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: 1815656
Sex: F
Age: 49
State: NY

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

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

Lab Data:

Allergies: Sulfa, Penicillin, seasonal

Symptom List: Dysphagia, Epiglottitis

Symptoms: The day of and after I had severe muscle and joint pain, tired, headache and stomach pain. A week later I developed chest pain on the right side of my chest, wheezing and breathlessness. Deep breaths hurt. I had to take my asthma pump. I almost never use it and have never had a flare up like this. I am still achy and have joint pain but it is better than earlier in the week. The chest pain and breathing issues are new and concerning.

Other Meds: Claritin

Current Illness: None

ID: 1815657
Sex: F
Age: 72
State: NM

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: bloodwork

Allergies: gluten, dairy, dye

Symptom List: Anxiety, Dyspnoea

Symptoms: passed out, weakness, brain fog, issues walking, microglia,

Other Meds: liothyronine, levothyroxine

Current Illness: bronchitis

ID: 1815658
Sex: F
Age: 31
State: TX

Vax Date: 10/23/2021
Onset Date: 10/23/2021
Rec V Date: 10/25/2021
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: chest pain starting 7 hours later and persisting to 10/25/2021

Other Meds: anxiety meds prn

Current Illness: none

ID: 1815659
Sex: F
Age: 53
State: CA

Vax Date: 09/03/2021
Onset Date: 09/01/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: Went into urgent care with intense pain in right shoulder. Injury was ruled out. Bursitis was diagnosed. Reason unknown. Visited a ortho doctor. X-rays taken. Cortisone shot given in right arm but left arm still in pain. Doctor told me to go to physical therapists. Ovary pain increasing. Juts feel like I have joint pain for the first time in my life without injury or previous problems. While I had reactions after first two shots of normal muscle pain, it was not until the third shot that I am experiencing these symptoms.

Allergies: sulfa medications

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Pain in shoulder joints first, then knees, neck and ovaries in pain now.

Other Meds: none

Current Illness: none

ID: 1815660
Sex: F
Age: 32
State: VA

Vax Date: 08/16/2021
Onset Date: 09/20/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: Went to urgent care and ER they both say allergic reaction to something. I haven?t changed anything in the last 6 months (I had a baby in April)

Allergies: Pecans Grass Roaches

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

Symptoms: Extremely itchy Rash all over body. Started on lower abdomen as little spots in one area on right side of abdomen. Went to urgent care September 28ish and they have no idea where rash could have come from. Went to ER a week later(it is not covering whole stomach, and back and both arms, they gave me prednisone which cleared it while I was taking it. Today 10/25 it is on my chest, inner thigh area, back of knees, and forearms and back ( where arms can reach)

Other Meds: None

Current Illness: None

ID: 1815661
Sex: F
Age: 61
State: CA

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

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

Lab Data: none

Allergies: none

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

Symptoms: Pt was administered Moderna Covid-19 2nd dose on 10.22.21. Vial had an expiration date of 10.21.21, which was extended by Moderna to expire on 12.21.21 on 10.22.21 (via e-mail from management). This morning new guidance was received stating only vials that were frozen are to be used with new expiration date. The vial used for your patient was previously thawed-out.

Other Meds: Norco, amlodipine, benazepril-HCTZ, lactulose, multivitamin, niraparib, pantoprazole, rucaparib

Current Illness: none

ID: 1815663
Sex: F
Age: 59
State: CA

Vax Date: 10/07/2021
Onset Date: 10/08/2021
Rec V Date: 10/25/2021
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: Walnut Coconut

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Reported illness symptoms began about a week ago (around 10/14) after receiving the booster 3rd dose of Pfizer at vaccine clinic, possible due to significant adverse effects of the COVID vaccine. She has been self-treated her symptoms without improvement; symptoms worsen. She had similar reactions after 2nd dose of Pfizer in the past.

