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: 1804859
Sex: F
Age: 22
State: WA

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

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

Lab Data: CT of Ear and Brain MRI w contrast came back normal, also had audio test done and balance test done.

Allergies: Adhesive and cannabis, Benzyl peroxide, cold urticaria

Symptom List: Dysphagia, Epiglottitis

Symptoms: My first dose on March 24th very next day I noticed I was getting light headed and a little dizzy. Tried to drink some water, however a half our later I was having issues walking and collapsed. I was constantly dizzy for 2 weeks later, swaying side to side, I felt like I was spinning rather than the room itself. Intense brain fog, light headedness and fatigue. Saw primary care assumed BPPV and was given maneuvers to help BPPV to subside. Vestibular therapy was started and a week or two later slight improvement. Triggers like quick eye movement to the corner of my eye, looking down at my lap etc. would being dizziness. 2nd Dose was administered however dizziness became worse for the dizziness. After 3 months of vestibular therapy I have seen some improvement. Uneven surfaces make my head spin and as long as I do not bend over walking is capable. Neurologist stated that there was nothing they could do from their stand point. Antidepressants were administered for anxiety. After coming off of Amitriptyline dizziness became even worse. Currently dizziness, headaches, night sweats, fatigue, brain fog, light headedness. Loss of hand eye coordination as well. Spatial Awareness becomes hard as well. Vestibular therapy would be good for an hour, however intense wave of dizziness can come and cause me to become fatigued. Shift in center of gravity is also a new sensation after weening off of nortriptyline. With 3PD cognitive Therapy and Vestibular Therapy Specialized in 3PD,

Other Meds: I was taking etonogestrel ring, clindamycin 1% topical, tryptamine 10mg tablets, 100mg gabapentin capsule during 2nd dose May nortriptyline 10 mg tablet[increased over next few months to 30 mg. beginning at July 18th.] Alertec 10mg tab

Current Illness: Dealing with Anxiety and Depression and nerve pain

ID: 1804860
Sex: M
Age: 46
State: AZ

Vax Date: 05/27/2021
Onset Date: 05/29/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data:

Allergies: Ceclor

Symptom List: Anxiety, Dyspnoea

Symptoms: Pain, numbness, limited range of motion

Other Meds: None

Current Illness: None

ID: 1804861
Sex: F
Age: 46
State: IN

Vax Date: 10/18/2021
Onset Date: 10/21/2021
Rec V Date: 10/21/2021
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:

Allergies: BIAXIN

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

Symptoms: ARM SWOLLEN @ INJECTION SITE; RAISED SPOT & REDDISH IN COLOR. SIZE INCREASED TO GRAPEFRUIT SIZE (REPORTED VERBALLY BY PATIENT). PHYSICIAN PRESCRIBED ANTIBIOTICS AND STEROIDS

Other Meds: LOSARTAN , METFORMIN , LEVOCETIRIZINE , OZEMPIC , VIT D, VIT C TABLETS

Current Illness: BURSITIES (FROM MARCH VACCINATION)

ID: 1804863
Sex: M
Age: 35
State: NM

Vax Date: 10/20/2021
Onset Date: 10/21/2021
Rec V Date: 10/21/2021
Hospital: Y

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

Lab Data: 10/21/2021 CTA Head and Neck with contrast, CT of Head without contrast and MRI of Brain with Contrast, CBC, CMP, Troponin High Sensitivity , Blood glucose , Ethanol-Serum, Urinalysis, Drug Screen, SARSCOV2, EKG and Cardiach ECH

Allergies: Tomato, chocolate

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Vaccine administered yesterday, patient had dysphagia, slurred, slow speech upon waking at 0530 AM. ED results showed no acute changes on MRI Brain with contrast, CTA Head and Neck with Contrast, or CT of Head without contrast. Tele-Neuro and Hospitalist recommended transfer to a stroke center and patient transferred.

