VAERS 2021 Database www.vaers.hhs.gov

Main Page | All 2021 Deaths | Videos
VAERS Updated: 10/01/2021
** VAERS DATABASE Last updated: October 1, 2021**
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Manufacturers

Total Manufacturer
187,133MODERNA
33,878JANSSEN
2,321PFIZER\BIONTECH
1,091GLAXOSMITHKLINE BIOLOGICALS
983UNKNOWN MANUFACTURER
363MERCK & CO. INC.
229SEQIRUS, INC.
45DYNAVAX TECHNOLOGIES CORPORATION
41NOVARTIS VACCINES AND DIAGNOSTICS
29SANOFI PASTEUR
18EMERGENT BIOSOLUTIONS
8PAXVAX
7TEVA PHARMACEUTICALS
4PFIZER\WYETH
3BERNA BIOTECH, LTD.
2SMITHKLINE BEECHAM
2INTERCELL AG
2PROTEIN SCIENCES CORPORATION
1CSL LIMITED

Incidents per State

State Total
77,548
AK1,869
AL5,581
AR3,688
AS47
AZ14,288
CA61,984
CO11,665
CT8,149
DC1,663
DE1,807
FL37,749
FM5
GA15,058
GU120
HI2,453
IA4,625
ID2,692
IL20,334
IN24,007
KS4,615
KY7,696
LA4,887
MA14,654
MD12,514
ME3,129
MH11
MI18,739
MN12,528
MO9,710
MP29
MS2,790
MT2,375
NC16,368
ND1,356
NE2,880
NH3,100
NJ17,634
NM3,916
NV4,239
NY34,355
OH19,081
OK6,195
OR8,636
PA23,083
PR2,370
QM2
RI2,088
SC6,411
SD1,212
TN9,131
TX35,174
UT4,273
VA14,937
VI64
VT1,676
WA14,909
WI11,259
WV2,388
WY861
XB5
XL1
XV2

ID: 1005346
Sex: F
Age:
State: NY

Vax Date: 01/09/2021
Onset Date: 01/09/2021
Rec V Date: 02/05/2021
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:

Symptom List: Dysphagia, Epiglottitis

Symptoms: Anaphylactic reaction; A spontaneous report (United States) was received from a consumer who is a female patient, who received Moderna's COVID-19 Vaccine (mRNA-1273) and experienced an anaphylactic reaction. The patient's medical history included allergy to azithromycin (hives). Concomitant medications were not reported. On 09 JAN 2021, the patient received her first of two planned doses of mRNA-1273 (Batch number: unknown) for the prophylaxis of COVID-19 infection. On 09 JAN 2021, while sitting in the waiting area, 8 to 10 minutes after the injection, the patient experienced warm feeling, tongue getting bigger and collapsed. She was given intravenous medications and health care professionals were monitoring her vitals. The patient was transported to emergency via ambulance and was given two doses of EpiPen in the ambulance and by the time she arrived hospital she was doing better and was discharged after 4 hours. Treatment provided included EpiPen and intravenous medications. Action taken with mRNA-1273 in response to the event was not reported. The outcome of event anaphylactic reaction was unknown.; Reporter's Comments: This case concerns a female patient of unknown age with relevant medical history of allergy to azithromycin who received her first of two planned doses of mRNA-1273 (Batch number: unknown) for the prophylaxis of COVID-19 infection and experienced a serious medically significant unlisted event of an anaphylactic reaction within 8-10 minutes after the injection. The reaction was described as warm feeling, tongue getting bigger and collapsed. Patient was transported to ER and given two doses of EpiPen while in the ambulance. By the time she arrived at the hospital, she was doing better and was discharged after 4 hours. Treatment also included IV medications. Based on temporal association between the use of the product and the start date of the event within 8-10 minutes after the vaccine administration, a causal relationship cannot be excluded and the event of anaphylaxis reaction is possibly related.

Other Meds:

Current Illness: Drug allergy (hives from azithromycin)

ID: 1005347
Sex: M
Age: 73
State: FL

Vax Date: 01/21/2021
Onset Date: 01/21/2021
Rec V Date: 02/05/2021
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: Fainted; Unconscious; A spontaneous report was received from a consumer who was also a 73-year-old, male patient who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced fainting and unconscious. The patient's medical history was not provided. Concomitant medications were levofloxacin, metformin, amlodipine and lisinopril. On 21 Jan 2021, prior to obtaining his vaccination, the patient took levofloxacin, metformin, amlodipine, and lisinopril. On 21 Jan 2021, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (Lot number: 012L20A) intramuscularly for prophylaxis of COVID-19 infection. On 21 Jan 2021, within minutes of receiving the vaccine, the patient fainted with his eyes open and was unconscious. His health care provider told him he was dehydrated and that might be why he fainted. Action taken with the second dose of mRNA-1273 in response to the event was not reported. The outcome for the events, fainting and unconscious, was considered resolved on 21 Jan 2021.; Reporter's Comments: This case concerns a 73-years-old male patient, who experienced medically significant unexpected events of Syncope and Loss of consciousness. The events occurred within minutes after first dose of mRNA-1273, lot # 012L20A. Concomitant medication included levofloxacin, metformin, amlodipine and lisinopril. Treatment details were not provided. Based on the current available information and temporal association between the use of the product and onset of the events a causal relationship cannot be excluded. Of note, dehydration was reported as potential contributing factor.

