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: 1825827
Sex: F
Age: 61
State: MI

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

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

Lab Data: None yet.

Allergies: Allergic to Penicillin

Symptom List: Dysphagia, Epiglottitis

Symptoms: Sensation in left ear which includes a fluttering thumping noise which is not going away--was not present prior to Vaccine and is still present. Includes a numb and tingling sensation around ear and head. Have not yet sought medical treatment for this. Is present only in the left ear.

Other Meds: Naproxen Sodium, Loratadine, Benadryl

Current Illness: None

ID: 1825828
Sex: M
Age: 84
State: AK

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

Symptom List: Anxiety, Dyspnoea

Symptoms: DEVELOPED PALPITATIONS AND POUNDING HEADACHE AFTER3RD PFIZER DOSE, WHICH HAS CONTINUED DAILY PAST T WEEKS. O/W NORMAL EXAM

Other Meds:

Current Illness:

ID: 1825830
Sex: F
Age: 31
State: AZ

Vax Date: 10/28/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
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: None

Allergies: None known

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

Symptoms: Anxious, tearful, chest pain, palpitations - onset about 3 hours after injection. Vaccine required by employer, patient reluctantly received it near deadline to meet work requirement. Stated she "wished she didn't have to get it." Paramedics called, patient then refused medical evaluation or transport to a hospital ER for further evaluation. She stated her usual BP was 160/100 but her "PCP is OK with it and said I could stop my meds." During adverse event BP 156/116. Patient strongly advised to go to ER but refused. Advised to make sure she called 911 for any worsening or if she changes her mind.

Other Meds: Patient can't remember names of meds for anxiety and depression.

Current Illness: Depression, anxiety, hypertension

ID: 1825831
Sex: M
Age: 67
State: HI

Vax Date: 10/26/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: None

Allergies: N/A

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Dizziness 10-28 early afternoon. On-going

Other Meds: Finasteride Tamsulosin Simvastatin Vitamin D Centrum

Current Illness: N/A

ID: 1825832
Sex: M
Age: 44
State: CA

Vax Date: 10/22/2021
Onset Date: 10/27/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Dizziness and brain fog

Other Meds:

Current Illness:

ID: 1825834
Sex: M
Age: 64
State: SC

Vax Date: 04/05/2021
Onset Date: 04/26/2021
Rec V Date: 10/28/2021
Hospital: Y

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: Too numerous to list all but some tests were CAT scans, cerebral angiograms, numerous bloodwork, x-rays, etc.

Allergies: none known

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

Symptoms: Patient suffered a subarachnoid hemorrhage (Hunt & Hess 5) on the evening of April 26 or the morning of April 27 that, after 3 cerebral angiograms, doctors have not been able to determine the cause of. His son found him unconscious the afternoon of the 27th. He spent 2.5 weeks in the ICU, 1 week in the step down unit, and 2.5 weeks in the rehab hospital. He recently completed 18 weeks of outpatient therapy. His recovery has been remarkable but he still has some short term memory issues. I don?t know if the vaccine and subarachnoid hemorrhage are related but I?ve been seeking advice as to whether patient should get a booster and was told to make sure a VAERS report was filed. It?s possible this is a duplicate since I?ve asked 2 doctors and the facility if a report was filed and have not gotten a definitive answer.

Other Meds: flecainide, rosuvastatin, metoprolol, low dose aspirin

Current Illness:

ID: 1825835
Sex: F
Age: 50
State: WI

Vax Date: 10/28/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data:

Allergies: NONE REPORTED.