Other Meds:

Current Illness:

ID: 1815664
Sex: M
Age: 54
State: DC

Vax Date: 10/23/2021
Onset Date: 10/23/2021
Rec V Date: 10/25/2021
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: Pharyngeal swelling

Symptoms: The client requested the Moderna Vaccine. DOCSII was checked and determined the client had not received any Covid vaccines. The syringe had .5ml Moderna vaccine. however .25 ml was wasted and witnessed by my colleague. Client received .25 ml of Moderna in his right Deltoid. It was his first dose of Moderna vaccine and he should have been given .5ml of the the Moderna vaccine. I did not discover the error until I had left the clinic. There were no noted symptoms after administering the .25ml of Moderna. The client was contacted on 10/25/2021 and notified that he received .25ml of Moderna instead of .5ml of Moderna. He was informed that he should contact his health provider to determine the course of action.

Other Meds:

Current Illness:

ID: 1815665
Sex: F
Age: 74
State: MI

Vax Date: 02/12/2021
Onset Date: 03/01/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: N/A

Allergies: sulfa medications, ceclor

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: I had a fever and chills for about 12 hours after the vaccine. In March and until July, I don?t know when the hot flashes started, but I would all of a sudden get a flushing feeling like I would get really hot. I felt that internal hotness like a hot flash. It would come and then it would go away. They were very random. I could not predict when they would happen, but I might have one or two a week. There was no rhyme or reason to them. The only reason I thought of them was because I haven?t had them in a very long time. I just put two and two together, and I?m not sure if they?re even related. But they started happening right after the second shot of the vaccine.

Other Meds: ? Armour Thyroid 30mg T,W,Th, S, Su.; 2 30mg tabs M, F ? Aspirin 81mg once daily ? Metoprolol 25mg 1 ? tab daily ? Atorvastatin 20mg once daily ? Move Free 2 tabs per day (Glucosamine Chondroitin) ? Quercetin with bromalin 2 tabs twice dail

Current Illness: N/A

ID: 1815666
Sex: F
Age: 64
State: FL

Vax Date: 08/30/2021
Onset Date: 08/31/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: arm pain that has lasted until today's date, back pain, knee pain

Other Meds:

Current Illness:

ID: 1815667
Sex: F
Age: 57
State: OH

Vax Date: 06/07/2021
Onset Date: 10/18/2021
Rec V Date: 10/25/2021
Hospital: Y

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

Lab Data: 10/25/21 Rapid COVID-19: positive UA: 10-20 WBC, 20-50 RBC, 2-5 epi, few bacteria, positive nitrites, large LE, Turbid Alk Phos: 140; AST: 33; total bilirubin: 0.22 SCr: 0.97; BUN: 22; K: 3.5; CO2: 17; anion gap: 20

Allergies: contrast, amiloride, penicillin, cephalexin

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

Symptoms: Patient presents to the ED with complaints of nausea, vomiting and diarrhea for the past week. She also reports abdominal pain, dizziness, fatigue, lightheadedness, body aches, and chills. The patient was found to be positive for COVID-19 and a UTI. The patient will be admitted and is receiving levofloxacin, LR, ondansetron, and famotidine.

Other Meds: Advair, Albuterol, amlodipine, atorvastatin, buspirone, carvedilol, fluoxetine, loratadine, losartan, montelukast, pantoprazole, probiotic, quetiapine, ranolazine, Spiriva, spironolactone

Current Illness:

ID: 1815668
Sex: F
Age: 65
State: WV

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

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

Lab Data: None

Allergies: None

Symptom List: Rash, Urticaria

Symptoms: After 3rd dose, got severe rigors that lasted 2 -2.5 hours

Other Meds: None

Current Illness: None

ID: 1815669
Sex: F
Age: 66
State: IA

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

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

Lab Data: Hep B antibodies (10/23/21) Hep C antibodies (10/23/21) HIV antibodies (10/23/21) Hep B antigen (pending - still not done)

Allergies: no allergies

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

Symptoms: After injecting the patient (11/13/2005), to use the vaccine shield/guard and accidentally pricked her finger. The next day (saturday 10/23/21) she went to the ER. On Sunday all her tests came back negative and she was additionally seen by occupational medicine on Monday 10/25/21.