Other Meds: LEVOFLOXACIN; AMLODIPINE; LISINOPRIL; METFORMIN

Current Illness:

ID: 1005348
Sex: F
Age: 76
State: MO

Vax Date: 01/30/2021
Onset Date: 01/31/2021
Rec V Date: 02/05/2021
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: Kiwi, Peanuts

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

Symptoms: woke up 15 hours after vaccine with throat swelling, drank warm water and symptoms relieved I 6-7 hour with out any medications He has a history of anaphylactic reactions to peanuts and kiwi so she does have an Epi Pen handy

Other Meds: Amlodipine, Lisinopril, Levothyroxine,

Current Illness:

ID: 1005349
Sex: F
Age: 78
State: CO

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: vaccine was administered from punctured vial that had been punctured for 5 days; A spontaneous report was received from a healthcare professional concerning a 78-year-old, female patient who received Moderna's COVID-19 vaccine (mRNA-1273) and was administered with the vaccine from a punctured vial that had been punctured for 5 days. The patient's medical history was not provided. The concomitant medications reported included oxygen, lisinopril, hydrochlorothiazide and metformin. On 17 Jan 2021, a vial containing mRNA-1273 was punctured. On 22 Jan 2021, prior to the onset of the events, the patient received their first of two planned doses of mRNA-1273 (Lot number: 028L20A) intramuscularly for prophylaxis of COVID-19 infection. The patient was administered with vaccine from the punctured vial that had been punctured for 5 days. No adverse events were reported. No treatment was reported. Action taken with mRNA-1273 in response to the events was not provided. The outcome for the event, administered with the vaccine from a punctured vial that had been punctured for 5 days was considered resolved on 22 Jan 2021.; Reporter's Comments: This case concerns a 78-year-old, female patient who received their first of two planned doses of mRNA-1273 (Lot#028L20A), reporting Expired product administered without any associated adverse events.

Other Meds: OXYGEN; LISINOPRIL; HYDROCHLOROTHIAZIDE; METFORMIN

Current Illness:

ID: 1005350
Sex: F
Age: 49
State: MD

Vax Date: 12/28/2020
Onset Date: 01/25/2021
Rec V Date: 02/05/2021
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: Passed out, loss of unconsciousness; Aching; Felt unwell, very sick; Shaky; Feverish; Fatigue; Nauseated; A spontaneous report was received from a 49-year-old, female consumer who received Moderna's COVID-19 vaccine (mRNA-1273) and experienced loss of consciousness, aching, fatigue, felt unwell, very sick, shaky, feverish, and nauseated. The patient's medical history was not provided. Concomitant medication was Loratadine. On 28 Dec 2020, the patient received their first of two planned doses of mRNA-1273 intramuscularly in the right arm for prophylaxis of COVID-19 infection. On 25 Jan 2021 prior to the onset of the events, the patient received their second of two planned doses of mRNA-1273 (Lot Number: 013L20A) intramuscularly in the right arm for prophylaxis of COVID-19 infection. On 25 Jan 2021, after receiving the vaccine the patient experienced loss of consciousness, aching, fatigue, felt unwell, very sick, shaky, feverish, nauseated. On 29 Jan 2021, the patient was experiencing fatigue. Treatment for the event was not provided. Action taken with the mRNA-1273 was withdrawn. The outcome for the events, loss of consciousness, aching, shaky, feverish and nauseated was Unknown and the outcome for the events, fatigue, felt unwell, very sick was considered Not resolved.; Reporter's Comments: This case concerns a 49 year old female patient experienced a serious unexpected event of loss of consciousness and NS unexpected events of aching, fatigue, felt unwell, very sick, shaky, feverish and nauseated. The events occurred after first dose of the study medication administration on the same day. Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded.

Other Meds: CLARITINE

Current Illness:

ID: 1005351
Sex: F
Age: 41
State: MN

Vax Date: 01/28/2021
Onset Date: 02/04/2021
Rec V Date: 02/05/2021
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: mild citric acid allergy

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

Symptoms: I think I have "covid vaccine arm." I got the shot on 1/28 in the afternoon. I was tired and my arm a little sore the next day. Then I was fine. On 2/4/5 at 8 at night a noticed my arm was itchy, red, lumpy, and warm at the injection site. This morning 2/5/5 it is still itchy, warm - almost hot. There is a two inch diameter red spot at the site. There is still the flatish lump at the site. I reported it to my regular doctor who gave me your contact information. I got the shot at a workplace clinic.