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: AT 10 MINUTES AFTER VACCINATION (4:20 PM), PATIENT REPORTED EXCESSIVE SALIVA PRODUCTION, WATERY EYES, AND TIGHTENING OF THROAT. SHE SAID SHE WAS STILL ABLE TO BREATH HOWEVER. I GAVE HER ONE TABLET OF 25MG DIPHENHYDRAMINE. I ASKED HER TO STAY AN EXTRA 30 MINUTES FOR OBSERVATION. ABOUT 10 MINUTES LATER, HER DAUGHTER REPORTED HER THROAT WAS CLOSING. I INJECTED 0.3 MG EPIPEN INTO HER LEFT THIGH AND ASKED TECHNICIAN TO CALL EMERGENCY. HER THROAT OPENED UP QUICKLY AND I GAVE HER WATER WHILE WE WAITED FOR EMS. EMS CHECKED HER VITALS AND LEFT AT 5 PM. I COUNSELED HER TO NOT GET THE 2ND PFIZER SHOT AND TO REPORT THE ALLERGY TO HER PCP. ALSO, IF SHE WERE TO EXPERIENCE ANY SIMILAR SYMPTOMS GOING FORWARD TO CALL EMERGENCY. PATIENT AND DAUGHTER WAITED FOR HER HUSBAND TO COME AND TAKE THEM HOME.

Other Meds: PATIENT WAS GIVEN 1 TABLET DIPHENHYDRAMINE 25 MG AT FIRST. SHE REPORTED WATERY EYES AND EXCESS SALIVA PRODUCTION AND THROAT FEELING TIGHT.

Current Illness:

ID: 1825836
Sex: M
Age: 64
State: SD

Vax Date: 10/28/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
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: NKA

Symptom List: Pharyngeal swelling

Symptoms: NO ADVERSE EVENT OF THIS TIME. PATIENT SHOULD HAVE RECEIVED FLUZONE QUADRAVALENT INSTEAD OF HD.

Other Meds: UNKNOWN

Current Illness: UNKNOWN

ID: 1825837
Sex: F
Age: 62
State: CA

Vax Date: 04/28/2021
Onset Date: 04/30/2021
Rec V Date: 10/28/2021
Hospital: Y

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

Lab Data: She was seen and cared for.

Allergies: Shortness of Breath, Itching, Nausea and Vomiting High 8/2/2016 Past Updates Chondroitin Sulfate A Shortness of Breath, Nausea and Vomiting High 8/2/2016 Past Updates Codeine Rash High 8/2/2016 Past Updates Cysteamine Shortness of Breath, Itching High 8/2/2016 Past Updates Dmsa [Technetium-99m] Rash High 4/9/2018 Past Updates Dmso [Dimethyl Sulfoxide] Rash High 4/9/2018 Past Updates Fentanyl Anaphylaxis High 4/3/2018 Past Updates Glucosamine Shortness of Breath, Itching High 8/2/2016 Past Updates Glutathione Shortness of Breath High 4/9/2018 Past Updates Ketamine Anaphylaxis, Nausea and Vomiting High 8/2/2016 Past Updates Morphine Anaphylaxis High 8/2/2016 Past Updates Phenergan [Promethazine] Shortness of Breath, Nausea and Vomiting High 4/9/2018 Past Updates Sulfa Drugs Anaphylaxis High 8/2/2016 Past Updates Thimerosal Shortness of Breath, Nausea and Vomiti

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient developed malaise,palpitations, chest pressure two days after vaccine. She was ultimately hospitalized twice for 5 days each time, with a myocardial infarction and then to have 3 stents placed. Since this event she now requires insulin whereas prior she was pre-diabetic.

Other Meds: Amlodipine; Vitamin D3; Plavix; Insulin; Lorazepam; Nitroglycerin; Zofran; Prometrium; Tramadol

Current Illness: Chronic disease (see 12)

ID: 1825838
Sex: F
Age: 61
State: VA

Vax Date: 10/08/2021
Onset Date: 10/13/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: Bloodwork - 16th; Monday, the 18th ER = ruled out pulmonary embolism - EKG - they told my EKG was normal and sent me home. Found out later when I got the written report that the EKG was not normal. Result was: Non specific ST abnormality and also Mild dependent Collapse-result of a Chest CT scan.