Other Meds: Acetaminophen PM

Current Illness: Unknown

ID: 1804864
Sex: F
Age: 26
State: CA

Vax Date: 10/21/2021
Onset Date: 10/21/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data: No known

Allergies: Nitrates, amoxicillin, capsaicin

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

Symptoms: Patient started feeling faint 5 to 10 minutes after getting the shot. Upon seeing the patient she felt nauseous and short of breath. Breathing rate became more rapid we moved her to a supine position on a cot. She complained of shortness of breath and tingling in extremities. We took her blood pressure at 2:05 PM which gave an initial reading of 119/51. After that patient began to shiver and complained of numbness in the arm where we did the blood pressure. Her O2 sats were at 100 with a HR of 81. 10 minutes later we took a follow up blood pressure at 2:19 PM which gave a reading of 118/88. After she began experiencing muscle weakness and fatigue we called EMS and they took her at 2:35 PM

Other Meds: CBD, Nucynta, Advil, Norco,

Current Illness: No known

ID: 1804865
Sex: F
Age: 55
State: NY

Vax Date: 08/03/2021
Onset Date: 08/03/2021
Rec V Date: 10/21/2021
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: Penicillin, Peanuts, Soy

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

Symptoms: Severe pain in upper arm at injection site, shoulder and joint. The pain began almost immediately but I didn?t realize how sever until around 5pm .

Other Meds: Desoxyn, Wellbutrin, Lexapro,

Current Illness: Deep toe laceration

ID: 1804866
Sex: F
Age: 40
State: NC

Vax Date: 10/19/2021
Onset Date: 10/21/2021
Rec V Date: 10/21/2021
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: Patient received her 2nd dose of the COVID-19 Moderna vaccine on 10/19/21. She visited the pharmacy on 10/21/21 presenting with a large swollen bump at the injection site that covered from the shoulder down to mid-arm. There was swelling and redness/discoloration. The patient did not attempt any treatments yet but plans to take an antihistamine when she arrived home. She stated she had the same reaction after her first dose and presented photos of her arm.

Other Meds: N/A

Current Illness: N/A

ID: 1804867
Sex: M
Age: 25
State: CA

Vax Date: 10/21/2021
Onset Date: 10/21/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Pharyngeal swelling

Symptoms: Patient was sitting down on the phone talking with his wife after his vaccination with Janssen at 11:47am. Another patient heard his phone drop and saw the patient fall back in his chair. The patient later stated that he suddenly felt as though someone were trying to kill him. Staff were alerted and responded immediately. It was then about 11:53, five minutes after vaccination. The patient did not fall out of his chair. A code was called. Patient appeared to be unconscious, seizing in his chair. This lasted until about 11:54 when the patient was able to sit up again, was hyperalert, and muttering to himself. He asked for water and appeared diaphoretic and frightened. He soon calmed down enough for his vital signs to be checked at 11:57 [BP119/69, HR: 53] He said he felt better and was given water. Patient reported that he had taken no medications that morning and that he had no history of seizures, although he stated that his mother told him he had seizures as a child. He had eaten some bread and milk that morning. Patient drank two juice packets and one and a half water bottles. He stated that he had been feeling nervous about the vaccine, but was feeling better. Patient's vitals were checked again at 12:03pm [BP:123/72 HR:56]. Patient called his wife to update her. Patient was kept another 30 minutes with his blood pressure (BP) and heart rate (HR) checked periodically; at 12:12pm [BP:118/75 HR:58], 12:17pm [BP:112/61 HR: 64], 12:22pm [BP:117/68 HR:60], 12:28 [BP:110/69 HR:65], 12:32 [BP:110/67 HR:59 Temperature:97.3 degrees F and O2 saturation:99%]. Patient stated he was feeling well and was permitted to leave.

Other Meds: None reported

Current Illness: Unknown

ID: 1804868
Sex: F
Age: 46
State: PR

Vax Date: 10/18/2021
Onset Date: 10/20/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data:

Allergies: no know allergies

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: PATIENT PRESENT REDNESS IN THE AREA OF ADMINITRATION WHICH SEEMS TO BE A CELLULITIS ACCORDING TO PRIMARY CARE PHYSICIAN.