Other Meds: Norvasc

Current Illness: none

ID: 1005352
Sex: U
Age:
State: FL

Vax Date:
Onset Date:
Rec V Date: 02/05/2021
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: Pyrexia, White blood cell count decreased

Symptoms: Administration error-seemed like most of the vaccine came out where the needle and syringe attach; most of the vaccine came out where the needle and syringe attach; A spontaneous report was received from a healthcare professional concerning a patient who received Moderna's COVID-19 Vaccine (mRNA-1273) and experienced administration error- seemed like most of the vaccine came out where the needle and syringe attach. The patient's medical history was not provided. No relevant concomitant medications were reported. On an unknown date, the patient received their first of two planned doses of mRNA-1273 for prophylaxis of COVID-19 infection. On an unspecified date, it was reported by the health care professional that it did not seem like the patient received any of the vaccine. No treatment information was provided. Action taken with mRNA-1273 in response to the event was not reported. The event of was administration error- seemed like most of the vaccine came out where the needle and syringe attach was considered recovered/resolved on an unknown date; Reporter's Comments: This case concerns a subject, who experienced a non-serious unexpected events of Vaccine underdose and Syringe Connection Issue. The events occurred at the time of first dose of the study medication administration. The events are more related to administration error rather than related to or caused by company medication. Based on the current available information, the events are assessed as unlikely related to mRNA-1273.

Other Meds:

Current Illness:

ID: 1005353
Sex: F
Age: 62
State:

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 02/05/2021
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: Myalgia

Other Meds:

Current Illness:

ID: 1005354
Sex: M
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 02/05/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient did not receive full dose of the Moderna COVID-19 vaccine; very little got into his muscle due to the needle retracting during admission; A spontaneous report was received from a healthcare professional concerning a male patient who received Moderna's COVID-19 Vaccine (mRNA-1273) and did not receive a full dose. The patient's medical history was not provided. No relevant concomitant medication was reported. On an unspecified date, the patient received the first of their two planned doses of mRNA-1273 (lot number unknown) intramuscularly for prophylaxis of COVID-19 infection. On an unspecified date, the patient received the second of their two planned doses of mRNA-1273 (lot number unknown) intramuscularly for prophylaxis of COVID-19 infection. The patient was not administered the full second dose of the vaccine, and very little got into his muscle due to the needle retracting during admission. No treatment information was provided. Action taken with the mRNA-1273 in response to the event was not reported. The event, did not receive a full dose, was considered resolved.; Reporter's Comments: This case concerns a male patient of unknown age who received their second of two planned doses of mRNA-1273 (Lot: unknown), reporting Wrong technique in product usage process and Incorrect dose administered.

Other Meds:

Current Illness:

ID: 1005355
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 02/05/2021
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: scarring of the lungs; double pneumonia; cold; flu; exhausted and wiped out; Initial information received on 27-Jan-2021 regarding an unsolicited valid serious case from media via consumer or non-health care professional (Patient). This case involves adult patient who experienced scarring of the lungs (pulmonary fibrosis), double pneumonia (pneumonia), cold (nasopharyngitis), flu (influenza) and exhausted and wiped out (fatigue), while patient received INFLUENZA VACCINE. It was unknown if the patient had any medical history, concomitant disease or risk factor. Medical treatment, vaccination and family history were not provided. On an unknown date, the patient received a dose of suspect INFLUENZA VACCINE (produced by unknown manufacturer) [lot number not and expiry date not reported] via n unknown route at an unknown administration site for prophylactic vaccination. On an unknown date, the patient developed a serious scarring of the lungs (pulmonary fibrosis) and double pneumonia (pneumonia) 5 times then (unknown latency) following the administration of INFLUENZA VACCINE. This event was assessed as medically significant. On an unknown date, the patient developed a non-serious cold (nasopharyngitis), flu (influenza) and wiped out (fatigue) unknown latency following the administration of INFLUENZA VACCINE. It was reported that, a flu shot almost killed patient over 12 years ago. The patient wanted to understand why. Therefore, studied vaccines and was shocked by what patient found. If it were not for the FGDE (Food Grade Diatomaceous Earth) and coffee enemas, patient would not have made it. Anyone who understands that understands the scarring of the lungs and that puts patient in jeopardy for the rest of life. Patient ran out of sick and vacation days so patient went back to work. It took patient a few more months to recovered and was on light duty because patient was completely exhausted and wiped out. It was only by the grace of God patient even survived. Patient had to repent for allowing the pharmaceutical industry to poison patient body. However, it began greatest portion of patient health and wellness journey. It was unknown if the patient experienced any additional symptoms/events. It was unknown if there were lab data/results available. It was not reported if the patient received any corrective treatment. At the time of reporting, the event outcome reported as unknown for events. Information on the batch number was requested.; Sender's Comments: This case involves adult patient who experienced pulmonary fibrosis, pneumonia, nasopharyngitis, influenza and fatigue after vaccination with INFLUENZA VACCINE (produced by unknown manufacturer). The time to onset is unknown. There is, however, no information regarding patient's condition at time of vaccination, past history and lab tests do not rule out alternate etiologies, particularly infectious. Based upon the reported information, the role of an individual vaccine cannot be assessed.