Other Meds: None

Current Illness: n/a

ID: 1815670
Sex: M
Age: 72
State: ME

Vax Date: 10/23/2021
Onset Date: 10/23/2021
Rec V Date: 10/25/2021
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: unknown

Allergies: none listed

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

Symptoms: Patient became increasingly lethargic while waiting in post-vaccination observation area. Patient became less responsive and paramedics were called. Patient was conscious and breathing but unresponsive to stimuli when paramedics arrived.

Other Meds: unknown

Current Illness: unknown

ID: 1815672
Sex: M
Age: 58
State: GA

Vax Date: 03/08/2021
Onset Date: 03/09/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: Blood draw

Allergies: No known allergies to food, medications or other products

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

Symptoms: chronic hives break outs along with severe itching Treatments: steroids, Allegra, Famotidine (20mg), Fexofenadine Hydrochloride (180mg)

Other Meds: fish oil (1200mg) and vitamin c

Current Illness: None

ID: 1815673
Sex: F
Age: 47
State: NV

Vax Date: 04/20/2021
Onset Date: 05/20/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: X-ray on my left shoulder-found tendinitis.

Allergies: None

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

Symptoms: My arm hurts. Sometimes I get spasms. I could only raise it to a certain level and it begins to hurt. I saw a doctor and they gave me a shot for the pain. The shot helped a little bit but my arm still hurts a little bit and that bothers me. Tiredness; fatigue all the time. General body aches-especially on my left-side.

Other Meds: Lisinopril 20mg; Euthyrox 25mg; Vitamin D 25mg; Montelukast 10mg Ibuprofen 800mg

Current Illness: None

ID: 1815674
Sex: F
Age: 54
State: WA

Vax Date: 04/01/2021
Onset Date: 04/01/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: Visual Inspection- Mild no treatment

Allergies: none

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

Symptoms: oral lichen planus

Other Meds: Thyroid replacement meds cynproid- hypothyroidism citalotram

Current Illness: none

ID: 1815675
Sex: F
Age: 66
State: CA

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

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

Lab Data: none

Allergies: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Pt was administered Moderna Covid-19 3rd dose on 10.22.21. Vial had an expiration date of 10.21.21, which was extended by Moderna to expire on 12.21.21 on 10.22.21 (via e-mail from management). This morning new guidance was received stating only vials that were frozen are to be used with new expiration date. The vial used for patient was previously thawed-out.

Other Meds: Norco, calcium-vit D, cyclobenzaprine, diclofenac gel, dicyclomine, ergocalciferol, estradiol topical, famotidine, folic acid, glimepiride, hydrocortisone topical, ibuprofen, ketoconazole, levothyroxine, loperamide, metformin, methotrexate,

Current Illness: none

ID: 1815676
Sex: M
Age: 44
State: NY

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

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

Lab Data:

Allergies: KIWI POSSIBLE PENCILLIN?

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: AT THE TIME OF THE INJECTION, ALMOST INSTANTLY TONGUE ENLARGED. TOOK ORAL BENADRYL, AND SAID SYMPTOM WAS SIMILAR TO REACTION HAD BY KIWI. PATIENT CLAIMED THAT MOTHER HAD SAME REACTION WHEN SHE WAS GIVENTHE COVID VACCINE AS WELL. THE LIQUID BENADRYL SEEMED TO HAVE REDUCE THE SIZE OF THE TONGUE. ALSO, CLAIMED THAT GLANDS WERE SLIGHTLY ENLARGED.

Other Meds: NOTHNG

Current Illness: NOTHING

ID: 1815677
Sex: M
Age: 79
State: NY

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

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

Lab Data: Patient was discharged from the hospital the morning of the vaccine. She was admitted Sunday for a similar event.

Allergies: None

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

Symptoms: Patient became unresponsive with irregular breathing after 15 minutes.