Other Meds:

Current Illness:

ID: 1804869
Sex: M
Age: 79
State:

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

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

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

Other Meds:

Current Illness:

ID: 1804870
Sex: F
Age: 68
State: AZ

Vax Date: 10/17/2021
Onset Date: 10/18/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data: Blood test

Allergies: None

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

Symptoms: Body aches, chills, fever, vomiting, diahrrea

Other Meds: Cephaloxin 500 mg

Current Illness: UTI

ID: 1804871
Sex: M
Age: 64
State: CA

Vax Date: 04/15/2021
Onset Date: 07/06/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data: 07/09/2021 Ultrasound on left leg

Allergies: SKIN ALLERGY TO NICKEL

Symptom List: Rash, Urticaria

Symptoms: Adverse Event- Blood Clots in left leg, pain and swelling Daily. Treatment-Eliquis blood thinner

Other Meds: 50 MG 1X DAILY LASTARTIN FOR HIGH BLOOD PRESSURE 600 MG 3X DAILY GABAPITIN

Current Illness: NONE

ID: 1804872
Sex: M
Age: 55
State: WI

Vax Date: 10/20/2021
Onset Date: 10/20/2021
Rec V Date: 10/21/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Alot of cold sores

Other Meds: Dexamethasone,Tylenol,Amoxicillin,zyrtec

Current Illness: Tooth infection

ID: 1804873
Sex: F
Age: 59
State: PA

Vax Date: 10/19/2021
Onset Date: 10/20/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data:

Allergies: penicillin

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

Symptoms: warm to touch large area "baseball size ring" not sore, red, not itchy - larger than usual injection site. Pt was going to see md.

Other Meds:

Current Illness:

ID: 1804874
Sex: M
Age: 67
State: WA

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

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

Lab Data: Per manufacturer and CDC guidance, pt needs to be revaccinated with this booster and have an evaluation with PCP.

Allergies: NKDA

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

Symptoms: Pt was administered an expired vaccine. The vaccine was diluted on 10/14 and administered on 10/19. It had been refrigerated during this time but was beyond the use date. Pt reported no symptoms. Pt scheduled for a follow up with this PCP.

Other Meds: Aspirin 81 Mg QD Hydrochlorothiazide 12.5 mg QD Ibuprofen 400mg as needed Tylenol 500mg 1 tab as needed Albuterol HFA 2 puffs Q6 H Amlodipine 10 mg QD Atorvastatin 40mg QD Famotidine 20mg QD Fluticasone 50mcg.act nasel spray BID Lisinopril

Current Illness: R knee osteoarthritis HTN Chronic chest pain Pre-diabetes

ID: 1804875
Sex: F
Age: 62
State: WA

Vax Date: 05/12/2021
Onset Date: 06/02/2021
Rec V Date: 10/21/2021
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 tests, CT with contrast, CT without contrast, Chest Xray, Stress test, Echo Stress Test, Cathedar to heart.

Allergies: Sulfer drugs

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

Symptoms: Felt like someone punched me in the center of my chest. Staff infection showed up on lower shin, Difficult breathing. Felt like a heart attack after a couple of weeks, declining every day. Walking went from 5 miles a day 6 days a week to being unable to walk 10 feet without catching my breath. Working out 3 days a week, 30 minutes a day, unable to workout 10 minutes lite weights

Other Meds: D3, Collegen

Current Illness: None

ID: 1804876
Sex: F
Age: 33
State: MT

Vax Date: 10/06/2021
Onset Date: 10/08/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data: Yes

Allergies: benadryl cymbalta zofran zoloft

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

Symptoms: Covid 19 vaccine reaction

Other Meds: Ibuprofen 800mg 3x daily Symbicort 160-4.5 Xopenexhfa 45mct inhaler Mommometasone 50mg nasal spray Oxycodone 5mg Stelara 90mg 1 every 90 days Humaloge Kwik 10pen Cephalexin 500mg capsule Spironolactone 100mg Diclofenac 1% gel Levocetirizi

Current Illness: No

ID: 1804877
Sex: M
Age: 24
State: TX

Vax Date: 10/05/2021
Onset Date: 10/07/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data: COVID rapid nasal swab resulted as negative (-)

Allergies: NKDA or Food allergies

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Reports chills, fatigue, sore throat, chest congestion, severe cough, sinus congestion , and runny nose that started just a few days after his booster and now lasting a week. Severe productive cough also included. Treated OTC for symptoms prior to clinic visit with antihistamines, cough lozenges, Tylenol, and ibuprofen with no relief.