Other Meds:

Current Illness:

ID: 1005356
Sex: F
Age: 86
State: IN

Vax Date: 01/22/2021
Onset Date: 01/24/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies: hay fever

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

Symptoms: I was talking on the phone and all of the the sudden I couldn't feel my cheekbone and all the way up to the eye socket and my tongue felt like a sponge, and I couldn't breathe very good. So I got my friend to take to me to the ER and they gave me oxygen, and the next my tongue was still swollen and had blisters on it. They recommended scheduling a follow appointment with PCP. They gave me a shot and three prednisone pills to take on a taper.

Other Meds: thyroxine 88 mg daily (thyroid) soprolo generic zyax 6.25 mg daily (blood pressure) sertraline 50 mg daily atorvatatine 20 mg (cholestrol) diclofenac 75 mg twice daily (arthritis) one a day vitamin for women calcium with vitamin D magne

Current Illness: no

ID: 1005358
Sex: F
Age: 45
State: VA

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 02/05/2021
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: Unknown

Symptom List: Rash, Urticaria

Symptoms: Acute headache; right behind her right eye.

Other Meds: Keppra

Current Illness: unknown

ID: 1005359
Sex: F
Age:
State: MO

Vax Date:
Onset Date:
Rec V Date: 02/05/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: hurt her hip; hives from head to toe; always get sick; went without a shot; Initial information regarding this unsolicited valid non-serious case via Medical Information (Reference number- 00440564) was received from a consumer/ non-health care professional and transmitted to Sanofi on 21-Jan-2021. This case involved a female patient of unknown age who hurt her hip (joint injury), hives from head to toe (urticaria), always get sick (illness) and went without a shot (product dose omission issue), while patient received vaccines INFLUENZA QUADRIVAL A-B VACCINE [FLUZONE QUADRIVALENT]. Medical history, past medical treatment(s), vaccination(s) and family history were not provided. At the time of the event, the patient had ongoing Alpha-gal allergy and Hives. Concomitant medications were not reported. On an unknown date, the patient received INFLUENZA QUADRIVAL A-B VACCINE [lot number: unknown and expiration date: unknown] at an unknown dose via unknown route in an unknown administration site for prophylactic vaccination. On an unknown date, patient who hurt her hip (joint injury), hives from head to toe (urticaria), always get sick (illness) and went without a shot (product dose omission issue) (latency: unknown) following the administration of suspect vaccine. No laboratory data was reported. It was not reported if the patient received a corrective treatment. Outcome of the events were unknown and not applicable for the event missed dose. Disclaimer: This suspected adverse reaction report is submitted and classified as a medication error solely and exclusively to ensure the marketing authorization holder's compliance with the requirements set out in Directive 2001/83/EC and Module VI of the Good Pharmacovigilance Practices. The classification as a medical error is in no way intended, nor should it be interpreted or construed as an allegation or claim made by the marketing authorization holder that any third party has contributed to or is to be held liable for the occurrence of this medication error. There will be no information available regarding batch number in this case.

Other Meds:

Current Illness: Alpha-gal allergy; Hives

ID: 1005360
Sex: M
Age:
State: TN

Vax Date: 10/08/2020
Onset Date: 10/08/2020
Rec V Date: 02/05/2021
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: A 17 year old patient was administered Flublok, no AE; Initial information was received on 22-Jan-2021 regarding an unsolicited valid non-serious case from a Nurse. This case involves a 17 year old male patient who was administered 0.5 ml dose of suspect INFLUENZA QUADRIVALENT RECOMBINANT VACCINE [FLUBLOK QIV] (lot UJ455AA, expiry date: 17-Mar-2021, pre-filled syringe) once via intramuscular route in the left deltoid for prophylactic vaccination on 08-OCT-2020 (Product administered to patient of inappropriate age). Medical history, medical treatment(s), vaccination(s) and family history were not provided. The patient had no other vaccines. It was a case of an actual medication error due to Inappropriate age at vaccine administration (latency same day). At the time of report, no adverse event was reported. This suspected adverse reaction report is submitted and classified as a medication error solely and exclusively to ensure the marketing authorization holder's compliance with the requirements set out in Directive 2001/83/EC and Module VI of the Good Pharmacovigilance Practices. The classification as a medical error is in no way intended, nor should it be interpreted or construed as an allegation or claim made by the marketing authorization holder that any third party has contributed to or is to be held liable for the occurrence of this medication error.

