospitalization on 10/14 after abnormal stress test. Ultimately underwent coronary catheterization (normal) and was discharged, but continues to have significant dyspnea 3 weeks after vaccination

Other Meds: Albuterol inhaler 2puffs prn

Current Illness: None

ID: 1801627
Sex: M
Age: 23
State: CO

Vax Date: 10/20/2021
Onset Date: 10/20/2021
Rec V Date: 10/20/2021
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 erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Patient received vaccine. Complained of pain in arm. Went out to car to get water and came back into the clinic, sat down in a chair and became unresponsive. Patient recovered consciousness about 10 seconds later. States he remembers feeling lightheaded and felt a "headrush." Patient remembers waking back up in chair. He was laid down on the floor with feet up and give a cookie and water.

Other Meds: None

Current Illness: None

ID: 1801628
Sex: M
Age: 35
State: KS

Vax Date: 09/15/2021
Onset Date: 09/30/2021
Rec V Date: 10/20/2021
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: Ekg, blood work, heart monitor 10/15/2021

Allergies: None

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

Symptoms: Fast heartbeat, extreme panic, sweating, confusion, sinus tachycardia , dizziness, cold sweats

Other Meds: None

Current Illness: None

ID: 1801629
Sex: F
Age: 45
State: AR

Vax Date: 08/19/2021
Onset Date: 08/19/2021
Rec V Date: 10/20/2021
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: Blood work-normal Scope and colonoscopy-results have not come back yet

Allergies: N/A

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: On August 19, 2021 patient had a intractable migraine. Pain level has been an 8 or higher. Very light sensitive. Vertigo has gotten really bad; participant can not drive. Extremely, dizzy, vomiting. Physical therapy started on October 18, 2021.

Other Meds: Botox for migraines-once every 12 weeks Topomax 100mg 2x a day Amitrittyline 100mg 1x a day Xanax 2 mg 1x a day Escitalopram 20mg 1x a day Hydromorphone 4 mg-20 tablets a month Vicotin-5-325mg 20 tablets a month Promethazine-20 mg

Current Illness: N/A

ID: 1801630
Sex: F
Age: 54
State: SD

Vax Date: 08/29/2021
Onset Date: 08/30/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: None

Allergies: Allergies sulfamethoxazole trimethoprim

Symptom List: Pharyngeal swelling

Symptoms: I felt pain in my left arm where the shot was given the next day along with feeling weak, achy, and very sluggish. The following days all symptoms went away other than my arm. The pain has moved down to the top bone area on my elbow and then the top and bottom of my arm. I have lost full strength in my arm and sometimes it's somewhat painful and affects me all day long. When I try to grab something with that arm, I feel pain especially in the lower arm. Pain has not gone away, just gotten worse but steady now. How long does the pain stay in my arm and when can I expect to get full strength back? I mentioned this to the pharmacist when I got my 2nd dose and she told me to try Bio Freeze, which I tried but it does not help.

Other Meds: Medications azelastine 137 mcg (0.1 %) 1 spray intranasally three times a day as needed for nasal congestion budesonide 0.5 mg/2 mL 0.5 mg via irrigation twice a day ipratropium bromide 21 mcg (0.03 %) 2 SPRAY intranasally twice a day as ne

Current Illness: None

ID: 1801631
Sex: F
Age: 71
State:

Vax Date: 03/25/2021
Onset Date: 10/12/2021
Rec V Date: 10/20/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Abdominal pain, Chills, Sleep disorder

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: 1801632
Sex: F
Age: 24
State: WA

Vax Date: 10/20/2021
Onset Date: 10/20/2021
Rec V Date: 10/20/2021
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: Doxycycline

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Difficulty breathing Hoarseness or wheezing Harsh coughing Throat infection

Other Meds: YAZ

Current Illness:

ID: 1801633
Sex: F
Age: 29
State: CO

Vax Date: 09/17/2021
Onset Date: 09/19/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data:

Allergies: Penicillin Dairy

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

Symptoms: Pregnant, due date 11/24/21 Triggered contractions, needed medication at hospital to stop contractions

Other Meds: Prenatal

Current Illness:

ID: 1801634
Sex: F
Age: 51
State: CA

Vax Date: 10/19/2021
Onset Date: 10/19/2021
Rec V Date: 10/20/2021
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: Diarrhea, nausea, fever, headache, redness and pain at the injection site, chills and all my body hurts.