Other Meds: Zyrtec

Current Illness: Learning Disorder

ID: 1804878
Sex: F
Age: 33
State: GA

Vax Date: 10/19/2021
Onset Date: 10/20/2021
Rec V Date: 10/21/2021
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: Pt presents with headache, fatigue and nasal congestion, left arm injection site pain. treatments increase fluids, motrin, sudafed vitamin C and rest

Other Meds: Zoloft, Clomid

Current Illness: sinus infection

ID: 1805951
Sex: M
Age: 34
State: WI

Vax Date: 01/21/2021
Onset Date: 01/22/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data: ECG, blood tests, chest x-rays

Allergies: Neosporin- skin allergy Cats- sinus allergies

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

Symptoms: Body aches, chills, fever, nausea, vomiting, diarrhea, facial and throat swelling, dizziness, confusion, disorientation, chest and back pain, new allergies to eggs and bees, intermittent racing heart rate while at rest (130bpm for several hours at a time while relaxing) causing blood pressure to increase to +185/125 - No previous history. Developed back pain and chest pain which occur intermittently and have persisted for 9 months since getting vaccine- no previous history onset approx 24 hrs after vaccine. Developed new severe egg allergy 24 hrs after vaccine. Previously ate 3-4 eggs/day with no issues, now even items containing trace amounts of eggs cause severe stomach cramping, pain, vomiting, and diarrhea, also causes full body rash/hives with burning sensation/worsening rash with sweat, skin contact with raw eggs causes burning/blistering rash. Developed severe allergy to bees, previously stung 10-20 times/year with no adverse effects, stung approx 1 week after vaccine caused massive swelling, second sting a week later caused anaphylactic reaction- no previous history of insect allergies, no prior history anaphylaxis prior to reaction to covid vaccine.

Other Meds: Adderall

Current Illness: None

ID: 1805952
Sex: F
Age: 57
State: TX

Vax Date: 02/23/2021
Onset Date: 06/05/2021
Rec V Date: 10/21/2021
Hospital: Y

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: Stress Echo EKG Chest MRI with contrast

Allergies: penicillian

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

Symptoms: Symptoms: Frequent PVC's - Bigeminy - Time: PVC's started 5/9/21 : Hospitalized 6/5/21 through 6/7/21 Treatment: Cardiac Ablation 6/7/21 Outcome: Cardiac Ablations cured my PVC's Additionally: My mother-in-law died of strokes 7/10/21 & Husband was in Atrial Fibrillation on 10/13/21. We all received the vaccine together. Both my husband and I were healthy with no previous heart conditions.

Other Meds: vitamins

Current Illness: none

ID: 1805953
Sex: F
Age: 35
State: CO

Vax Date: 03/22/2021
Onset Date: 03/25/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data: Ultrasound occurring on April 8, 2021 showed that i had had a missed miscarriage, the baby had died but did not miscarry naturally.

Allergies: None

Symptom List: Unevaluable event

Symptoms: I was pregnant with my fourth pregnancy (three healthy pregnancies and births previous to this fourth pregnancy, no history of miscarriage) and was due October 28, 2021. I had not yet had my first appointment with my doctor as that occurred the first week in April. I had my first vaccination on March 22 and it is estimated that the baby died around March 25 due to its size. When I went for my first appointment on April 8 there was no heartbeat. While it is unlikely the vaccine caused this adverse reaction, I wanted to have it documented in the rare even there were other similar complications.