Other Meds:

Current Illness:

ID: 1005361
Sex: F
Age: 43
State: FL

Vax Date: 01/22/2021
Onset Date:
Rec V Date: 02/05/2021
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: bursitis around her elbow; elbow is pretty swollen; Initial information received on 22-Jan-2021 regarding an unsolicited valid non-serious case received from a consumer or non-health care professional. This case involves a 43 year-old female patient who experienced bursitis around elbow (bursitis) and elbow was pretty swollen (joint swelling), while she received vaccine INFLUENZA QUADRIVALENT RECOMBINANT VACCINE [FLUBLOK QIV]. The patient's medical history, past medical treatment(s), vaccination(s) and family history were not provided. No concomitant medication was given. On 22-Jan-2021 at 10:00 am, the patient received a dose of suspect INFLUENZA QUADRIVALENT RECOMBINANT VACCINE (lot QFAA2060 and expiry date 30-Jun-2021) via unknown route in the right deltoid or shoulder for prophylactic vaccination. On an unknown date, the patient developed non-serious bursitis around elbow (bursitis) and elbow was pretty swollen (joint swelling) (Unknown latency) following the administration of INFLUENZA QUADRIVALENT RECOMBINANT VACCINE. It was also reported that patient said this was not anything she had experienced before. Details of laboratory data were not reported. It was not reported if the patient received any corrective treatment. At the time of reporting, outcome of the event was unknown.

Other Meds:

Current Illness:

ID: 1005362
Sex: M
Age: 56
State:

Vax Date: 12/30/2020
Onset Date: 12/31/2020
Rec V Date: 02/05/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: First dose (Moderna) received 12/30/2020 - reaction 12/31 - 1/1. " Flu like sx: severe fatigue, chills, SOB, felt like hear racing" : was tested for COVID on 1/6 , reportedly negative & for Flu B . F/u with PCP, who dx'd with 'atypical flu' - sx su,bsequChills,Fatigue

Other Meds:

Current Illness:

ID: 1005363
Sex: F
Age: 81
State: NY

Vax Date: 01/23/2021
Onset Date: 01/30/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies: Morphine

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

Symptoms: No reaction day1. Day 2 swelling and redness size of dime. Day 3-6 no reaction. Day 7 pm red, swollen , itchy red spot size a little larger than golf ball and slight headache . This lasted 5 days with red area 31/2? wide and feeling tired and slight headache. Days 12and 13 all symptoms vanish. This morning, 2/05/2021 my arm is again 3? area red, itchy, slight headache and fatigue. I hear that this called Covid arm and seems to affect about .06 % of those who have had the Moderna vaccine. I thought I should report this because my husband who had the same injection had no symptoms at all...not even redness at the site.

Other Meds: Multi vitamin, Tramadol before bedtime for spinal stenosis

Current Illness: None

ID: 1005364
Sex: F
Age: 73
State: CT

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

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

Lab Data:

Allergies: Adhesives

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Within 5 minutes pain @ site with swelling, redness and pain. Then 1 hour some hives @ site. The next day extremely tired and slept the entire day.But

Other Meds: Prolia, hydrochlorothiazide,

Current Illness: None

ID: 1005365
Sex: F
Age: 17
State: FL

Vax Date: 12/30/2020
Onset Date: 12/30/2020
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Vaccine administered to a minor.

Other Meds:

Current Illness:

ID: 1005366
Sex: F
Age: 54
State: NJ

Vax Date: 02/03/2021
Onset Date: 02/04/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: chills, fatigue, body aches.

Other Meds: Nexium, biotin, vitamin B12

Current Illness:

ID: 1005367
Sex: F
Age: 79
State: FL

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 02/05/2021
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: none reported

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

Symptoms: Client/spouse report hives and rash around injection site that appeared a few hours subsequent to administration

Other Meds: unknown

Current Illness: skin carcinoma; skin graft surgery

ID: 1005368
Sex: F
Age: 28
State:

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/05/2021
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: Unevaluable event

Symptoms: Pre-filled syringes of Moderna were sent in subcutaneous syringes and not not intramuscular. Dose was administered intramuscular via a subcutaneous syringe.