Allergies: Sulfa drugs

Symptom List: Diarrhoea, Nasal congestion

Symptoms: I saw a doctor on four different occasions. On Wednesday, the 13th, I had a telehealth for extreme lethargy. I couldn't get out of bed. I had the classic symptoms right after the vaccine - that started late Friday night and through Sunday - and then Monday the achy went away but I still couldn't get out of bed and I was kind of light headed and Tuesday was the same and Wednesday was the same. The doctor said to give it another couple of days. I made an appt on the Saturday after that (16th) and was seen by a doctor that day. She thought I was have an extreme allergic reaction the vaccine. On the following Monday, I still wasn't feeling great and I had a weird feeling in my chest and some shortness of breath. I went to an Urgent Care and they did and EKG and it was abnormal and they sent me to ER Hospital. They sent me home after telling things were normal. But they weren't normal. They did not send me home with any treatment. They told me it was important that I follow up with my primary care physician. I followed up with the doctor (in person) on the 23rd. She is making referrals to cardiology and pulmonology. Plus she has ordered a repeat Chest CT. No treatment yet. I still have shortness of breath and I have an odd feeling in my chest. I have gotten some energy back. Got the flu vaccine 9/29/2021 through my work - before this 3rd dose of my COVID vaccine.

Other Meds: Gabapentin; Oxybutynin

Current Illness: None

ID: 1825839
Sex: F
Age: 20
State: OR

Vax Date: 10/28/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: None

Allergies: Unknown

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

Symptoms: Pt had Pfizer vaccine for Dose 1. Pt was inadvertently given Moderna vaccine for Dose 2.

Other Meds: Unknown

Current Illness: Unknown

ID: 1825840
Sex: M
Age: 56
State:

Vax Date: 09/21/2021
Onset Date: 09/21/2021
Rec V Date: 10/28/2021
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:

Symptom List: Rash, Urticaria

Symptoms: 2 mins post vaccination (13:28), pt c/o Flushing/sweating. Vitals: BP 118/82, HR 88, RR 22, O2 Sat 97% -- > 126/80, 76, 96%. Pt VSS but was a little lightheaded when standing. Pt drank water and walked around. Pt stable and released from the vaccination site ~50mins post vaccination

Other Meds: Medications: albuterol 90mcg/act cetirizine 10mg daily fosinopril 10mg daily PEG 17gm daily PRN Constipation Metamucil 3.4gm daily Xarelto 20mg daily

Current Illness:

ID: 1825841
Sex: F
Age: 20
State: AZ

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/28/2021
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 DRUG ALLERGIES PER PATIENT

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

Symptoms: PATIENT FAINTED ABOUT 5 MINUTES AFTER RECEIVING VACCINATION. PATIENT WAS SITTING ON A BENCH AFTER VACCINATION AND STATED SHE FELT LIKE SHE WAS GOING TO PASS OUT OR THROW UP. WE WERE ABLE TO CATCH HER BEFORE SHE FELL, LAID HER DOWN ON HER LEFT SIDE AND SHE WOKE BACK UP. AFTER WAKING UP SHE SAID SHE IS PRONE TO FAINTING AND WAS VERY NERVOUS TO GET THE VACCINATION. GOT THE PATIENT A BOTTLE OF WATER, SHE LAID ON THE BENCH AND DRANK THE WATER FOR ABOUT 20 MINUTES, SAT UP FOR A FEW MINUTES THEN LEFT THE STORE STATING SHE WAS FEELING FINE.

Other Meds:

Current Illness:

ID: 1825842
Sex: F
Age: 47
State: ID

Vax Date: 09/24/2021
Onset Date: 09/24/2021
Rec V Date: 10/28/2021
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:

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

Symptoms: left upper arm pain, progressively worsening since administration, pt reports administration was very high

Other Meds:

Current Illness:

ID: 1825843
Sex: F
Age: 50
State: NJ

Vax Date: 08/20/2021
Onset Date: 09/07/2021
Rec V Date: 10/28/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: 1 week after 1st dose, dizzyness that lasted 6 weeks, after 2nd dose caused inflammation throughout arm, back. affecting ability to use arm

Other Meds:

Current Illness:

ID: 1825844
Sex: M
Age: 58
State: OH

Vax Date: 10/25/2021
Onset Date: 10/25/2021
Rec V Date: 10/28/2021
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: NKA

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

Symptoms: Rash starting in RT. Arm then quickly spread to left arm then both leg . is most severe in RT. leg with blisters approx. the size of a kidney bean.