Other Meds: Pre-Natal pill and Fish Oil

Current Illness: None

ID: 1805954
Sex: F
Age: 74
State:

Vax Date: 03/06/2021
Onset Date: 10/12/2021
Rec V Date: 10/21/2021
Hospital: Y

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

Lab Data:

Allergies:

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

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

Other Meds:

Current Illness:

ID: 1805956
Sex: F
Age: 57
State: NY

Vax Date: 10/21/2021
Onset Date: 10/21/2021
Rec V Date: 10/21/2021
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. No adverse reaction reported.

Allergies: None attested to

Symptom List: Injection site pain, Pain

Symptoms: There was no adverse reaction and provider stayed to observe patient for 30 minutes. The VAERS report is being submitted because the patient had received a first dose of Pfizer, but was vaccinated today with Moderna. The patient said the first dose she received previously was Moderna, but it was Pfizer. Vaccination of second dose was not the same manufacturer.

Other Meds: unknown

Current Illness:

ID: 1805957
Sex: F
Age: 42
State: CA

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data: xrays and autoimmune work up pending.

Allergies: penicillin causes a rash, no known allergies to foods or other products.

Symptom List: Injection site pain, Menorrhagia

Symptoms: member reports joint pains in several joints (hands, feet, knees, back) that have persisted since the time of original vaccine administration. by now it's been about 7 months since symptom onset.

Other Meds: levothyroxine 25mcg once daily by mouth jardiance 10mg once daily by mouth losartan 50mg by mouth once daily lipitor 20mg by mouth one daily metformin 1000mg by mouth twice daily

Current Illness: no acute illnesses before or during vaccinations.

ID: 1805958
Sex: F
Age: 79
State: IL

Vax Date: 10/18/2021
Onset Date: 10/19/2021
Rec V Date: 10/21/2021
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: corn and mold products -- many antibiotics Iodine dye

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

Symptoms: Horrible headache, horrible nausea, fever (100.3), joint/muscle pain, mouth/gums and jaws hurt, chills, arm pain at injection site. My checks seemed a little swollen. I had an awful metal taste in my mouth for a day. I felt like I had been poisoned.

Other Meds: Vit D3 Vit B12 Losartin 100mg Nasacort Nexium amlodipine 5mg

Current Illness: None

ID: 1805959
Sex: F
Age: 65
State: CA

Vax Date: 10/21/2021
Onset Date: 10/21/2021
Rec V Date: 10/21/2021
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: no

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Trimmer and shaking

Other Meds: synthroid

Current Illness: none

ID: 1805960
Sex: F
Age: 37
State: IL

Vax Date: 10/21/2021
Onset Date: 10/21/2021
Rec V Date: 10/21/2021
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: Pt felt dizzy after receiving her 1st Pfizer dose. 2 ice packs were used. Crackers and water was offered. BP at 12:11pm 128/78 Hg/mm, O2 97, HR 81. Patient was helped down to floor to lay on yoga mat, pillows and blankets were used. Feet was raised up. After a while she was helped back up to the chair. Pt stated she was very anxious to get the vaccine as she was now required to get the vaccine for her work or lose her job. She had recently lost her spouse and has been working long hours. She didn?t have any breakfast and have been under a lot of stress. BP at 12:30pm 132/80Hg/mm, O2 99, HR 65. Pt states she feels better now. Recommended to eat before coming to get her 2nd dose and come with a family member. Do let the clinician know of this before getting the 2nd dose. Patient verbalized understanding. Entire team was present and full PPE in used.

Other Meds:

Current Illness:

ID: 1805961
Sex: M
Age: 40
State: CA

Vax Date: 10/01/2021
Onset Date: 10/01/2021
Rec V Date: 10/21/2021
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: I had to be admitted to the ED for IV Solumedrol, Benadryl, and Pepcid

Allergies: None

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

Symptoms: Severe full body redness, tachypnea, tachycardia

Other Meds: None

Current Illness: None

ID: 1805962
Sex: F
Age: 67
State: SC

Vax Date: 03/05/2021
Onset Date: 03/05/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data: In process

Allergies: None

Symptom List: Nausea

Symptoms: None stated.