Other Meds:

Current Illness:

ID: 1005369
Sex: F
Age: 50
State: NJ

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 02/05/2021
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: Shellfish, Tegaderm, Pecan, Walnut, Gluten, Berries, MSG, Doxycycline, Erythromycin, Bactrim, Reglan, Nickel, NSAID

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

Symptoms: Throat tightness, severe dizziness almost immediately after. Nausea and tiredness. 24 hours later throat still tight and still very dizzy. Arm extremely painful and swollen.

Other Meds: Zoloft, Multivitamin, Probiotic

Current Illness: None

ID: 1005370
Sex: F
Age: 72
State: NC

Vax Date: 01/22/2021
Onset Date: 02/01/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies: Contrast Dye

Symptom List: Injection site pain, Pain

Symptoms: 1/22/21 - right after shot-headache, lightheaded, fatigue, muscle weakness, chills, joint and muscle aches, chills, nasal congestion, pain at shot site. Except for pain at shot site, lasted 24 hours 2/1/21- Developed feeling of anxiety, muscle spasms in arms and legs, sleeplessness, headache, lightheaded, joint and muscle pain, chills, sweats, continued pain in arm, itching, nasal congestion, low blood sugar. Symptoms began receding on second day with only itching and nasal congestion today 2/5 In the past, I have had similar reactions to some antibiotics, otc/herbal meds, flu shots. Was told by Allergist that these were not allergic reactions but side effects.

Other Meds: Atenelol, Actos, Metformin, Levotyhroxine, Potassium, Trimeter

Current Illness: None

ID: 1005371
Sex: F
Age: 53
State: WI

Vax Date: 02/03/2021
Onset Date: 02/04/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Fever, body aches, Fatigue

Other Meds:

Current Illness:

ID: 1005372
Sex: M
Age: 53
State:

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 02/05/2021
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:

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

Symptoms: Headache, Myalgia, Fatigue

Other Meds:

Current Illness:

ID: 1005373
Sex: F
Age: 37
State:

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 02/05/2021
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:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: "Moderna 042L20A Exp 7/5/21, First dose, L arm Administration time 08:30 Reactions start time 08:35 Symptoms: Hot, Flushed, Nausea, Burning sensation to shoulders, back of neck. No rash or redness noted at that time. Previous reactions/allergies: Avocados, Pistaccios however did report with last flu vaccine had redness, warmth and swelling. 08:40 122/82, 100, 98% Increased nausea 08:50 121/79, 95, 98% Nausea improved 09:00 110/75, 83, 100% No nausea, continued burning to upper shoulder, back of neck. 09:15 145/91, 100, 99% Increased burning up back, neck, pt sat up and had increased dizziness, slight frontal Headache, Rash noted to R inner arm and L arm. Slight sensation of tightness in swallow. 09:18 25 mg Benedryl PO 09:30 135/85, 85, 100% Palmer surface of hands flushed. Increased nausea, increased dizziness. 09:45 Up to the bathroom. 09:50 126/84, 88, 100% No change 10:00 125/85, 86, 100% Continued bilateral upper extremity rash and dizziness. Benedryl 25 mg PO given 10:15 124/82, 77, 95% Increased warmth at back of neck and shoulders. Contacted primary care provider and arranged for appointment today. 10:25 124/83, 85, 100% No change 10:40 Waiting for spouse in Waiting area with RN at side, increased heat sensation to back of neck and shoulders. Stated that she just did not feel right. 10:45 Ad Rep and Lead RN to evaluate. 10:50 Transport to the ED with RN and Rep.

Other Meds:

Current Illness:

ID: 1005374
Sex: M
Age: 30
State: IN

Vax Date: 02/03/2021
Onset Date: 02/04/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Fever/Chills that lasted 24 hours.

Other Meds: None

Current Illness: None

ID: 1005375
Sex: F
Age: 66
State: IL

Vax Date: 02/04/2021
Onset Date: 02/04/2021
Rec V Date: 02/05/2021
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: Avelox-rash; Flexerill-rash; Iodine-rash; Lebquin-rash; Penicillins-rash; Sulfa-rash; Vicodin-rash; Betadine-rash

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

Symptoms: Tongue tingling, thickening, red blotches, Took Benadryl to relieve symptoms,

Other Meds: Aspirin-81 mg; Biotin-800 mcg; Vitamin D-2000 mg; Lisinopril-20 mg; Montelukast-10 mg; Omeprazole-20 mg; Escitalopram-10 mg; Probiotic; Furosemide-20 mg; Bystolic-5 mg; Ezetimibe-10 mg; Cefdinir-300 mg;

Current Illness: UTI

ID: 1005376
Sex: M
Age: 66
State: TX

Vax Date: 01/26/2021
Onset Date: 01/31/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Nausea

Symptoms: After a few days an upper arm rash at the injection site appeared along with some minor swelling and itching. Size about 3 inches in diameter. Now about 10 days after shot, rash is still there, perhaps darkening in color somewhat. No material pain though.