Other Meds: Patient is on chemotherapy

Current Illness: Cancer

ID: 1815678
Sex: M
Age: 54
State: VA

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

Allergies: Rocephrin; brimonidine; rhopressa

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

Symptoms: Ear pain

Other Meds: Levothyroxine; timolol maleate; baclofen; Tylenol; folic acid; Vitamin D 50000; lisinopril hcl;

Current Illness: No illness. Received a flu shot on October 14 2021

ID: 1815679
Sex: M
Age: 27
State: WI

Vax Date: 09/27/2021
Onset Date: 09/28/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: None. Did not seek treatment because knew beforehand temporary myocarditis was known side effect.

Allergies: None

Symptom List: Unevaluable event

Symptoms: Pain/ache in heart area for around 72 hours, lessening and then ending. Heart seems to be working fine (can run 8K in about the same time as before vaccination). Did not affect daily activities, except didn't run until pain was gone. No treatment except refraining from running.

Other Meds: Vimpat 250mg x2 daily, Keppra 1000mg x2 daily, multivitamin x1 daily, Vitamin D3 50mcg x1 daily, Vitamin C tablet x2 daily

Current Illness: None

ID: 1815680
Sex: M
Age: 26
State: UT

Vax Date: 05/14/2021
Onset Date: 10/16/2021
Rec V Date: 10/25/2021
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 and blood tests - ER in Hospital Physical therapist appt - on Wednesday of this week. November 6, I have an appt with a neurologist.

Allergies: no

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

Symptoms: The night of the 16th, I had just finished working. I started driving for two hours to hotel. While I was driving - I noticed that my muscle would just die in my arms (both) when I let go of the steering wheel. It continued the next day when I drove another 8 hours back. Tuesday the 19th, I was at work and I was walking around and started getting very light headed. My muscles were still very weak. I collapsed into the chair because my muscles kind of gave out. They took me to the Hospital ER. They took an MRI and did a bunch of blood tests. Those tests came out okay - I have a couple of pinched discs in my neck but they did not think my symptoms were related to that injury. I received IV fluids and they gave me some pain killers (very mild). That did not help with my symptoms. They prescribed a corticosteroid to try to see if that would help. It's called: Methylprednisolone. I finished that - it was a six day thing. I still have the same symptoms of muscle weakness and light headed at this time.

Other Meds: no

Current Illness: no

ID: 1815681
Sex: F
Age: 55
State: CA

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

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

Lab Data: none

Allergies: none

Symptom List: Injection site pain, Pain

Symptoms: Pt was administered Moderna Covid-19 3rd dose 10.22.21. Vial had an expiration date of 10.21.21, which was extended by Moderna to expire on 12.21.21 on 10.22.21 (via e-mail from management). This morning new guidance was received stating only vials that were frozen are to be used with new expiration date. The vial used for patient was previously thawed-out.

Other Meds: albuterol, vit D, allegra, wixela inhub, gabapentin, hydroxychloroquine, leflunomide, levothyroxine, nabumetone, tiotropium

Current Illness: noone

ID: 1815682
Sex: M
Age: 61
State: MN

Vax Date: 03/01/2021
Onset Date: 04/23/2021
Rec V Date: 10/25/2021
Hospital: Y

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

Lab Data: CT Scan 4/23 MRI 4/23 Echocardiogram 4/25 2nd Echocardiogram (Mayo) May 2021 30-day Heart Monitor June / July 2021 Thyroid Test and Stress Test August 2021

Allergies: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Blood clot that resulted in stroke symptoms; transported via ambulance; administered clot busting drug; hospitalized for three days, and released.

Other Meds: One-a-Day Multivitamin; Baby Aspirin; Claritin

Current Illness: None

ID: 1815683
Sex: M
Age: 70
State: HI

Vax Date: 04/16/2021
Onset Date: 09/12/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: On the morning of Sept 16 went to the drive-in test center and within 10 minutes received a text stating that I tested positive for SARS COV2.