Other Meds: Tylenol

Current Illness: None

ID: 1801635
Sex: M
Age: 27
State: TX

Vax Date: 10/20/2021
Onset Date: 10/20/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: UNKNOWN

Allergies: NO KNOWN ALLERGIE

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

Symptoms: Shot given at 12:00 noon. Witness to the event states pt started to have eyes roll back in his head and have a seizure around 3pm. Called ambulance and is in route to ER with active seizure. Pt was driving when he started to have symptoms and pulled off on the side of the road.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1801636
Sex: M
Age: 59
State: MO

Vax Date: 10/12/2021
Onset Date: 10/15/2021
Rec V Date: 10/20/2021
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: NKA

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

Symptoms: About 3 days (72 hours) after getting my 2nd Covid vaccine dose, I developed mild congestion that worsened over the next 24 hours into runny nose and cough by the end of day 4. I called the pharmacist to see if this may be a reaction to the shot and they said no, likely a cold. Sinuses and cough cleared up after 3 days, which put us at day 6 after the shot. (Shot received Tuesday, 10/12/21, congestion starts 10/15/21, clears up by end of 10/18/21). On 10/19/21, I woke up after a good night's sleep, no stuffiness, but could not smell anything. Loss of sense of smell is a Covid sign. I never had a fever, but timing is suspicious between the shot and onset of symptoms. Loss of sense of smell is the only remaining symptom.

Other Meds: 40 mg Pantoprozole, 20 mg Atorvastatin, 2000 IU Vitamin D, 81 mg aspirin

Current Illness: None

ID: 1801638
Sex: M
Age: 60
State: FL

Vax Date: 10/20/2021
Onset Date: 10/20/2021
Rec V Date: 10/20/2021
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: No known allergies

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

Symptoms: After vaccination, Patient reported dizziness. Quickly patient became unconscious and breathing stopped. Epipen was administered due to suspected allergic reaction. Soon after that patient came back to consciousness. Paramedics came and took patient to hospital for further evaluation. Patient was reported doing well later in the day.

Other Meds: None

Current Illness: None

ID: 1801639
Sex: M
Age: 42
State: MI

Vax Date: 10/20/2021
Onset Date: 10/20/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: I immediately notified my office manager and I called PharmD who is the head pharmacist for University. I informed him of what happened. He informed me there is a very low chance of the vaccines interacting with one another since they are very similar in nature. I discussed the error with the pt and informed them of the information from PharmD. I also informed the pt of common side effects of the booster to be aware of. I will follow up the pt in a week to see how he is feeling. Pt felt fine after his 15 minutes waiting period and did not report any abnormal findings.

Allergies: Crestor - swelling

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

Symptoms: Pt presented to the office today to receive a booster vaccine. Pt scheduled himself through system for a Moderna Booster. We currently do not have Moderna Boosters in our office as they have not been FDA or CDC approved/recommended. This is an issue with the system scheduling process. I forgot to confirm with the pt before administering the vaccine if Pfizer was correct, this then would have prompted me not to administer the Pfizer Booster. It was not until after the vaccine was administered and the new lot number stickers were placed on the vaccine record card was it noticed the wrong vaccine booster was given. Documentation of the vaccine administration was done at the time of vaccine administration.

Other Meds:

Current Illness:

ID: 1801640
Sex: F
Age: 33
State: FL

Vax Date: 10/12/2021
Onset Date: 10/13/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: None

Allergies: None

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

Symptoms: Body aches, neck pain, headache, clogged right ear

Other Meds: Birth control

Current Illness: None

ID: 1801641
Sex: F
Age: 56
State: ID

Vax Date: 07/14/2021
Onset Date: 07/14/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data:

Allergies: NSAIDS, Penicillin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient was given 0.3 ML of undiluted Vaccine

Other Meds: Fluaxetine, Gabaentin, simvastatin

Current Illness: None

ID: 1801642
Sex: F
Age: 40
State: CA

Vax Date: 05/11/2021
Onset Date: 06/01/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Triggered systemic inflammation, horrific pain behind my eyes and temple. Heart racing, head spinning and nausea. It's been going on for 5 months now and I am still suffering.