Other Meds: Golo Release, Go-Digest, Metoprolol Tartrate 50mg, Pantoprazole sod dr 40mg, Apple cider vinegar 1500mg, Saw Palmetto 1235mg, Magnesium complex 500mg, Align dual biotic

Current Illness: None

ID: 1825845
Sex: F
Age: 57
State: WA

Vax Date: 03/28/2021
Onset Date: 04/26/2021
Rec V Date: 10/28/2021
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: Following the SARS-CoV-2 vaccine, I developed tinnitus in the left ear. It was a gradual process, but it is now present 24/7 without any relief.

Other Meds: None

Current Illness: None

ID: 1825846
Sex: F
Age: 92
State: IA

Vax Date: 10/28/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient was to receive a booster dose of Moderna (previous two-dose series had been Moderna). Pfizer was administered instead as the booster.

Other Meds:

Current Illness:

ID: 1825847
Sex: F
Age: 61
State: CA

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

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

Lab Data: Patient had tests done in er on 10/27/21 and tests ordered by md on 10/28/21. Results are not reported to pharmacy.

Allergies: No known allergies

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient experienced dizziness, numbness of tongue/mouth and spreading to body, stroke-like symptoms.

Other Meds: Farxiga 10mg, Levothyroxine 88mcg, Losartan 50mg, Metformin 500mg, Zylet ophth drops

Current Illness: Unknown

ID: 1825848
Sex: F
Age: 21
State: OR

Vax Date: 10/28/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: None

Allergies: Unknown

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

Symptoms: Pt had Pfizer for dose 1 of series. Pt was inadvertently given Moderna 0.5 ml for dose 2.

Other Meds: Unknown

Current Illness: Unknown

ID: 1825849
Sex: F
Age: 39
State: OR

Vax Date: 10/08/2021
Onset Date: 10/19/2021
Rec V Date: 10/28/2021
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 received medication through a IV.

Allergies: I am allergic to sulfa drug and carate.

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

Symptoms: After the booster shot I had muscle soreness and that barley lasted a day and it was mild this was in the first 72 hours. I went to the emergency room in October 19, 2021due to a bad migraine that I am still suffering with.

Other Meds: Yes I take was prescribtion

Current Illness: I had a sinus infection.

ID: 1825850
Sex: M
Age: 32
State:

Vax Date: 10/18/2021
Onset Date: 10/18/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data:

Allergies: NKA or medications.

Symptom List: Unevaluable event

Symptoms: Pt also received Fluzone Flu vaccine to RA UJ687AA 10 mins post vaccination (10:05) pt reported sweating, lightheadedness, dizziness. Vitals: @ 10:15 BP 74/44, HR 49, RR 18 -- > @10:20 124/80, 70, 16. An HCP called at 10:26 Pt assessed by MD. Likely vasovagal episode. No LOC during event. Pt given water, crackers. Pt mentating okay. Pt resting in Clinic gurney, and verbalizing, joking with Staff. RN assisted ambulating pt, on Unit Floor. Pt ambulatory w/ stable vitals. Pt stable and released from the vaccination site @10:50.

Other Meds: NKA or medications.

Current Illness:

ID: 1825851
Sex: F
Age: 33
State: NV

Vax Date: 10/28/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
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: NSAID: anaphylaxis

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

Symptoms: I was mistakenly given six doses of the vaccine. So far symptoms include: headache and site pain

Other Meds: Labetalol 25mg once a day

Current Illness:

ID: 1825852
Sex: F
Age: 72
State: CA

Vax Date: 10/25/2021
Onset Date: 10/26/2021
Rec V Date: 10/28/2021
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: Fatigue. Sore body. 3 days

Other Meds: Effexor. Synthroid. Abilify. Lisinopril. Lipitor. Concerta.