Other Meds: Brace vitamins heating pad aspirants pain medication

Current Illness: None

ID: 1805963
Sex: F
Age: 47
State: MD

Vax Date: 09/18/2021
Onset Date: 09/18/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Patient complaining about sore arm, pain and swelling

Other Meds:

Current Illness:

ID: 1805964
Sex: M
Age: 38
State: AZ

Vax Date: 09/14/2021
Onset Date: 09/21/2021
Rec V Date: 10/21/2021
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: Injection site induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Patient with progressive arm pain, back pain. Progressed to GBS within 3 weeks.

Other Meds:

Current Illness:

ID: 1805965
Sex: F
Age: 28
State: AZ

Vax Date: 10/18/2021
Onset Date: 10/19/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data: none

Allergies: none

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

Symptoms: erythematous truncal rash - 1-2mm papules without itching, pain, nor drainage. No significant spread or progression in severity after initial presentation. Preceded by tender left axillary lymphadenopathy (ipsilateral to covid vaccine; no right-sided LAD) and arm soreness - both of these sx were within expected severity for covid vaccine.

Other Meds: none

Current Illness: none

ID: 1805966
Sex: F
Age: 93
State: FL

Vax Date: 10/21/2021
Onset Date: 10/21/2021
Rec V Date: 10/21/2021
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: nka

Symptom List: Tremor

Symptoms: dizziness

Other Meds: not known

Current Illness: HBP

ID: 1805967
Sex: M
Age: 56
State: MI

Vax Date: 07/01/2021
Onset Date: 08/20/2021
Rec V Date: 10/21/2021
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: Erythema, Pruritus

Symptoms: I used to be able to run machines and the coolant didn't bother my hands but now it seems that after I had my Moderna vaccinations I have to wear gloves because my skin is now sensitive to the coolants the machine uses and my hands don't like having rubber gloves on all day so I have to use Desitin lotion and bandages for rashes

Other Meds: none

Current Illness: none

ID: 1805968
Sex: F
Age: 14
State: IN

Vax Date: 10/18/2021
Onset Date: 10/18/2021
Rec V Date: 10/21/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies:

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

Symptoms: Mother of patient requested COVID-19 vaccination with Pfizer manufacturer. Pharmacy technician asked screening questions and thought mother requested flu vaccination. Flu vaccination was entered by technician and pharmacist verified data and administered flu vaccination. After administration, mother asked about second dose and error was recognized that requested vaccination was not administered. No immediate adverse effects seen in patient.

Other Meds:

Current Illness:

ID: 1805969
Sex: F
Age: 31
State: CA

Vax Date: 09/09/2021
Onset Date: 09/13/2021
Rec V Date: 10/21/2021
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: Mangos

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

Symptoms: Pulsing and twitching in deltoid muscle daily post vaccine continuing for over a month now

Other Meds: Zoloft, prenatal pills

Current Illness:

ID: 1805970
Sex: F
Age: 52
State: SC

Vax Date: 04/17/2021
Onset Date: 09/10/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data: Rapid COVID Test - Negative

Allergies: Iodine (dyes internal/external), Seafood, Sulphur, Antibiotics, and Bee Stings

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: I experienced extreme fatigue, coughing, and fever over the weekend. Upon arriving at work the following Monday, the school Nurse sent me home and I went to Urgent department who performed the rapid test and stated that because I was in close contact with my daughter and others who had been exposed that it may come back with a false positive; however, the test came back negative. I was also given a Flu test that also came back negative; therefore, the diagnosed me with a viral infection. I was prescribe Prednisone, Bromfed DM, and oral steroids for my symptoms.

Other Meds: I took my normal medications: Buspar 15mg 2x per day, Spironolactone 100mg 1x per day, Singular 10mg 1x per day, Pristiq 100mg 1x per day, Topamax 100mg, Estrodrine .5 mg, Fenofibrate 100mg, Ambien 10mg, and Zyrtec, Flonase 2 sprays, and Fl

Current Illness: No

ID: 1805971
Sex: F
Age: 50
State: WA

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data: since have had my routine mammogram with a growth of a cyst which was not there on prior mammograms, so far is benign and watching. Had an ANA once but may have another as the increased pain continues.