Allergies:

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

Symptoms: Likely date of exposure was 9/9/21 after review of my calendar. Evening of the 12th had flu-like symptoms, sinus congestion, followed by dry coughs. These subsided after 2 days but sinus irritation/congestion, fatigue and loss of smell gradually came down over 2 weeks. Isolated for 10 days after test results(below)

Other Meds:

Current Illness:

ID: 1815685
Sex: F
Age: 93
State: NM

Vax Date: 10/23/2021
Onset Date: 10/24/2021
Rec V Date: 10/25/2021
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: Tetanus shots

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Red, minor swollen, warm, sore area from injection site proceeding down arm towards fingers. About 3 inches wide by 6 inches long. Only routine soreness of arm, no loss of function. Minor complaints from patient who has lewy body dementia. First noticed the day after the shot, got just a little bigger from day after to second day after.

Other Meds: Amlodipine Besylate; Atorvastatin; Escitalopram; Lisinopril; Memantine; Rivastigmine; aspirin; B12; D3; Stool Softener

Current Illness: Lewy Body Dementia; High BP

ID: 1815686
Sex: F
Age: 40
State: NC

Vax Date: 09/24/2021
Onset Date: 10/24/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: None

Allergies: Sulfa

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Changes in menstruation. Early period approx. 1.5 week after vaccine with repeat period and spotting 2 weeks after that. No history of irregular periods.

Other Meds: Nexium prn, Flonase prn

Current Illness: None

ID: 1815687
Sex: F
Age: 58
State: CO

Vax Date: 04/16/2021
Onset Date: 09/22/2021
Rec V Date: 10/25/2021
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: N/A

Allergies: Sulfa

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

Symptoms: So, the first week I was sore on my left arm. It felt like a lump under my armpit, it was very painful, and I decided to get checked. My doctor suggested a mammogram, but everything came back normal, and it came back as a small cyst.

Other Meds: Vitamin C; Vitamin D3; B12

Current Illness: I went to a trip and when I came back I was very congested with a very bad cold that lasted a week or two. Terrible sinus congestion. No fever.

ID: 1815688
Sex: F
Age: 30
State: CA

Vax Date: 10/22/2021
Onset Date: 10/25/2021
Rec V Date: 10/25/2021
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: none

Symptom List: Nausea

Symptoms: Pt was administered Moderna Covid-19 2nd dose 10.22.21. Vial had an expiration date of 10.21.21, which was extended by Moderna to expire on 12.21.21 on 10.22.21 (via e-mail from management). This morning new guidance was received stating only vials that were frozen are to be used with new expiration date. The vial used for patient was previously thawed-out.

Other Meds: Humira Pen, cyclobenzaprine, omeprazole, triamcinolone topical

Current Illness: none

Date Died: 10/02/2021

ID: 1815689
Sex: F
Age: 87
State: NC

Vax Date: 10/01/2021
Onset Date: 10/02/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Injection site pain

Symptoms: Patient complained about being nauseous and then shortness of breathe. Then by the time her aid was able to call 911 for help she died.

Other Meds: Losartan, HydroChlorothiazide, Desvenlafaxine, metoprolo succ

Current Illness: none

ID: 1815690
Sex: F
Age: 36
State: GA

Vax Date: 10/22/2021
Onset Date: 10/23/2021
Rec V Date: 10/25/2021
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: ranitidine

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

Symptoms: Next day following the injection, patient had severe chills and body aches. Some chest tightness. No fever. Following day, chills improved but still with body aches states bones felt painful. This morning, patient developed a painful and pruritic rash to left side of abdomen. Pain radiates into breast.

Other Meds: flexeril, atarax, oxycodone, ibuprofen, duloxetine

Current Illness: no

ID: 1815691
Sex: F
Age: 77
State: OR

Vax Date: 10/22/2021
Onset Date: 10/23/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: N/A

Allergies: N?A

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

Symptoms: Injection site became red and swollen. The swelling and redness became larger. The redness kept going down my arm to the elbow, I was worried it was going down pass my elbow, but it stopped there. the site is starting to lessen insize and color but is still itchy.