Current Illness: None

ID: 1825853
Sex: F
Age: 54
State: NY

Vax Date: 10/22/2021
Onset Date: 10/24/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data:

Allergies: no

Symptom List: Injection site pain, Menorrhagia

Symptoms: Left became swollen red itchy and hot

Other Meds: lostarn, metformin, multi vit, iron pill, garlic pill, aspirin, turmeric, cinnamon, fish oil,

Current Illness: no

ID: 1825854
Sex: F
Age: 43
State: TX

Vax Date: 04/06/2021
Onset Date: 06/09/2021
Rec V Date: 10/28/2021
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: 2 virectomy surgeries in left eye (June 16, 2021), one follow-up/preventative laser surgery in right eye (July 23rd); small imperfection/scuff mark on lens remains resulting in 20/50 (corrected) vision, halos, and blurriness in left eye. 2 days worth of surgery, 17 days of recovery at home; 14 of which I was immobilized at home

Allergies: reglan, flagyll

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

Symptoms: In June 2021, 2 months after 2nd dose shot (April 2021), experienced sudden vision changes and migraines. (Had severe general malaise and racing heart beat after first dose in March 2021). Upon investigation, it was determined that I had a macular hole and detached retina in my left eye. I was diagnosed with a CHIRPE (don't remember if it was my left or right eye) 14 years earlier in 2007, however it had been stable ever since as verified at my yearly optometry and ophthalmologist appts.

Other Meds: zoloft, ozempic, synthroid,adk10, oneaday womens, b12, crestor,trazadone, mg sulfate

Current Illness: none

ID: 1825855
Sex: F
Age: 38
State:

Vax Date: 10/19/2021
Onset Date: 10/19/2021
Rec V Date: 10/28/2021
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: Allergies: Shrimp

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: 23mins post vaccination pt started having tightness in mouth,itchy eyes, facial swelling and itching in upper extremeties. @16:37 Pt c/o throat sensation, no SOB @16:42 NO Resp distress @16:47 c/o face itching and several areas of urticaria @16:50 MD notified and pt given Epi 0.3mg IM to R thigh @16:55 Benadryl 25mg IM to R deltoid and EMS called @17:02 EMS arrived @17:10 Pt comforatble and leaving vaccination site by Ambulance VItals: @16:42 BP 118/68, HR 61, RR 16, O2Sat 99% RA -- > @16:47 115/74, 69, 16, 100% -- > @16:51 115/74, 69, 16, 100% -- > @16:55 116/68, 62, 16, 99% -- > @17:02 116/68, 62, 16, 100%RA -- > @17:10 120/74, 79, 100% RA In the ED pt states that she has been having allergy symptoms on a chronic basis and has been worked up without obvious cause. No SOB reported. Pt was not symptomatic and released from the ED after observation. On 10/21, pt presented to the ED again w/ left arm swelling where she got the shot, heaviness on her left eye and started to have heaviness on her jaw. Pt able to swallow, denies SOB. Per ED provider note, "The patient has developed progressively worsening left shoulder swelling and pain that radiates down her left arm. The patient notes a tingling that is going up the neck and the face. She notes no weakness there is no shortness of breath. The onset of symptoms was gradual and symptoms are moderate. Patient spoke with the advice nurse and was referred to the emergency department. There is no chest pain or shortness of breath no fevers no chills." VSS BP 124/72, HR 90, Temp 97.7, RR 17, O2Sat 99% Pt stable and released from the ED.

Other Meds: Medications: cetirizine 10mg BID hydroxyzine 25-50mg PRN QHS Nortriptyline 10mg QHS Montelukast 100mg Daily Depo-Provera 150mg IM Allegies: Shrimp

Current Illness:

ID: 1825856
Sex: F
Age: 36
State: AZ

Vax Date: 09/21/2021
Onset Date: 10/17/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: Full panel labs were done 09/16/2021 from PC and I was told my cholesterol was high and I was told to do a lifestyle change and they will retake my labs in January 2022

Allergies: N/A

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: I started feeling numbness on my mouth and face, tingling all over my body. It felt like I was electrocuted.

Other Meds: Daily Vitamin

Current Illness: I got sick with maybe COVID in mid July, I got tested but it came back negative. I was just told I had inflammations in my body. than the booster got approve and got it on 09/2021 and I Started with tingling sensation. Went to the doctor and he recommended Vitamin and it has helped with my nervous system. I was told to take NAC 600MG once a day, Folic Acid 250MG 1 a day, L_cernitine 250MG 1 day.

ID: 1825857
Sex: F
Age: 66
State:

Vax Date: 10/28/2021
Onset Date: 10/28/2021
Rec V Date: 10/28/2021
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:

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

Symptoms: Pt. c/o itchiness at 10:32. Pt. was observed, vitals taken, 25 mg Benadryl given PO with water. Pt. symptoms improved, vitals stable.

Other Meds:

Current Illness:

ID: 1825858
Sex: F
Age: 37
State: CA

Vax Date: 10/21/2021
Onset Date: 10/21/2021
Rec V Date: 10/28/2021
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: NKA

Symptom List: Nausea

Symptoms: Client stated two weeks after her first Pfizer dose, she experienced one day of heavy period with clots. This lasted one day and then her period ended when expected. She received her second Pfizer dose per guidelines.

Other Meds: None

Current Illness: Unknown

ID: 1825859
Sex: F
Age: 69
State:

Vax Date: 03/28/2021
Onset Date: 03/28/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: EKG

Allergies:

Symptom List: Injection site pain

Symptoms: Extreme fatigue, headaches, migrane, vertigo. Pain on right side, pain on left side, heart attack, temporary paralysis on right side, temporary blindness in right eye, pain in kidneys, 2nd heart attack. Contacted the CDC on three different occasions, was told they didn't know what to do. Referred to supervisor. No calls back. Referred to the state department of health. Also told didn't know what to tell.

Other Meds: None

Current Illness: None

ID: 1825860
Sex: M
Age: 61
State: NH

Vax Date: 04/22/2021
Onset Date: 07/23/2021
Rec V Date: 10/28/2021
Hospital: Y

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

Lab Data: They did a brain CAT scan with tracer. MRI of brain. EEK of brain. EKG of heart. Ultra sound of heart. All that was to rule out stroke.

Allergies: Codeine, Morphine

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

Symptoms: Sudden loss of what I was doing, going to do, had been doing. Confusion about what day it was, what was happening. Later I had little memory of what had happened prior to being in the hospital.

Other Meds: Gingko Baluba. Vitamin C immune boost

Current Illness: None

ID: 1825861
Sex: F
Age: 74
State: AZ

Vax Date: 10/22/2021
Onset Date: 10/26/2021
Rec V Date: 10/28/2021
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: Penicillin, macrodantin

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

Symptoms: Itchy, red, raised patch on arm around injection site. Approx 3 inches x 2 inches. Took one Benadryl after appearance, took two Benadryl the following evening. Red area was also hot to he touch.

Other Meds: Multivitamin, Tums, Vitamin D3

Current Illness: None

ID: 1825862
Sex: F
Age: 55
State: TX

Vax Date: 10/13/2021
Onset Date: 10/14/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: EKG was normal . EKG done 10/28/21- Wasn't perfect so getting CT scan November 15th, 2021

Allergies: Penicillin

Symptom List: Tremor

Symptoms: I was achy took tylenol that relieve it. Got chest pains and heart palpitations, so came and went. Face is also puffy and fatigue. Went to ER

Other Meds: Omeprazole 20mg 1xday , Amitrittylin 10mg 1xday, Linsopril 10mg 1xday, Synthorid 50mcg 1xday

Current Illness: None

ID: 1825863
Sex: M
Age: 31
State: NY

Vax Date: 10/11/2021
Onset Date: 10/11/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: Return of myocarditis and syncope (dull chest pain continuously abs tight stabbing pain attacks a few times daily from the second day 11/10/2021- continues til now (28/10/2021) Severe nausea (near constant lasting from the night of the injection until now - over 18 days- low rare is constant and several times each day I feel so nauseous I am faint ) and vomiting- for reference it is extremely unusual for me to vomit even with severe nausea. There has also been reduced capacity to think clearly and exaxustion but this is probably from the stress of the above and not independently correlated to the vaccine (I don?t have health insurance and so cannot go to doctor for care about this)

Other Meds:

Current Illness:

ID: 1825864
Sex: F
Age: 60
State: WA

Vax Date: 04/28/2021
Onset Date: 10/14/2021
Rec V Date: 10/28/2021
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: FIT (fecal occult blood by fit) - positive on 10/14/2021

Allergies: vagicaine

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

Symptoms: I just had a FIT (Fecal Immune Test) test that you take every year for blood in your stool, and that was in the first week of October, and I was notified that it came back positive for blood. I haven't gone yet to see if there's anything inside my colon. Who knows if it's related, but I have never had a positive FIT test and I've been taking them for years. Updates to come.

Other Meds: EMERGEN-C vitamins

Current Illness: None

ID: 1825865
Sex: F
Age: 31
State: NY

Vax Date: 05/24/2021
Onset Date: 10/18/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: Urgent Care - COVID test - negative result

Allergies: Aspirin; pertussis vaccine; penicillin; strawberries; walnuts

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

Symptoms: It started with me being extremely tired. I was extremely tired and then on Thursday when I finally went to the Urgent Care, I woke up with a really bad migraine. I had a sinus infection and I felt a lot of pressure in my face. I didn't feel congested but I just felt the pressure. They gave me antibiotics for sinus infection. I had a lot of fluid built up (she could see it in my ears). The antibiotics have been helping me. They have me using a nasal spray, too. I started them on Saturday and was able to go back to work on Tuesday. I am feeling quite a bit better but it's not completely gone. It was really bad. I did not have any side affects immediately after this vaccine or the first one.

Other Meds: Duloxetine; hydroxyzine; Implant in my arm - birth control

Current Illness: No

ID: 1825866
Sex: F
Age: 39
State: NC

Vax Date: 04/08/2021
Onset Date: 04/09/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: Patient has been to cardiologist, pulmonologist, and will go next week to gastrologist to do test on esophagyl sphinter to see if still working at all. She is worse than when had original Covid infection.

Allergies: dairy products, Gluten, corn, Penicillin, Sulfa drugs, cephalosporins, azithromycin, neomycin, montelukast, latex

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: had history of covid infection with side effects (more than those being reported at the time), was told to get vaccine and started next morning with increased intensity: Shortness of breath, heart palpitations, increased migraines, reflux issues, weakness and neurological pain. Six months later, she still has lots of symptoms of asthma, chest pain, sharp pain and reflux.

Other Meds: Sucralfate 1gm, metformin ER 500mg, Levothyroxine 88 mcg, Pantoprazole 40mg, Advair 115/21 inhaler, Vit B-12, B complex tabs, Flaxseed oil, Vit D-3 5000iu, Niacin 500 mg, Prebiotic, Probiotic

Current Illness: covid longhauler , kidney infection

ID: 1825867
Sex: F
Age: 58
State: MN

Vax Date: 04/09/2021
Onset Date: 10/25/2021
Rec V Date: 10/28/2021
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: None

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

Symptoms: Starting 10/25/2021: felt achy, sore throat. Her temperature was 101.3. She's had a very mild cough. She's had some body aches and chills.

Other Meds: Vitamin C, Zinc, Aspirin; Trazodone, B12 health booster

Current Illness: None

ID: 1825868
Sex: M
Age: 60
State:

Vax Date: 10/20/2021
Onset Date: 10/21/2021
Rec V Date: 10/28/2021
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: The morning after injection I began having severe headaches, daily bouts of diarrhea, stomach discomfort and increased irritability. These have continued daily since injection. Use of the Covid 19 vaccine has aggravated my existing disabilities.

Other Meds:

Current Illness:

ID: 1825869
Sex: F
Age: 51
State: MO

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

Symptom List: Pain in extremity

Symptoms: I had frequent PACs. I am an ER physician. I felt these and also witnessed on my Fitness Watch. These escalated through 9/30 then resolved by10/2. I had no chest pain or shortness of breath. Just palpitations, up to 15 per minute.

Other Meds: HCTZ, Metoprolol Succinate, Vit D, Vit C, Magnesium, Vit E, Fish Oil, Calcium, Ginko Biloba

Current Illness: None

ID: 1825870
Sex: M
Age: 44
State: PA

Vax Date: 09/28/2021
Onset Date: 09/30/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: On October 1st I spent 8 hours in Urgent Care. Chest Xray, EKG, and full blood panel were performed.

Allergies: None.

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

Symptoms: 60 hours after the second dose of Moderna I had extreme heart pain. Urgent care reported no heart attack. Nothing in the bloodwork showed any signs of heart issues. 1 hour after the vaccination my finger tips pruned. And are still pruned as of this entry.