Allergies: Codeine, Percocet, Amoxicillin

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

Symptoms: with Fibromyalgia my daily pain was 3-4 constant, since the second Covid vaccine has been 7-8/10 for the last 9 months, which I have had to increase medications to try to work. I also had left breast pain for most of that 9 months also.

Other Meds: venlafaxine, allegra, Flonase, calcium, vitamin d, pre/probiotics

Current Illness: Fibromyalgia, Depression/anxiety, hx of stroke

ID: 1805972
Sex: F
Age: 61
State: CA

Vax Date: 04/20/2021
Onset Date: 07/01/2021
Rec V Date: 10/21/2021
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: Saw an ENT about dizziness -- everything was normal. Had a 2-week Holter heart monitor -- everything was normal

Allergies: a number of antibiotics...penicillin, keflin, vacamycin, oxacillin

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

Symptoms: 5+ weeks after the second dose, (July 1, 2021) I developed benign positional vertigo. After a few weeks, the significant spinning lessened but turned into general foggy-headed, mild dizziness, general fatigue, heart palpitations. This lasted 2.5 months Now, three months later, the fatigue and heart palpations are gone. The dizziness is almost gone but not entirely. I am in physical therapy and being treated for Vestibular Ocular Reflex. I have no idea whether this has anything to do with the vaccine. It could be that I got COVID, am having long term symptoms without having had any of the normal symptoms. Just thought this might be helpful

Other Meds: Vit D, fish oils

Current Illness: none

Date Died: 09/04/2021

ID: 1805973
Sex: F
Age: 94
State: CA

Vax Date: 09/03/2021
Onset Date: 09/04/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data:

Allergies: Macrobid

Symptom List: Pain in extremity

Symptoms: Patient died one day after receiving the Pfizer Booster at her skilled nursing home.

Other Meds: Vit D, Synthroid, Hydrocodone/APAP,Depakote

Current Illness: Dementia, ASCVD, Low Vit D, Hypothyroid, OA, HTN, Depression, Thrombocytopenia

ID: 1805974
Sex: M
Age: 37
State: CA

Vax Date: 09/30/2021
Onset Date: 10/13/2021
Rec V Date: 10/21/2021
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: Right leg shingles/zoster (L4 dermatome with rash and sensory symptoms), sensory symptoms alone extending from L4-T8 dermatomes on right.

Other Meds: None

Current Illness: None

ID: 1805975
Sex: F
Age: 73
State:

Vax Date: 10/21/2021
Onset Date: 10/21/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Elderly woman came in for booster dose of Pfizer. She had very thin arms and when the immunizing technician went to administer she hit bone. While depressing the syringe the technician tried to pull back from the bone and the needle came out of the patient's arm. The was liquid that then continued to come out of the syringe and run down the patients arm. It was determined after speaking with the immunizing technician that she believed about half the dose was administered to the patient. Per CDC guidelines the dose was considered complete and not re administered

Other Meds:

Current Illness:

ID: 1805976
Sex: M
Age: 31
State: CA

Vax Date: 09/03/2021
Onset Date: 09/23/2021
Rec V Date: 10/21/2021
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 got my eyes checked the doctors said they seem fine we will never know if it was related to the vaccine

Allergies: None

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

Symptoms: I experienced a terrible left eye pain felt like my eyeball was going to burst out of my face. My father experienced the same pain as well, His was 10 minutes after the second dose mine was a few weeks after the first dose. We both experienced the pain for less than five minutes it was something we have never felt in our life.

Other Meds: Asthma inhalers

Current Illness: None

ID: 1805977
Sex: M
Age: 43
State: CA

Vax Date: 09/23/2021
Onset Date: 10/01/2021
Rec V Date: 10/21/2021
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: none reported

Symptom List: Vomiting

Symptoms: Patient reported that everything went well with his shot until two weeks after he got it. Patient stated that he felt a regular shoulder pop in his left shoulder. His shoulder then felt warm and was red and swollen. Pt reported that he visited his doctor about the shoulder pain and had imaging done looking for fluid in the joint, of which none was found. Patient reported being informed that this was likely due to aging, however patient requested that the event be reported in case it might be related to the vaccination. The patient returned today for his second dose of Moderna, 4 weeks after his initial dose. He reports that his arm is still sore, but that he is continuing to use it and wanted his second dose in the same arm, the left.

Other Meds: 1 baby aspirin daily

Current Illness:

ID: 1805978
Sex: F
Age: 12
State: IN

Vax Date: 10/18/2021
Onset Date: 10/18/2021
Rec V Date: 10/21/2021
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: CUCUMBER, PICKLES, RELISH

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Mother of patient requested COVID-19 vaccination with Pfizer manufacturer. Pharmacy technician asked screening questions and thought mother requested flu vaccination. Flu vaccination was entered by technician and pharmacist verified data and administered flu vaccination. After administration, mother asked about second dose and error was recognized that requested vaccination was not administered. No immediate adverse effects seen in patient.

Other Meds:

Current Illness:

ID: 1805979
Sex: F
Age: 72
State:

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

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

Lab Data:

Allergies: Allergies Allergen Reactions ? Penicillins CV - anaphylaxis Severe reaction in childhood ? Pneumovax 23 [Pneumococcal Vac Polyvalent] GENERAL - fever, SKIN - pruritis, CV - anaphylaxis and MUSC/SKEL - body aches DX: cellulitis ? Ceftriaxone SKIN - rash Whole body rash ? Erythromycin OTHER (explain in comments) Severe abdominal pain ? Cephalosporins SKIN - hives ? Codeine NEURO/PSYCH - headache ? Sulfa Drugs SKIN - hives, SKIN - rash and EENT - angioedema To gantrasin

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

Symptoms: arm pain, arm redness, itchy arm, started 2 days after vaccine

Other Meds: Current Outpatient Medications Medication Sig ? albuterol HFA 108 (90 Base) MCG/ACT inhaler Inhale 2 puffs 4 times daily as needed. ? ALPRAZolam (XANAX) 0.25 MG tablet TAKE 1 TABLET(0.25 MG) BY MOUTH THREE TIMES DAILY AS NEEDED ? cholecalci

Current Illness:

ID: 1805980
Sex: F
Age: 56
State: NJ

Vax Date: 09/20/2021
Onset Date: 09/21/2021
Rec V Date: 10/21/2021
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:

Allergies: doxycycline

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Pressure on chest, numbness

Other Meds: c5

Current Illness:

ID: 1805981
Sex: F
Age: 42
State: MD

Vax Date: 06/05/2021
Onset Date: 07/02/2021
Rec V Date: 10/21/2021
Hospital:

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

Lab Data: Sinus CT scan, Allergy tests, chest x-ray, full panel blood test, Physical therapy Epely Maneuver, BPPV, ear irrigation,

Allergies: None

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

Symptoms: Sinus infection, bilateral ear infections, vertigo, dizziness, nausea, heart palpitations

Other Meds: Amlodipine Vitamin C Womens One a Day Calcium

Current Illness: None

ID: 1805982
Sex: F
Age: 11
State: PA

Vax Date: 10/21/2021
Onset Date: 10/21/2021
Rec V Date: 10/21/2021
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: Bee stings

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

Symptoms: After receiving Menactra in her left arm, she immediately started with swelling and erythema around the Menactra injection. I was called into the room by the medical assistant and patient was upset and crying that her arm hurt. She had an approx. 4 inch diameter area of erythema around the injection site and it was swollen. We immediately applied an ice pack. Then a few minutes later, mom noted three small red macules on her right forehead and a splotchy red rash on her chest. Her chest was clear, there were no respiratory symptoms, no mouth or facial swelling. Vitals were stable the entire time. She was given 300mg ibuprofen for the pain and 37.5mg benadryl for the rash. Even before giving the benadryl, the chest rash disappeared and the forehead rash started to improve. Patient was observed for approx. 45-50 minute after the vaccine and rash, swelling, and pain had completely resolved prior to leaving the office. Lungs were clear the entire time.

Other Meds: None

Current Illness: None

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am