Other Meds:

Current Illness: none

Date Died: 01/01/2021

ID: 1005377
Sex: M
Age: 80
State: FL

Vax Date: 01/05/2021
Onset Date: 01/01/2021
Rec V Date: 02/05/2021
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: Significant other reported patient expired "a week before 2nd vaccine was due".

Other Meds:

Current Illness:

ID: 1005378
Sex: F
Age: 42
State:

Vax Date: 01/07/2021
Onset Date: 01/07/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Upon arrival for second dose individual reported rash itching and fever following first dose. Seen by Dr and second dose deferred until seen by an allergist

Other Meds:

Current Illness:

ID: 1005379
Sex: M
Age: 67
State: IN

Vax Date: 02/02/2021
Onset Date: 02/03/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Fever, nausea, chills, dizziness

Other Meds: Diclofenac75 mg Omeprazole 20 mg Montelukast 10 mg Amlodipine Besylate 10mg

Current Illness:

ID: 1005380
Sex: F
Age: 42
State: IN

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 02/05/2021
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: macrobid

Symptom List: Tremor

Symptoms: Swelling in lymph nodes on left side between armpit and breast. Mammogram and ultrasound confirmed not cancerous, but rather likely enlarged lymph node. Aches, headache, fatigue.

Other Meds: none

Current Illness: none

ID: 1005381
Sex: M
Age: 76
State: OH

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 02/05/2021
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: Erythema, Pruritus

Symptoms: Fever, malaise, headache, pain at injection site....Tylenol as treatment. Resolved after 24 hours

Other Meds: Irbesartan, hydralazine, Carvedilol, Rosuvastatin, aspirin 81 mg, Azelastine, Levothyroxine, Metformin, Allegra, Famotidine

Current Illness: Diabetes, Hypertension, GERD, Hypercholesterolemia

ID: 1005382
Sex: F
Age: 71
State: NC

Vax Date: 01/21/2021
Onset Date: 02/04/2021
Rec V Date: 02/05/2021
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: unknown

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

Symptoms: Pt. called 2-5-2021 with c/o a circle the size of fist on Lt. arm at site of injection with a red spot. No pain or itching but did have fever. Pt. did also say she had pain to upper Rt. arm starting last Sunday 1-31-2021 where she had difficulty even lifting arm. Denies taking anything for symptoms except using heat to Rt. arm. FNP discussed with the pt. about possible side effect from vaccine of body aches. Also recommended she get okay from PCP before receiving second dose. Pt. did say that symptoms were better today.

Other Meds: none

Current Illness: unknown

ID: 1005383
Sex: F
Age: 64
State: CA

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Head ache, nausea first day, second day diarrhea, fever, head ache and body aches. Third day injection site red the size of a quarter, hot and sore to the touch and hard. Arm aches into shoulder.

Other Meds:

Current Illness:

ID: 1005384
Sex: F
Age: 70
State: OH

Vax Date: 01/26/2021
Onset Date: 01/29/2021
Rec V Date: 02/05/2021
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: NKDA

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Fever 101F, chills, HA, Body Aches, fatigue - stayed in Bed - after 24 hours fever resolved felt better. Missed one day of work.

Other Meds: Vag-a-fem, calcium, D3, Pepcid, evista

Current Illness: None

ID: 1005385
Sex: F
Age: 76
State: AR

Vax Date: 02/02/2021
Onset Date: 02/03/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Heavy breathing and wheezing

Other Meds:

Current Illness:

ID: 1005386
Sex: F
Age: 48
State: CA

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/05/2021
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: Part of cerium drizzled down patients arm. No concern by person who gave the injection.

Other Meds:

Current Illness:

ID: 1005387
Sex: M
Age: 34
State: IL

Vax Date: 02/04/2021
Onset Date: 02/05/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Pain in extremity

Symptoms: temp at 8AM: 101.3: PRN Tylenol admin

Other Meds: na

Current Illness: NA

ID: 1005388
Sex: F
Age: 58
State:

Vax Date: 12/31/2020
Onset Date: 12/31/2020
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Left arm pain immediately after injection into high deltoid. Use of prescription pain reliever and prevented in daily activities referral to specialist

Other Meds:

Current Illness:

ID: 1005389
Sex: F
Age: 82
State: MT

Vax Date: 01/26/2021
Onset Date: 02/03/2021
Rec V Date: 02/05/2021
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: penicllin, sulfa, lincocin, seconal, tuinel, butazolidin, diphenhydramine, oxycodone insect bites

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

Symptoms: Moderna COVID-19 Vaccine EUA Large area of swelling, redness approximately 6" below injection site. Redness had a large, firm lump in the center. Skin was hot and very itchy, soreness, dizziness. Today (2-5-21) large lump in greatly reduced in size. Redness is still present. Burning sensation is less.