Other Meds: None.

Current Illness: None.

ID: 1825871
Sex: F
Age: 81
State: NV

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

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

Lab Data:

Allergies: NONE KNOWN

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

Symptoms: PATIENT STATES THAT HER LEFT ARM STARTED GETTING RED AND WARM/HOT LATER IN THE DAY SHE RECEIVED VACCINE. THIS IS FOUR DAYS LATER AND STILL HAS THE SAME EFFECT.

Other Meds: NOT KNOWN

Current Illness:

ID: 1825872
Sex: M
Age: 13
State:

Vax Date: 10/01/2021
Onset Date: 10/02/2021
Rec V Date: 10/28/2021
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:

Allergies:

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

Symptoms: Hematochezia (7 days), pancytopenia, and transaminitis with now new diagnosis of autoimmune hepatitis.

Other Meds:

Current Illness:

ID: 1825873
Sex: M
Age: 53
State: MI

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

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

Lab Data: NONE

Allergies: NONE

Symptom List: Vomiting

Symptoms: The Lymph Node in my left armpit swelled up. I noticed it Wednesday Morning after getting out of the shower. No treatment at this time. My doctor said to keep an eye on it and if does not get better by the 3rd of November to call her back.

Other Meds: MELOXICAM, TRAMADOL

Current Illness: NONE

ID: 1825874
Sex: F
Age: 78
State: NC

Vax Date: 10/26/2021
Onset Date: 10/26/2021
Rec V Date: 10/28/2021
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: Patient stated that she developed fever and chills the night of the vaccines and the next morning she fainted while walking in her house.

Other Meds:

Current Illness:

ID: 1825875
Sex: M
Age: 52
State: CA

Vax Date: 02/23/2021
Onset Date: 02/25/2021
Rec V Date: 10/28/2021
Hospital:

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

Lab Data: none

Allergies: none

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

Symptoms: On 2/23/21, client received his second dose of Pfizer. Client reports that 1-2 days later his lips swelled. He did not take any medication for it and he stated that it resolved in one day. Per MD consult his booster dose was given on 10/27/21. Client was observed for 30 minutes and client did not report any symptoms.

Other Meds: None

Current Illness: none known

ID: 1825876
Sex: F
Age: 58
State: MN

Vax Date: 03/31/2021
Onset Date: 10/26/2021
Rec V Date: 10/28/2021
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: PENICILLIN DRUGS: hives - Allergy Doxycycline Monohydrate: skin burning, feet swelling

Symptom List: Injection site swelling, Limb discomfort

Symptoms: headache- sore throat- chills- productive cough- shortness of breath- body aches- ear pain- sinus congestion- nasal congestion- swollen glands- wheezing- sneezing starting 10/26/21

Other Meds: ?Triamcinolone Acetonide 0.1 % Cream 1 application Externally twice a day ?Fluticasone Propionate 50 MCG/ACT Suspension 2 sprays Nasally Once a day ?Vitamin D ?Albuterol Sulfate HFA 108 (90 Base) MCG/ACT Aerosol Solution 2 puffs a

Current Illness: none

ID: 1825877
Sex: F
Age: 63
State: VA

Vax Date: 10/26/2021
Onset Date: 10/27/2021
Rec V Date: 10/28/2021
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: I am allergic to sulfa and medical tape

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

Symptoms: After getting the booster I had a bad headache, fatigue, and pain in my arm. This was enough that I couldn't do my regular activates. The next day my heart went through aneurysm. This is when I called my cardiologist, and was notified go to the emergency room if nothing went back to normal with my heart rhythm.

Other Meds: None

Current Illness:

ID: 1825878
Sex: M
Age: 37
State:

Vax Date: 10/27/2021
Onset Date: 10/27/2021
Rec V Date: 10/28/2021
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:

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

Symptoms: There was a miscommunication. The intern gave the patient the concentrated (unconstituted) vaccine of 0.3 ml. We spoke to the patient the next morning. He said he only has a sore arm so far but his wife is a nurse and will monitor him.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 654,986

Page last modified: 13 November 2021 9:17am