Other Meds: clonazePam. Jardiance. furosemide KLor-con Pramipexole LANYUS. losartan atorvastatin. prcegablin FLuoxetine atorvastatin furosemide Insulin A

Current Illness: N/A

ID: 1815692
Sex: M
Age: 64
State: CO

Vax Date: 02/26/2021
Onset Date: 08/24/2021
Rec V Date: 10/25/2021
Hospital: Y

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

Lab Data:

Allergies: cefepime

Symptom List: Tremor

Symptoms: Moderna COVID-19 Vaccine EUA: six months after COVID-19 vaccination patient admitted for systemic inflammatory response syndrome secondary to choliangitis and found to have COVID-19 infection without hypoxia. Patient received antibiotics, improved, and discharged medically stable.

Other Meds: vitamin D3, metformin, docusate, morphine, omprazole, ondansetron, senna

Current Illness: pancreatic head adenocarcinoma

ID: 1815693
Sex: F
Age: 59
State: CA

Vax Date: 10/11/2021
Onset Date: 10/12/2021
Rec V Date: 10/25/2021
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: Extensive hospitalization that is ongoing with numerous procedures and lab results. Brain biopsy 10/25/21 - results pending LP x2 10/18 and 10/21 - bland CSF Ongoing prolonged EEG - most recent results recorded from 10/24/21: Impression: This is a mildly abnormal study secondary to: 1. Theta frequency background slowing with overlying focal delta activity over the left hemisphere. 23 imaging studies during hospitalization and numerous serial labs - too numerous to include without timing out the reporting.

Allergies: Reglan [Metoclopramide Hcl] Shortness of Breath ? Tomato Other

Symptom List: Erythema, Pruritus

Symptoms: Patient presented to ED with fever and alerted mental status 10/12/21. Initially concerned for stroke with negative imaging and then infectious etiology and possible encephalitis, but workup also negative with benign LP x2. Prolonged EEG without perceptible seizures. Given empiric IVIG. L sided unilateral hemispheric gyral thickening/leptomeningeal enhancement found on repeat brain MRI, not present previously, and brain biopsy completed 10/25/21. Results from biopsy as well as auto immune encephalitis and MOG antibodies pending. Patient clinically slightly improved but MRI worse. Remains hospitalized and workup is ongoing.

Other Meds: albuterol 108 (90 Base) MCG/ACT inhaler, Inhale 2 puffs by mouth every 6 hours as needed for Shortness of Breath., Disp: 1 each, Rfl: 3 ? aspirin 325 MG tablet, Take 1 tablet (325 mg) by mouth daily., Disp: 100 tablet, Rfl: 0 ? Atorvastat

Current Illness: Interstitial lung disease with exacerbation of shortness of breath 2 weeks prior covid vaccination 1st dose moderna - 2 weeks prior

ID: 1815694
Sex: F
Age: 39
State: HI

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/25/2021
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: Medication was constituted according to labeling, 0.5ml of medication was administered to patient instead of the recommended 0.3ml. Error was not identified until after the 15 minute waiting period post vaccine was administered and the patient left the office. No adverse reaction was experienced by patient during the waiting period.

Other Meds:

Current Illness:

ID: 1815695
Sex: F
Age: 50
State: VA

Vax Date: 10/22/2021
Onset Date: 10/23/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: n/a

Allergies: NONE.

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

Symptoms: Note: I'm not sure of the Lot number - it's definitely 088D_ _A. The blanks could be a 2 or Z, and a 1 or an I. So I received the booster shot at 11:30am on Friday and by 7am on Saturday I started feeling flu-like, with body aches and chills, and a fever of 99'. Throughout the day, fever climbed to 104. Arm (right) is sore with tight muscle, with increased redness and swelling below the injection site. Fever, body aches and chills were gone as of Sunday. Arm symptoms continue to remain and have slightly increased since day of injection. Waiting a couple more days before I see a doctor to see if symptoms subside. I did get a flu shot on 10/8/21 in the same arm, which could be cause of inflammation/reaction.

Other Meds: NO PRESCRIPS. TAKING ONE-A-DAY 50+ MULTI VIT FOR WOMEN, FISH OIL, CALCIUM, TUMERIC, GENSING, GINKO, AND COLLAGEN PEPTIDES

Current Illness: NONE.

ID: 1815696
Sex: F
Age: 65
State: MD

Vax Date: 06/01/2021
Onset Date: 06/02/2021
Rec V Date: 10/25/2021
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: Penicillin

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Badly swollen red arm - 4 days - iced it for 2 days Pain in chest that would come and go for 3 days Rattling sound in chest for 3 days Ached all over body - 2 days Persistent cough for 3 months

Other Meds: Lisinopril 10 mg PreserVision AREDS 2

Current Illness: None

ID: 1815697
Sex: F
Age: 80
State: CT

Vax Date: 10/06/2021
Onset Date: 10/13/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: EKG

Allergies:

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

Symptoms: Patient started having an electrical feeling/chest pain. She went to see her doctor and he diagnosed her with cardiomyopathy.

Other Meds:

Current Illness:

ID: 1815698
Sex: F
Age: 33
State: VA

Vax Date: 10/22/2021
Onset Date: 10/23/2021
Rec V Date: 10/25/2021
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:

Allergies:

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

Symptoms: Redness and pain in the site of injection. Lymph nodes swelling, heat, and pain: under armpit, shoulder, and neck. All on the left side. Low grade fever, malaise.

Other Meds: Acetaminophen 1000mg (every 8 hrs started on 10/23 at 6:30AM) Ibuprofen 400mg (in between acetaminophen, every 8 hours started on 10/23 at 11AM) Stopped above treatment and started taking nimesulide 100mg on 10/24 at 11PM. Developed a boil

Current Illness: took the flu shot on 10/18/2021 on the same arm (left).

ID: 1815699
Sex: F
Age: 64
State: WI

Vax Date: 03/24/2021
Onset Date: 09/12/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: Hearing Testing, Balance Evaluation

Allergies: None

Symptom List: Pain in extremity

Symptoms: 8-7-2021 Upper Respiratory Infection 9-2-2021 Treated for Outer Ear Infection 9-15-2021 Treated for Vertigo, Tinnitus with Prednisone and Meclizine. Referral to PT for Vestibular Therapy 9-21-2021, 9-29-2021, 10-27-2021. Referral to Audiology for hearing test 10-14-2021. Referral to Otolaryngology 10-14-2021. Hearing loss, Tinnitus, Labyrinthitis.

Other Meds: Lisinopril, Amlodipine, Citracal, Laxative, Fiber gummies

Current Illness: None

ID: 1815701
Sex: F
Age: 23
State: SD

Vax Date: 10/05/2021
Onset Date: 10/05/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: N/A

Allergies: Penicillin, Ceclor

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

Symptoms: Redness, raised, warm to touch, itchy- first two days after injection Arm numbness/tingling and cold sensation- three days after injection

Other Meds: Birth Control

Current Illness: N/A

ID: 1815702
Sex: F
Age: 40
State: CA

Vax Date: 04/26/2021
Onset Date: 04/27/2021
Rec V Date: 10/25/2021
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: No allergies, gluten sensitivity

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

Symptoms: I have been experiencing heavy and painful periods since vaccines. Also I began getting head pressure with no pain. I felt my head was being squeezed and then slowly the sensation stopped. I didn?t not get headaches just the pressure. I started feeling this in June after my 2nd dose. The last time I felt this was las month.

Other Meds: Mega food vitamin d3, iron supplement

Current Illness: None

ID: 1815703
Sex: F
Age: 55
State: SC

Vax Date: 08/15/2021
Onset Date: 08/17/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: I have had continued issues with taste and smell. Many foods taste like chemicals and the outside air smells like chemicals. Many smells from cooking food is terrible as well.

Other Meds: Synthroid

Current Illness: None

ID: 1815906
Sex: F
Age: 69
State: CA

Vax Date: 09/26/2021
Onset Date: 09/26/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: No

Allergies: Latex; wool; adhesive tape; penicillin; morphine; codeine; contract media for MRI procedures

Symptom List: Vomiting

Symptoms: The first dose I had a sore arm, 2nd dose I couldn't move in the middle of the night. Kidney pain that lasted about a week. 3rd dose I was fine until I had shoulder pain, back pain, & lymph node enlargement in chest & arm pit as well as swelling. It would come up then come down.

Other Meds: Acyclovir; estrogen patch; vaginal ring; multivitamin; vitamin D; stool softener

Current Illness: No

ID: 1815907
Sex: F
Age: 19
State: ME

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/25/2021
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: Within 15 minutes of patient receiving vaccination, patient had a fainting spell and experienced brief loss of consciousness. Patient was able to communicate and say he felt tired, dizzy, nauseated and hot/clammy. Within 20 minutes of event, patients symptoms improved and she was able to sit up in a chair on her own. Pharmacist on duty assessed BP during this time (BP reading 1: 87/66, BP reading 2: 92/67, BP reading 3: 91/69) .

Other Meds:

Current Illness:

ID: 1815908
Sex: F
Age: 30
State: GA

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/25/2021
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: no lab work done

Allergies: non reported

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

Symptoms: Patient started to feel nausea, dizziness, perspiration, and chest pain. with in 30 mins of taking the vaccine. Patient repeated saying she has chest pain and wanting to lay down and having continuously feeling dizzy. Patient had palpitation and BP was un reported

Other Meds: non reported

Current Illness: None reported

ID: 1815909
Sex: F
Age: 53
State: MD

Vax Date: 10/22/2021
Onset Date: 10/22/2021
Rec V Date: 10/25/2021
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: Kenalog time release for sinus issues, resulted in panic attacks and ongoing depression for months

Symptom List: Injection site swelling, Limb discomfort

Symptoms: WIthin a few hours of the Modern booster (I received the J&J one dose shot on 3/11/21 and was therefore eligible for a booster on Friday) a severe sore throat developed on right side, constant post nasal drip and runny nose, congestion, dull headache. Initially after injection felt a bit of a heart flutter and maybe woosy walking around, nothing serious but a little lightheaded. It could have been needle anxiety and hyper focus on the reactions, but sore throat and runny nose was already starting a couple hours later. It's now Monday night and the runny nose, sneeze has been pretty constant. The sore throat shifted to the left side a day later and now it's gone but I have just under a 101 fever, dull headache and eyes ache, very low energy, some chills on and off but not much. I noticed that my sense of smell was gone in the middle of the night last night, it was fine up til then. I haven't had a cold in the past year or the flu, this was the first time this happened and coincidentally it developed a couple hours after the vaccine. I took a rapid COVID test and negative on that. I have a cough that produces on a tiny bit of mucus, mainly an irrittion cough. My chest hurts a little - nothing serious, like when dealing with a mild respiratory infection.

Other Meds: Multi vitamins, low dose aspirin, occasional ibuprofen, occasional hydroxyzine, Afrin daily

Current Illness: None

ID: 1815910
Sex: F
Age: 46
State: NY

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

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

Lab Data:

Allergies: NKDA per form

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

Symptoms: Patient presented to the pharmacy counter about 5 minutes after injection with a rash on chest and left arm. At first I gave her 50mg of oral Benadryl. She started to mention she was having a hard time swallowing. I grabbed the Epipen and administer it into left thigh. At that time I also called emergency and EMS came. They evaluated her and took her to the emergency room. When she left she was able to breath and talk.

Other Meds: Unknow, patient was traveling

Current Illness: Unknown, Patient was traveling

ID: 1815911
Sex: F
Age: 36
State: UT

Vax Date: 08/14/2021
Onset Date: 09/04/2021
Rec V Date: 10/25/2021
Hospital:

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

Lab Data: MRI done Oct 13; Tysabri initiated on oct 15, 18 ant 19 IV solumedrol given ; glucose was high, platelets were low, fe low.

Allergies: none

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

Symptoms: Pt. with new onset of numbness in lower extremities starting Sept 29 with neg rapid pcr testing then - L side starting at umbilicus and R side at knee; cognitive issues and problems with focus and working also noted. 4 new brain lesions and one thoracic spine lesions.

Other Meds: Prenatal vitamin

Current Illness: None

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am