Other Meds:

Current Illness:

ID: 1801643
Sex: F
Age: 38
State: SC

Vax Date: 04/19/2021
Onset Date: 09/23/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: Covid-19

Allergies: N/A

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

Symptoms: I had fatigue, fever, sore throat, lost of taste and smell. This symptoms lasted about 3 days. I went to get tested for Covid-19, which came back positive.

Other Meds: N/A

Current Illness: N/A

ID: 1801644
Sex: F
Age: 71
State: MO

Vax Date: 10/02/2021
Onset Date: 10/05/2021
Rec V Date: 10/20/2021
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: I had a standard 6 month lab test, but nothing related to the hives.

Allergies: I'm not allergic to anything.

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

Symptoms: I got hives, they first started on my arms. They traveled around, I had to wait to see a doctor and they prescribed Percocet, PEPCID 20 mgs twice a day, to help with the hives. They changed locations, one day it could be my legs or arms and then my back. They appear and disappear, I'm currently still dealing with the hives.

Other Meds: Luxarden; hydrochloride; aspirin; vitamin C; fish oil; probiotic; vitamin D

Current Illness: I had an acid reflex and they diagnosed with gerd.

Date Died: 10/02/2021

ID: 1801645
Sex: M
Age: 74
State: KY

Vax Date: 01/26/2021
Onset Date: 10/02/2021
Rec V Date: 10/20/2021
Hospital: Y

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

Lab Data: Clinic, laboratory test: 9/14/2021

Allergies: N/A

Symptom List: Unevaluable event

Symptoms: Patient had breakthrough infection and expired while infected

Other Meds: None

Current Illness:

ID: 1801646
Sex: F
Age: 80
State: WY

Vax Date: 02/18/2021
Onset Date: 02/18/2021
Rec V Date: 10/20/2021
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: MRI; Urinalysis

Allergies: Smoke, Dust, Pollens

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

Symptoms: About the time I went to bed 12 hours after shot I started getting chills, so I put a heating pad on and rolled with the punches and fell asleep. Around 3 AM the fainting incidents happened, and I have no recollection except for the first one when I passed out and ended up flat on the floor. The other two I have no recollection of even getting out of bed. All the tests my PCP ran would be in my records. They did not figure out what happened. I had an MRI 10 years ago and so they did a comparison to see if there was a mini stroke and there was no evidence of that. My biggest issue is worrying about the third shot.

Other Meds: None

Current Illness: None

ID: 1801647
Sex: F
Age: 38
State: NC

Vax Date: 10/19/2021
Onset Date: 10/19/2021
Rec V Date: 10/20/2021
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: Fatigue and headache.

Other Meds:

Current Illness:

ID: 1801648
Sex: M
Age: 51
State: CA

Vax Date: 04/09/2021
Onset Date: 04/12/2021
Rec V Date: 10/20/2021
Hospital: Y

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

Lab Data: MRI

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: 3 strokes after vaccine

Other Meds:

Current Illness:

ID: 1801649
Sex: M
Age: 44
State: FL

Vax Date: 08/01/2021
Onset Date: 08/30/2021
Rec V Date: 10/20/2021
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: 5 days in the ICU, 5 Days in regular hospital room (10 days total) 2 surgery's totaling over 8 hours to remove blood clot and implant 4 stints Blood thinner for life

Allergies: None

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

Symptoms: DVT/PE with complete occlusion of in the left leg and partial occultation of right leg. Clots from knee's to belly button and in the lungs. Requiring 2 extensive surgeries and 4 stint implants.

Other Meds: None

Current Illness: None

ID: 1801650
Sex: F
Age: 57
State: WA

Vax Date: 08/31/2021
Onset Date: 09/01/2021
Rec V Date: 10/20/2021
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: X-ray- normal EKG and a test to see if I had a blood clot- normal

Allergies: Seasonal allergies

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: After the first vaccine it seem like things were ok. The worst thing I had was not being able to breathe. I also had fatigue, headaches, and weakness. It progressed. I started using my inhaler more and then it was kind of fine. Then my inhaler did not work. It became painful to breathe. My chest would hurt like there was not enough room in my lungs. I went to urgent care on 09/28/2021. They thought it was my heart so they did an x-ray and they referred me to a pulmonologist. They ruled out pneumonia with the x-ray. I missed a week of work. I continued to not be able to breathe, in fact I am still having trouble to breathe right now. After the second shot I had a more severe headache and vomiting but I did not go to the doctor. I also had trouble visually and trouble concentrating and I was losing my train of thought. I had a foggy brain. I was very fatigued. I would sleep more than I would normally sleep. More than 8 hours.

Other Meds: Symbicort inhaler, Rescue inhaler ProAir, Singulair, Amlodipine, Metformin, Trazadone PRN, Hydroxyzine, Fluoxetine

Current Illness: None

ID: 1801651
Sex: M
Age: 24
State: GA

Vax Date: 10/20/2021
Onset Date: 10/20/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data:

Allergies: NA

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient received his second dose of Pfizer today (10/20/2021). Minutes after administration and counseling, patient returned back to pharmacy window to report numbness to the right side of his face from the top of his forehead down to the bottom of his jaw. Patient was counseled to continue to sit for further observation. After 30 minutes, there were no other progression of side effects. Patient reported that the area of numbness had not spread, no numbness/weakness in arm. Patient was able to carry on conversation with me with no signs of confusion or slurred speech. Blood pressure was taken and was 126/70. He reported some tension headache and pressure under his jaw and back of his head. Patient is a store associate working a shift tonight. Asked him to check back with the pharmacy again before 9pm and to let us know if he develops any other side effects/symptoms.

Other Meds: Ibuprofen

Current Illness: Common Cold

ID: 1801652
Sex: M
Age: 67
State: TN

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 10/20/2021
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: had neg MRI/MRA brain, CTA chest, CT chest, echo x 2, cardiac cath, temporal artery biopsy

Allergies: codeine pregabalin tramadol

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

Symptoms: temporal arteritis/severe headaches, dyspnea, chest pain, near syncope. Pt has been hospitalized several times with neg work up, but continues to have chronic dyspnea on exertion, fatigue/weakness, chest pain, near syncope, HA, visual changes

Other Meds: albuterol sulfate alendronate aspirin atorvastatin buspirone Calcium with Vitamin D fluoxetine ibuprofen isosorbide mononitrate metoprolol tartrate nitroglycerin omeprazole potassium chloride prasugrel Vitamin D3

Current Illness: coronary arteriosclerosis coronary artery bypass graft hypogonadism low back pain mixed anxiety and depressive disorder osteoarthritis osteopenia sleep apnea

ID: 1801653
Sex: F
Age: 27
State: ME

Vax Date: 10/02/2021
Onset Date: 10/03/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data:

Allergies: - Almonds - Hazelnuts - Walnuts - Mold - Pollen - Cats, dogs, horses - Penicillin - Amoxicillin - Sulfamethoxazole

Symptom List: Nausea

Symptoms: Unilateral axillary lymphadenopathy on left side. Area tender on palpation. No redness or other discoloration. Lasted approximately 2-3 days.

Other Meds: Vyvanse 40mg

Current Illness: Common cold in early September (multiple negative COVID-19 tests; resulted in cough variant asthma for following month)

ID: 1801654
Sex: F
Age: 55
State: GA

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: Bloodwork showed elevated pancreatic enzyme levels.

Allergies: Sulfa prep meds make me nauseated; Codeine makes me hyper and sometimes a rash, irritability

Symptom List: Injection site pain

Symptoms: I began feeling nauseated and tired the afternoon of the day I was vaccinated. I ran a fever overnight. Extreme diarrhea and nausea set in the next morning for 5-6 hrs. Then I was fatigued for a couple of days. 7 days laterI experienced extreme bloating and pain unlike I have every experienced before. I could not stand upright. This was the beginning of problems with nausea, extreme gas and bloating, and periodic bouts of diarrhea. Prior to this I tended to be constipated more often than not. I was treated initially with Flagyl thinking this was food or water-borne. This improved symptoms but did not make it go away. The systems returned even worse once the meds were discontinued. About 2 weeks later the pain became so acute that I went to urgent care on the advise of the on-call doctor as he feared it was appendicitus or something equally awful. They prescribed a broad spectrum antibiotic and large doses of Gas-X. This calmed things down but I basically lived on yogurt and Gas-X for the next month. I lost at least 5 lbs in the course of this illness. Eventually my gut settled down and I was able to return to a normal diet and my normal bowel habits. I finally was able to see Dr. about 4-6 weeks ago. He listened to the details of my experience and informed me that he felt the vaccine set off some type of response in my colon, maybe a bacterial overgrowth of some type due to the effect of the vaccination on my immune system. He suggested that I should take a Pfizer booster when required to see if I could avoid a repeat experience.

Other Meds: Lisinopril (5 mg); Duloxetine (60 mg); Estradiol (2mg); NP Thyroid (15 mg); Metformin (2000 mg); Emgality; Cequa; Multivitamin; Calcium; Omega-6; Glucosamine/chondroitin; Vitamin D; Miralax; Testosterone; allergy shots (pollens, mold and mi

Current Illness: None. I wear a mask and haven't really been sick since the beginning of COVID

ID: 1801656
Sex: F
Age: 39
State: NV

Vax Date: 04/17/2021
Onset Date: 08/20/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: bloodwork - CBCs - three times - doctor's office; blood culture; CT abdomen - CT sinuses (did that one pretty late but was getting better on antibiotic - still having fevers); They checked my stools. They checked my urine and did a urine culture. Three COVID tests - they did two PCR tests on different days and a rapid test - all negative.

Allergies: Ciprofluxozine;

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

Symptoms: Right after vaccine, I had a low grade fever for a day; and then I had pain and swelling at the injection site (that lasted two weeks). My shoulder had a swelling and quite a bit of tenderness. I also got Lymphadenitis - my lymph nodes on my right side under arm were swollen for 5 1/2 months. That was painful - it was hard to put my clothes on. The pain and tenderness finally stopped about 2 weeks ago. August - I started having mucous charge and thick mucus coming down from my sinus and bad fevers - 103.9 was highest it got with loss of appetite. I was very weak with muscle aches and pains. I was breathless - very breathless. I went to the doctor and figured out it was bacterial sinusitis. My neutrophil count 600 cells per microliter - 10 to the power of 3; it's come up now. I was really low though from late August to early October. I have never had low neutrophil counts. They started with Augmentin - for 10 days and then I spiked a 103.9 and so they gave me Prednisone for five days and I was still pretty bad, getting worse. So then they gave me Clindamycin; - for 10 days. And finally Azithromycin; Doxycycline for 14 days. After all of that I'm doing better. I had to take two different courses of Azithromycin because I was still having a fever. I do still have mucus drainage from my nose but it's much better. My neutrophil count also came up. I am still a little breathless. Urgent Care - for IV fluids.

Other Meds: Calcium; One a day Women's Multi-Vitamin

Current Illness: no

ID: 1801657
Sex: M
Age: 55
State: KY

Vax Date: 06/29/2021
Onset Date: 10/18/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: SARS Antigen FIA

Allergies: No

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

Symptoms: Tested positive for Covid

Other Meds: Unknown

Current Illness: No

ID: 1801658
Sex: F
Age: 66
State: ME

Vax Date: 10/08/2021
Onset Date: 10/08/2021
Rec V Date: 10/20/2021
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: ASA Penicillin

Symptom List: Tremor

Symptoms: Chills, headache, malaise, diarrhea Symptoms began with chills approximately 12 hours after the shot. Symptoms lasted about 24 hours

Other Meds: Wixela Lexapro Calcium and vitamin D

Current Illness: asthma

ID: 1801659
Sex: F
Age: 55
State: MD

Vax Date: 05/01/2021
Onset Date: 05/07/2021
Rec V Date: 10/20/2021
Hospital: Y

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

Lab Data: I had a biopsy done on July 19th which they found no cancer and on July 16 I had bronchoscope I had a lot of test done which you can request them from my doctor or Medical Center

Allergies: No allergies

Symptom List: Erythema, Pruritus

Symptoms: After getting the vaccine I got sick with something they call Vasculitis is process caused by inflammation of the blood vessel walls, which affected my lungs and caused me to have problems breathing to the point where now I?m on oxygen I?ve been in the hospital twice and they did a biopsy and a bronchoscope . I never ever had these problems before but once I took this vaccine it affected my body and changed my life . I haven?t worked since May 20,2021 I?ve been out on medical leave and right now I?m not able to go back because of being on oxygen

Other Meds: Lisinopril

Current Illness: No illness

ID: 1801660
Sex: M
Age: 54
State: OR

Vax Date: 05/21/2021
Onset Date: 05/21/2021
Rec V Date: 10/20/2021
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: MRI of the arm results were: Shallow partial-thickness tear or fraying on the bursal surface of the anterior supraspinatus tendon insertion

Allergies: Wheat-gluten allergy

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

Symptoms: Within 48 hours of receiving my 2nd dosage, I started having a sore arm that progressed from sore to pain when I moved it. Pain when not moving was a 2 on a scale of 1 to 10 (10 being highest) but when I moved it especially during bathing and dressing the pain shot to about a 7 or 8. Saw my Family Physician who referred me to a specialist who did a thorough examination then referred me for a MRI of the arm. Results were: Shallow partial-thickness tear or fraying on the bursal surface of the anterior supraspinatus tendon insertion.I then was prescribed Prednisone followed by 4-5 session of physical therapy. I had to stop physio as the pain was too much to handle.

Other Meds: Vitamin C, B-Complex Vitamin and Multi-vitamin

Current Illness: See Item 12

ID: 1801661
Sex: F
Age: 30
State:

Vax Date: 10/20/2021
Onset Date: 10/20/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient reported at 1235 tingling in her throat and small swelling of the tongue. Administered Benadryl IM to right deltoid. 1237 Vital signs: b/p: 126/82, p:54, R: 18, O2: 99%. Monitored for 30 minutes and patient did not report any other symptoms and stated her symptoms have lessened. Patient was driven home by her mother.

Other Meds:

Current Illness:

ID: 1801662
Sex: F
Age: 38
State: AL

Vax Date: 04/17/2021
Onset Date: 09/29/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: I was pregnant at the time of vaccination and gave birth to a healthy baby(7lb 5 oz) at 39weeks + 4days gestation. When my baby was about 10 weeks old I developed mastitis and sought care from my primary doctor, who prescribed antibiotics.

Other Meds:

Current Illness:

ID: 1801663
Sex: U
Age: 39
State: MT

Vax Date: 01/04/2021
Onset Date: 09/29/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Breakthrough COVID 19 infection in fully vaccinated patient not requiring hospitalization

Other Meds:

Current Illness:

Date Died: 10/10/2021

ID: 1801664
Sex: F
Age: 67
State: KY

Vax Date: 03/25/2021
Onset Date: 10/10/2021
Rec V Date: 10/20/2021
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:

Allergies: N/A

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

Symptoms: Patient had breakthrough infection and expired.

Other Meds: N/A

Current Illness: N/A

ID: 1801665
Sex: U
Age: 30
State: OH

Vax Date: 09/23/2021
Onset Date: 09/24/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List: Pain in extremity

Symptoms: I practice herbal medicines and I have not had things injected in me since I was a child however, I felt symptoms right away from shortness of breath my right jaw line, felt as if I was having a stroking & I am only 30 no underline conditions or high blood pressure or diabetes . I felt weak which I know is common my symptoms spanded for 3 weeks I felt my right ear experience ringing. I also experienced the vaccine seeping to the right side back of my neck was a throbbing pain, than as the days went I felt the right side of my eye feeling droopy as if the vaccine gave me post Stroke symptoms, I had a rash start to form under my left arm that turned raw that has never happen, it was rash and I do not have eczema. I also felt serve head aches and also a rash around my lips and the crack line of my lips as white marks, and it was not from any sexual transmitted diseases because I practice celibacy's, I have a red rash in my lip closer to my teeth line

Other Meds: No I practice herbal medicines

Current Illness: None

ID: 1801666
Sex: U
Age: 42
State: MT

Vax Date: 01/07/2021
Onset Date: 09/29/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Breakthrough COVID-19 infection in fully vaccinated patient not requiring hospitalization

Other Meds:

Current Illness:

ID: 1801667
Sex: M
Age: 17
State: MA

Vax Date: 10/20/2021
Onset Date: 10/20/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data: none

Allergies: none

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

Symptoms: As soon as vaccine was given patient became pale, nauseous, dizzy, and fainted

Other Meds: none

Current Illness: none

ID: 1801668
Sex: F
Age: 51
State: IN

Vax Date: 10/18/2021
Onset Date: 10/20/2021
Rec V Date: 10/20/2021
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: Food allergies: turkey, wheat, olives, mangoes, raw cashews Medication allergies: codiene, gabbopentin, vancamyacin,

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

Symptoms: Right axillary is swollen significantly. "A" cup.

Other Meds: singulair, flexeril, probiotic, eye sense, go cleanse, fish oil, multi vitamin, estrogen, celebrex

Current Illness: none

ID: 1801669
Sex: F
Age: 40
State: CA

Vax Date: 04/29/2021
Onset Date: 04/29/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List: Vomiting

Symptoms: within 2 hours after the injection, I developed tingling and numbness in my left arm . I retained the majority of sensation but there was a noticeable difference from normal sensation. The initial symptoms lasted about 4 days, becoming progressively less noticeable until the tingling disappeared and the perception of numbness diminished past the point I noticed it. I did not seek medical attention. Since then, every few weeks my left arm will develop a tingle for 12-24 hours and a noticeable decrease in touch sensitivity in comparison to my right hand, similar sensation to wearing a thin glove on only one hand. Each time I hope it's the last, but this has been going on for 6 months now which I find concerning. I'm considering consulting a physician once I can afford to do so.

Other Meds: Metoprolol 100 mg Spirinolactone 25 mg Dymista

Current Illness: None

ID: 1801670
Sex: U
Age: 68
State: MT

Vax Date: 01/07/2021
Onset Date: 09/29/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Breakthrough COVID 19 infection in fully vaccinated patient not requiring hospitalization

Other Meds:

Current Illness:

ID: 1801672
Sex: M
Age: 78
State: MA

Vax Date: 02/25/2021
Onset Date: 08/20/2021
Rec V Date: 10/20/2021
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: 8/21/21- covid positive chest x ray impression on 8/20/21: patchy bilateral airspace opacities concerning for multifocal pneumonia

Allergies: aspirin, ace inhibitors, beta blockers

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

Symptoms: Patient presented to ED on 8/20/21 with dyspnea at rest and recurrent fever after casirivimab and imdevimab infusion. Patient is fully vaccinated and was tested positive for Covid on 8/17. Patient was treated appropriately for Covid and was discharged on 8/25 with dexamethasone PO to complete a ten day course on 8/30.

Other Meds: allopurinol, calcitriol, Colesevelam, duloxetine, ferrex, fluconazole, gabapentin, mycophenolate, omeprazole

Current Illness: N/A

ID: 1801674
Sex: F
Age: 44
State: CA

Vax Date: 08/30/2021
Onset Date: 09/11/2021
Rec V Date: 10/20/2021
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: NA

Symptom List: Injection site swelling, Limb discomfort

Symptoms: My legs would become weak and unable to walk on my own. Also hospitalized for 12 days due to non epileptic seizures. I know have to have in home physical therapy and unable to be alone or drive due to seizure activity

Other Meds: HydroXYCHLOROQUINE 400 MG Q DAY GABAPENTIN 600MG TID

Current Illness: lupus Fibromyalgia

ID: 1801675
Sex: M
Age: 55
State: NY

Vax Date: 10/15/2021
Onset Date: 10/18/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Narrowing of vision as if I were passing out initially Tightness in chest then burning in stomach Feeling cold and as if I had a fever

Other Meds: Dovato Bupropion

Current Illness: None

ID: 1801677
Sex: F
Age: 50
State: IL

Vax Date: 04/03/2021
Onset Date: 04/03/2021
Rec V Date: 10/20/2021
Hospital:

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

Lab Data:

Allergies: spinach, eggplant

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

Symptoms: Severe chills, body aches, 101 fever, swollen lymph nodes, sore throat, headache, diarrhea, exhaustion, extreme arm pain, lasting 72+ hours

Other Meds: prozac 20mg

Current Illness: none

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am