Other Meds: Vitamin D 3, calcium, multiple vitamin

Current Illness: none

ID: 1005390
Sex: F
Age: 70
State: CA

Vax Date: 01/21/2021
Onset Date: 01/31/2021
Rec V Date: 02/05/2021
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: Hypotonia, Lethargy, Respiratory rate decreased, Screaming, Skin warm

Symptoms: On Jan 31st noticed a rash forming on arm and warm to the touch. Saw a Dr. on Feb 3rd. Diagnosed with cellulitis.

Other Meds: lisinopril, amloplopipine besylae, espriva, ontelukast sodium and albuterol

Current Illness:

ID: 1005391
Sex: F
Age: 41
State: TX

Vax Date: 12/22/2020
Onset Date: 01/04/2021
Rec V Date: 02/05/2021
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

Symptom List: Vomiting

Symptoms: Hives all over body that lasted almost two weeks.

Other Meds: Xyzal, levythyroxine

Current Illness: none

ID: 1005392
Sex: F
Age: 67
State: TX

Vax Date: 01/28/2021
Onset Date: 01/28/2021
Rec V Date: 02/05/2021
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: PNC

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Face got red and warm and a burning sensation in her throat. Gave Benadryl PO. Continued to monitor for 30mins and patient still complained of burning and tightness in throat. Called her family and they drove her to the ER. I have spoken with patient and she has had to go to the ER a total of 3 times.

Other Meds: Atendol 50mg q day, losartin 50mg q day, rosudastatin 20mg q day, Ezetimibe 10mg q day, Gapibentin 300mg q day, metformin 500mg q day, GNC diabetic vitamin q day, Vit D 2000 q day, 2 81mg ASA q day, B complex q day, Calcuim q day, omega

Current Illness:

ID: 1005393
Sex: F
Age: 76
State: MD

Vax Date: 01/28/2021
Onset Date: 02/04/2021
Rec V Date: 02/05/2021
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: Latex, Non steriodal anti inflammatories

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

Symptoms: seven days after receiving the shot I developed a rash and ichy sensation around the injection site. On the day of the vaccination I thought my tongue was a little swollen.

Other Meds: Diltiazem, Levothyroxine, Rosuvastatin, Centrum vitemins for Women, Soolantra topical gel

Current Illness: vertigo : had it for 7 weeks. Never had it before. Doctor could find no cause. It was gone two to three weeks before i got the Moderna shot.

ID: 1005394
Sex: F
Age: 89
State: TX

Vax Date: 02/05/2021
Onset Date: 02/05/2021
Rec V Date: 02/05/2021
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: fluticasone ibuprofen meloxicam Methylprednisolone (Pak) Percodan phenylephrine Sulfa (Sulfonamide Antibiotics) tamoxifen

Symptom List: Injection site swelling, Limb discomfort

Symptoms: I was called to patient's room at approximately 09:35 after she received her COVID vaccine at 09:14. The nurse reports she was pale and diaphoretic while in observation at 09:20. She had no chest pain, SOB, nausea/vomiting, headache. She stated that she was feeling weak and had lost all her energy. When taken, her BP was elevated, but her other vitals signs and blood sugar were normal. Her heart rate/rhythm was normal and regular. She reported some epigastric pain. Overtime, her symptoms improved without intervention. She was given water, and rested under observation. Her daughter came to drive her home. She was released after a minimum of 45 minutes post-injection.

Other Meds: Amlodipine 5mg daily, Aspirin 81mg daily, Digoxin 0.125mg daily, Montelukast 10mg daily, Rosuvastatin 10mg daily, Symbicort 160/4.5 2 puffs BID, tramadol 50mg prn, Xopenex 45mcg 2puff q6hrs prn rescue.

Current Illness: None

ID: 1005395
Sex: F
Age: 40
State: TN

Vax Date: 02/02/2021
Onset Date: 02/03/2021
Rec V Date: 02/05/2021
Hospital:

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

Lab Data:

Allergies: Keflex and morphine allergies

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

Symptoms: Hives, backache, fatigue, and body aches

Other Meds: none

Current Illness: none

ID: 1005396
Sex: F
Age: 22
State: FL

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 02/05/2021
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: N/A

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

Symptoms: High fever (102.4) beginning around 2am on 2/4/2021 ending around 2pm on 2/4/2021 Vomiting numerous times from 2pm-4pm on 2/4 Chills starting at 9pm 2/3/2021 still continued Headache starting at 9pm on 2/3/2021

Other Meds: Norgestimate and Ethinyl Estradiol Tablets (Birth control - was on inactive week), Vitamin D, Vitamin C

Current Illness: N/A

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm