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: 1025095
Sex: M
Age: 69
State: SC

Vax Date: 02/04/2021
Onset Date: 02/11/2021
Rec V Date: 02/12/2021
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: None

Symptom List: Dysphagia, Epiglottitis

Symptoms: After seven days a red itchy swelling occurred.

Other Meds: Talafadil Vitamin D

Current Illness: None

ID: 1025096
Sex: F
Age: 35
State: NJ

Vax Date: 02/05/2021
Onset Date: 02/10/2021
Rec V Date: 02/12/2021
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: None

Symptom List: Anxiety, Dyspnoea

Symptoms: Itchy body

Other Meds: Levothyroxine 125mcg

Current Illness: None

ID: 1025097
Sex: U
Age:
State: FL

Vax Date: 02/08/2021
Onset Date: 02/08/2021
Rec V Date: 02/12/2021
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:

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

Symptoms: pain in arm, itching at injection site

Other Meds:

Current Illness:

ID: 1025099
Sex: F
Age:
State: CA

Vax Date: 08/17/2012
Onset Date: 08/01/2012
Rec V Date: 02/12/2021
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: This initial spontaneous report was received from a lawyer regarding a case in litigation and refers to an adolescent female patient. Information on the Pt's concurrent conditions, medical history or concomitant therapy was not reported. On 17-AUG-2012, the Pt was vaccinated with a first dose of GARDASIL (lot#, expiration date, dose, route of administration and anatomical location were not reported). On an unknown date in August 2012, reported as almost immediately, Pt experienced a seizure-like episode which included a staring spell, facial swelling, slurred speech and severe headache. Within a few days of receiving her first dosage of GARDASIL, the Pt developed migraines, dizziness, and numbness. Over the following months, she also experienced constant headaches and severe migraines, abdominal pain, nausea, vomiting, rapid heartbeat and palpitations, insomnia, and symptoms of auditory hallucinations and parasomnias. On an unknown date in February 2013, the Pt empierced a seizure and was taken to the emergency department at a hospital. A head CT was performed and returned normal, and she was diagnosed with a first-time seizure. On an unknown date in March 2013, after suffering from headaches, vomiting, and nausea for about five days, the Pt was taken to the hospital for a DHE protocol. Although the protocol resolved her nausea and vomiting, the Pt continued to have migraines and occasional hallucinations. On an unknown date in April 2014 (reported as in April/May of 2014), the Pt began to experience irregular menstrual problems, including heavy bleeding at the beginning of each cycle. After six months of suffering, the Pt's mother made an appointment for a consultation with a pediatrician. On 21-OCT-2014, the Pt was administered with the second dose of GARDASIL, by a physician. On 23-OCT-2014, the Pt collapsed at school while running in her P.E. class and was taken to the ED. By an unknown date in December 2014 (also reported as early December 2014), the Pt's menstrual problems had changed to an absence of menses and severe abdominal pain. An ultrasound performed on an unknown date in March 2015, showed that she had a hemorrhagic cyst in her right ovary and large Nabothian cysts in her cervix. Further testing indicated that the cysts were getting larger, and as the Pt was in constant pain, she decided to have the cyst on her ovary surgically removed. On unknown dates in May and June 2015, Pt experienced several more seizures and was taken to the hospital each time. As the months progressed, so did the Pt's injuries. She was seen by multiple physicians and specialists for complaints, which included, among others: constant nausea and abdominal pain; reflux and heartburn; multiple seizures; feeling faint and lightheaded; heart rate irregularities and palpitations; chest pains; dizziness and blurry vision; dyspnea with walking; significant fatigue; continued menstrual irregularities; joint hypermobility; hives and facial flushing; severe food allergies; chronic dehydration; and recurring ovarian cysts. As a result of her GARDASIL symptoms, Pt had been unable to engage in the normal activities that a teenager and young adult would enjoy. As a result of her GARDASIL induced injuries, she had to drop out of high school to complete her schooling at home. She was unable to hold down a job for any significant amount of time due to chronic pain and poor health. Pt could not drive a car because of the risks of fainting or having a seizure while driving. Pt was once a happy child, but as a result of her GARDASIL symptoms, she had experienced a significant decline in her mental health. Due to the significant stressors related to her physical illnesses, she experienced hallucinations and sustained severe emotional distress which led to her cutting herself as a young teenager (dates unknown). Pt suffered from recurring ovarian cysts, endometriosis, and early onset menopause. She did not get regular periods, therefore would not be able to conceive naturally in the future. She had a high risk for seizure, stroke, heart attack and blood clots and was medically unable to undergo hormone therapy to relieve the pain from the ovarian cysts, or to restore her menses. Therefore, she must live with the chronic, debilitating pain from the recurring cysts, and have them surgically removed when necessary. To date, Pt has had four or more surgeries to remove ovarian cysts. Based on her chronic and severe GARDASIL symptoms and adverse events as outlined above and the tests performed by a number of medical providers, Pt had been diagnosed with various medical conditions, including but not limited to, dysautonomia, postural orthostatic tachycardia syndrome ("POTS"), orthostatic intolerance ("OI"), mast cell activation syndrome ("MCAS"), complex migraine headaches, seizure disorder, vasculitis, eosinophilic esophagitis, endometriosis, and interstitial cystitis. Pt contended that her injections of GARDASIL, individually or in combination, caused her to develop serious and debilitating injuries, including but not limited to, dysautonomia, postural orthostatic tachycardia syndrome (""OTS"), orthostatic intolerance ("OI"), mast cell activation syndrome ("MCAS"), complex migraine headaches, seizure disorder, vasculitis, eosinophilic esophagitis, endometriosis, and interstitial cystitis, as well as a constellation of adverse symptoms, complications, and injuries, many of which are alleged herein and all of which were caused by GARDASIL or otherwise linked to her GARDASIL-induced autoimmune disorder. As a proximate result of Company's wrongful acts and omissions and its negligent and fraudulent testing, labeling, manufacturing, marketing and promotion of GARDASIL, Pt had suffered and continued to suffer severe and permanent physical injuries and associated symptomology and had suffered severe and permanent emotional injuries, including pain and suffering. Pt also had a substantial fear of suffering additional and ongoing harms, including but not limited to now being at an increased risk of cancer and future symptoms and harms associated with her autoimmune disease and other injuries caused by GARDASIL. As a direct and proximate result of her GARDASIL-induced injuries, Pt had suffered and continued to suffer economic losses, including considerable financial expenses for medical care and treatment, and diminished in come capacity, and he will continue to incur these losses and expenses in the future. The outcome of the events was reported as not recovered. The reporter considered all events to be disabling and related to GARDASIL. Information regarding this Pt was also received via social media. It was reported that on 17-AUG-2012, the Pt was vaccinated with GARDASIL. On 18-AUG-2012, also reported as one day after the first injection, Pt had an epileptic episode that included a "gaze spell", swelling of the face, slurred speech and severe headache. She later developed severe migraines, abdominal pain, and a host of other debilitating health problems. On an unknown date in January 2013, also reported as five months after her first injection, Pt had an epileptic seizure and was taken to the emergency room. At that time, she was also facing irregular menstrual problems, including heavy bleeding at the start of each cycle. Her health continued to deteriorate after receiving another dose of the GARDASIL. Just two days after the second injection, Pt collapsed during physical education class and was rushed to the emergency department of a hospital. Pt has had at least one surgery per year on her reproductive organs since she was 15-year-old. Doctors said she would not be able to get pregnant or consider in vitro fertilization. The Pt's clinical diagnoses included dysautonomia, postural orthostatic tachycardia syndrome ("POTS"), orthostatic intolerance ("OI"), small fiber neuropathy ("SNF"), neuropathy, mast cell activation syndrome ("MCAS"), seizure disorders and endometriosis. among others. Due to these and other sequelae, Pt was unable to maintain a job for a significant period of time. She also could not drive due to the risk of fainting or seizures while dri

Other Meds:

Current Illness:

ID: 1025100
Sex: F
Age: 56
State: GA

Vax Date: 08/09/2019
Onset Date: 08/01/2019
Rec V Date: 02/12/2021
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: Infectious disease; tingling along the trigeminal nerve / started at the neck and going up to the head / occasional tingling behind the ear; Trigimenal nerve pain; fatigue; myalgia; headache; being unable to work for approximately 4 months, due to symptoms; This case was reported by a nurse and described the occurrence of infection in a 56-year-old female patient who received Herpes zoster (Shingrix) (batch number C5E43, expiry date 10th August 2021) for prophylaxis. The patient's past medical history included shingles (active Shingles infection). Concurrent medical conditions included genital herpes. On 9th August 2019, the patient received the 1st dose of Shingrix (intramuscular). In August 2019, less than 2 weeks after receiving Shingrix, the patient experienced infection, tingling, nerve pain, fatigue, myalgia, headache and inability to work. On an unknown date, the outcome of the infection, nerve pain, fatigue, myalgia, headache and inability to work were recovered/resolved and the outcome of the tingling was not recovered/not resolved. It was unknown if the reporter considered the infection, tingling, nerve pain, fatigue, myalgia, headache and inability to work to be related to Shingrix. Additional details were reported as follows: This case was reported by patient herself. The reporter reported that onset of symptoms was between 9th August or either 17th August or 19th Aug 2019. The patient experienced severe headache, tingling along the trigeminal nerve, tingling started at the neck and going up to the head, fatigue and myalgia. The reporter went to the emergency room 4 or 5 times, as well as s her primary care physician, who referred her to infectious diseases. The patient was unable to work for approximately 4 months due to symptoms. All symptoms were resolved with the exception of occasional tingling behind the ear. The patient had not yet received the second dose of Shingrix. The reporter asked timeline between getting a vaccine because that was when a lot of people really find out about the shingles vaccine was once they had it and then they need to know how long they need to wait after active infection to get the vaccine. There were no studies on if you only went for one dose, would you have been any protection at all. The reason for not getting the second dose could have been the physician said no, because of the bad reaction. The reporter also asked, was it not recommended for patients who had a history or herpes. The reporter consented to follow up.

Other Meds:

Current Illness: Genital herpes

ID: 1025101
Sex: F
Age:
State: FL

Vax Date: 02/01/2016
Onset Date:
Rec V Date: 02/12/2021
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:

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

Symptoms: some sort of anaphylactic reaction; Eyes were full of blood; throat swelled up; bilateral conjunctivitis; Initial information regarding an unsolicited valid serious case was received from a consumer/non-health care professional via Agency (Reference number- US-SANOFI-00457182) and transmitted to Sanofi on 02-Feb-2021. This case involves a female patient (unspecified age) who had some sort of anaphylactic reaction (anaphylactic reaction), eyes were full of blood (ocular hyperaemia), throat swelled up (pharyngeal swelling) and bilateral conjunctivitis (conjunctivitis), while she received INFLUENZA QUADRIVAL A-B HIGH DOSE HV VACCINE [FLUZONE HIGH-DOSE QUADRIVALENT]. Medical history, medical treatment(s), vaccination(s) and family history were not provided. Concomitant medications included DIPHENHYDRAMINE HYDROCHLORIDE (BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE]). In February 2016, the patient received a dose of suspect INFLUENZA QUADRIVAL A-B HIGH DOSE HV VACCINE [FLUZONE HIGH-DOSE QUADRIVALENT] ( lot number and expiry date not reported) via unknown route in unknown administration site for prophylactic vaccination. On an unknown date in 2016, the patient developed a serious some sort of anaphylactic reaction (anaphylactic reaction) unknown latency following the administration of INFLUENZA QUADRIVAL A-B HIGH DOSE HV VACCINE. This event was assessed as medically significant. On an unknown date in 2016, the patient developed a non-serious eyes were full of blood (ocular hyperaemia), throat swelled up (pharyngeal swelling) and bilateral conjunctivitis (conjunctivitis) unknown latency following the administration of INFLUENZA QUADRIVAL A-B HIGH DOSE HV VACCINE. No laboratory data was provided. It was not reported if the patient received a corrective treatment. At the time of reporting, the outcome of event was unknown. Information on lot number was requested for this case.; Sender's Comments: This case concerns female patient (unspecified age) who had anaphylactic reaction, ocular hyperaemia, pharyngeal swelling and conjunctivitis, after vaccination with FLUZONE HIGH-DOSE QUADRIVALENT. The time to onset is unknown. Additional information regarding medical history, condition at the time of vaccination, lab data excluding other etiologies would be needed for complete assessment of the case. Based upon the reported information, the role of the vaccine cannot be assessed.

Other Meds: BENADRYL [DIPHENHYDRAMINE HYDROCHLORIDE]

Current Illness:

ID: 1025102
Sex: M
Age:
State: NY

Vax Date:
Onset Date:
Rec V Date: 02/12/2021
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: anaphylactic reaction/ Anaphylactic shock; Initial information received on 03-Feb-2021 regarding an unsolicited valid serious case from a consumer/non-health care professional via Agency. This case involves a 90 years old male patient who experienced anaphylactic reaction/ anaphylactic shock (anaphylactic reaction), after receiving TETANUS TOXOID. Reported that earlier in life, he received a Tetanus vaccine and did not have a reaction. Past medical treatment, concomitant medication, family history not reported. Before vaccination, the patient had car accident and was hospitalized. On an unknown date in 2002, the patient received a dose of suspect TETANUS TOXOID produced by unknown manufacturer (lot number and expiration date not reported) via unknown route in unknown administration site for prophylactic vaccination. It was also reported that he was not sure of the exact name of the Tetanus vaccine because it was given to him after he was in an accident and his wife informed him that they gave him a vaccine. On an unknown date in 2002, the patient developed a serious anaphylactic reaction/ anaphylactic shock (anaphylactic reaction) (latency unknown) following the administration of TETANUS TOXOID. This event was assessed as medically significant. The reporter wanted to know that if he could get the Covid-19 (Coronavirus disease) vaccine because of the above stated. No laboratory data reported. It was not reported if the patient received a corrective treatment. At the time of reporting, the outcome was not reported for the event anaphylactic reaction. Information on the batch number to be requested.; Sender's Comments: This case concerns a 90 years old male patient who had anaphylactic reaction, after vaccination with TETANUS TOXOID(produced by unknown manufacturer).The time to onset is unclear. Also reported that at the time of vaccination patient was in the hospital due to having a car accident. Previously, he received a Tetanus vaccine and did not have a reaction. Moreover, patient's medical condition at the time of vaccination and lab tests were not reported. Based upon the reported information, the role of vaccine cannot be assessed.

Other Meds:

Current Illness:

ID: 1025103
Sex: F
Age: 64
State: CA

Vax Date: 01/29/2021
Onset Date: 02/12/2021
Rec V Date: 02/12/2021
Hospital:

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

Lab Data:

Allergies: Gluten, dairy intolerant Latex (rash on skin)

Symptom List: Pharyngeal swelling

Symptoms: Round swollen, itchy patch at injection site about 3 inches in diameter

Other Meds: Metformin, Jardiance, Atorvastatin, Tylenol, ibuprofen

Current Illness:

ID: 1025104
Sex: M
Age: 72
State: OH

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

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

Lab Data:

Allergies: None known

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Moderna COVID-19 Vaccine EUA Moderate redness and itching at injection site - ongoing

Other Meds: Simvastatin 10 mg Losartan/Hydrochlorothiazide 25 mg/6.25 mg

Current Illness: None

ID: 1025105
Sex: F
Age: 70
State: WI

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 02/12/2021
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: Prescription pain meds, propofol and propylene glycol products.

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Moderna COVID-19 Vaccine EUA Woke up the following with a sore throat, cough and runny nose Runny nose lasted only 2-3 hours. Cough just about dissappeared, but throat still feels a little funny. I have appt to get tested for COVID at Urgent care later this morning.

Other Meds: Losartan, Omeprazole and allipurinol, Vitamin D3, Pantothenic Acid and Calcium pill.

Current Illness: Felt fine in thelast month right up to the vaccination.

ID: 1025106
Sex: F
Age: 68
State: SC

Vax Date: 02/10/2021
Onset Date: 02/11/2021
Rec V Date: 02/12/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: increase in blood pressure..156/96 for at least 6-8 hrs. ..blood pressure has not been elevated in 2-3 years. I took my prescribed blood pressure medication prior to bed time. This morning b/p is in normal range. other side effects: sore arm, leg and hip pain. This am has improved.

Other Meds: ziac 2.5mg (blood pressure), Multiple Vit, Vit b,c,d and zinc

Current Illness: Tested positive for Covid-19 1 month prior to vaccine

ID: 1025107
Sex: M
Age:
State: FL

Vax Date:
Onset Date: 02/08/2021
Rec V Date: 02/12/2021
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: cant sleep , body aches , some dizzyness , HA

Other Meds:

Current Illness:

ID: 1025108
Sex: F
Age: 24
State: PA

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 02/12/2021
Hospital:

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

Lab Data:

Allergies: Bactrim

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

Symptoms: Received the second dose of moderna at 1:30 pm on 12/11 and at 12 AM on 12/12 I woke up from my body shaking vigorously with nausea and increased heart rate. Was unable to get up from bed to take my temperature, Heart rate or blood pressure. Called the emergency department to find out if I should go there. Shivering continued for about 1 hour after taking Tylenol 1300 mg and clonazepam 0.25 mg for panic symptoms. I then slept for the remainder of the night and woke up with nervous system ?shock like? feelings of shivers and shaking.

Other Meds: Magnesium, vitamin D, multivitamin, vitamin C

Current Illness: None

ID: 1025109
Sex: F
Age: 65
State: FL

Vax Date: 01/30/2021
Onset Date: 01/30/2021
Rec V Date: 02/12/2021
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: felt woozy ten minutes after injection, strange smell , throat tingling , sensation in the nose , currently has head dizziness 10 days later , no other issues .

Other Meds:

Current Illness:

ID: 1025110
Sex: M
Age: 57
State:

Vax Date: 02/05/2021
Onset Date: 02/06/2021
Rec V Date: 02/12/2021
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: chills, fever, fatigue injection site pain swelling at injection site use of prescription pain reliever prevent daily activity myalgia diarrhea nausea

Other Meds:

Current Illness:

ID: 1025111
Sex: M
Age: 29
State: NJ

Vax Date: 02/02/2021
Onset Date: 02/08/2021
Rec V Date: 02/12/2021
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: Nausea, Pain, Pain in extremity, Paraesthesia oral, Pyrexia

Symptoms: Red, light swelling, warm to the touch around injection site.

Other Meds: None

Current Illness: None

ID: 1025112
Sex: M
Age: 43
State: WV

Vax Date: 02/10/2021
Onset Date: 02/12/2021
Rec V Date: 02/12/2021
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: None

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

Symptoms: Red rash at injection site approx 5 inches across, joint pain, fatigue, restless legs, arm pain in right arm

Other Meds: None

Current Illness: None

ID: 1025113
Sex: F
Age: 65
State: NJ

Vax Date: 02/07/2021
Onset Date: 02/09/2021
Rec V Date: 02/12/2021
Hospital:

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

Lab Data:

Allergies: sulfa

Symptom List: Ear pain, Hypoaesthesia

Symptoms: onset of severe chills, arm pain, and brusing on left hand, left arm

Other Meds: fish oil; vit c, vit d, astragalus, adrenal support, zinc, calcium builders, atacand,

Current Illness: none

ID: 1025114
Sex: M
Age: 48
State: NC

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/12/2021
Hospital:

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

Lab Data:

Allergies: Codeine. Penicillin

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: When to bathroom. Had blood in urine and was dark brown too drank 3 12oz bottles of water and cleared up but still yellow. I have abdominal Paine and headache and tired

Other Meds: Lisinopril 10 mg Simvastatin. 10mg. Omeprazole 20 mg. Vitamin c. D. Zinc magnesium potassium Testosterone injection 200 mg ibuprofen

Current Illness: Small bowel resection

ID: 1025115
Sex: U
Age:
State: FL

Vax Date: 02/03/2021
Onset Date: 02/03/2021
Rec V Date: 02/12/2021
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: diarrhea, cramps, took Imodium and has resolved. Now experiencing swollen, tenderness, and redness at injection site.

Other Meds:

Current Illness:

ID: 1025116
Sex: F
Age: 27
State:

Vax Date: 02/02/2021
Onset Date: 02/02/2021
Rec V Date: 02/12/2021
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:

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

Symptoms: Woke up with Nausea, chills, headache and body aches about 10 hours post second dose of vaccine. Nausea and headache resolved within a few hours. Chills and Body aches lasted about 24 hours post onset of symptoms. I was back to feeling 100% by about 36 hours post vaccine injection.

Other Meds:

Current Illness:

ID: 1025117
Sex: M
Age: 92
State: FL

Vax Date: 01/29/2021
Onset Date: 01/30/2021
Rec V Date: 02/12/2021
Hospital: Y

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

Lab Data:

Allergies: None

Symptom List: Unevaluable event

Symptoms: Fever, chills, debilitating weakness, atrial fibrillation, renal effects

Other Meds: Cardiac, Renal, Type 2 Diabetes, Parkinsonian

Current Illness: None

ID: 1025118
Sex: F
Age: 43
State: VA

Vax Date: 02/10/2021
Onset Date: 02/11/2021
Rec V Date: 02/12/2021
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: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: In the morning of 2/11/21 received very bad headache, then once at work, shakes, trembling all over my body, sever pain behind right eye, upset stomach, cold/hot spells, heavy weight on my chest (breathing light and fast), dizzyness. 2/12/21 - upset stomach, headache, fatigue

Other Meds:

Current Illness:

ID: 1025119
Sex: F
Age: 37
State: MI

Vax Date: 02/05/2021
Onset Date: 02/10/2021
Rec V Date: 02/12/2021
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: Prozac, possibly penicillin

Symptom List: Injection site pain, Pain

Symptoms: Burn like skin abrasion on left chest area (upper breast, near shoulder) developed on Wednesday mid-day (a few days after receiving vaccine).

Other Meds: Multivitamin, iron supplement

Current Illness: None

ID: 1025120
Sex: F
Age: 59
State: MN

Vax Date: 02/04/2021
Onset Date: 02/11/2021
Rec V Date: 02/12/2021
Hospital:

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

Lab Data:

Allergies: Sulfa

Symptom List: Injection site pain, Menorrhagia

Symptoms: Swelling of salivary glands in cheeks - bilateral sialadenitis - started within days of first dose of vaccine and resolved, reaction was delayed with second dose - started that time about 7 days after second dose of vaccine given.

Other Meds: Amoxicillin 500mg three times daily Chlorhexadine mouthwash

Current Illness: Had a dental bone graph the day prior to repair

ID: 1025121
Sex: F
Age: 51
State: PA

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/12/2021
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: None

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

Symptoms: 7 PM-feeling cold & body aches. Took Advil PM at 9 PM. At 11:45 PM -6 AM next morning intense shivering (could not get out of bed to check temperature) and dull headache. Fatigue & body aches continue. By 4 PM next day only periodic chills and body aches....much improved. I had called and left message at my MD office yesterday, and nurse from the office called back this morning to say that since my side effects were 'common', they said that the doctor's office would not report the side effects I informed them of.

Other Meds: Amlodipine for blood pressure at 7 AM. Advil PM at 9 PM due to feeling cold and body aches at 7 PM.

Current Illness: None

ID: 1025122
Sex: M
Age: 41
State: MO

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/12/2021
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: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Again fatigue and just feels awful but also leg numbness which is new.

Other Meds: Unknown

Current Illness: Fatigue, fever, for 2-4 days after the first dose of vaccine

ID: 1025123
Sex: F
Age: 75
State: FL

Vax Date: 01/18/2021
Onset Date: 01/19/2021
Rec V Date: 02/12/2021
Hospital: Y

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

Lab Data:

Allergies: Sensitivities to food and medications,: goes into anaphylactic shock Yeast allergy wheat meat quinine mushroom penicillin

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Jan 18 COVID vaccine usf 11:30 am pfizer vaccine first dose, starting feeling bad: headache the next day had class collapsed and stubbed toe, bleeding etc. ambulance came and assessed, PT felt so weak could not stand but was declared ok to drive by emt, got home and collapsed on the floor and crawled around for 6 days, lived on boiled eggs and rice cakes, doctor said call an ambulance, ambulance picked her up and took her to hospital, hospital took care of her for 16 days, got discharged yesterday (2-9-2021)

Other Meds: Armor thyroid 10mg vitamin pill (multivitamin) Alieve every once in a while Probiotic for children

Current Illness:

ID: 1025124
Sex: F
Age: 51
State: PR

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/12/2021
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: aspirin, peniciilin, sulfa, egg, almond,

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

Symptoms: STARTED ON 2/11/2021 WITH HEADACHE ,FEVER ,CHILL,S BODYACHE, HEADACHE, LOSS OF APPETITE, NAUSEA, PAIN AND TIGHTNESS LEFT ARM AND LEFT AXILLA, LEFT CERVICAL PAIN, PHOTOPHOBIA. UNABLE TO GO TO WORK TODAY.

Other Meds: januvia 100mg, lozaartan, hctz, spiriva, allegra, atrovent, xopenex

Current Illness: low back pain

ID: 1025125
Sex: F
Age: 54
State: NY

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/12/2021
Hospital:

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

Lab Data:

Allergies: Cephalosporin, Hydromorphone

Symptom List: Nausea

Symptoms: Patient felt dizzy post vaccine

Other Meds:

Current Illness:

ID: 1025126
Sex: F
Age: 34
State: SC

Vax Date: 01/18/2021
Onset Date: 01/29/2021
Rec V Date: 02/12/2021
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: A week after the shot, starting at the injection site wrapping around inside of my bicep and down towards the elbow a: red; occasionally warm; hyper sensitive; pain with touch mark appeared. It was rectangular in shape approximately 3" x 5 ". It was present for no less than 1 & 1/2 weeks. I do not believe it was anaphylaxis in nature. I did not take anything.

Other Meds: birth control

Current Illness: none

ID: 1025127
Sex: F
Age: 52
State: MS

Vax Date: 01/22/2021
Onset Date: 01/22/2021
Rec V Date: 02/12/2021
Hospital:

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

Lab Data:

Allergies: Sulfa medications Tegaderm tape Albuterol

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

Symptoms: Slight swelling of back of tongue. Enough to repeatedly clear my throat. Felt like I had phlegm stuck in throat and tried to clear it out. Started about 5 minutes after shot and lasted about 30 minutes

Other Meds: Adderall Levothyroxine Liothyrine Wellbutrin Temazepam

Current Illness: None

ID: 1025129
Sex: F
Age: 61
State: IL

Vax Date: 02/10/2021
Onset Date: 02/11/2021
Rec V Date: 02/12/2021
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 up to 102 F, vomiting, headache, myalgias, malaise

Other Meds:

Current Illness:

ID: 1025130
Sex: M
Age: 65
State: VA

Vax Date: 02/06/2021
Onset Date: 02/07/2021
Rec V Date: 02/12/2021
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: Demerol

Symptom List: Tremor

Symptoms: 02/07/2021- AM have abundance of floaters in right eye, not had previously. Later in day had some nausea, headaches and extreme soreness at swelling site but those 3 issues went away after a few hours. That evening I started getting what I will call "Lightening Bolts" flashing along the outer right edge of my right eye when I moved my head side to side. 02/08 & 09/2021- "Lightening Bolts were constant and I went to hospital.

Other Meds: Bisoprolol Fumarate 5mg Viberzi 100mg Levothroxine 125mcg Duloxeting 20mg Chewable Aspirin 81mg Tylenol Arthritis 650mg Allergy 10mg 1 day AM Men's multi vitamin 2 day AM Krill Omega 50+ with CoQ10

Current Illness: None

ID: 1025131
Sex: F
Age: 86
State: PA

Vax Date: 01/29/2021
Onset Date: 02/10/2021
Rec V Date: 02/12/2021
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: sulfa

Symptom List: Erythema, Pruritus

Symptoms: Rash began 12 days after her shot. Mild rash from her shoulder to her elbow. Slight itching. No fever or aches.

Other Meds: Vitamin D3,Losartan 25 mg, Melatonin oral, Metoprolol tartate 25 mg, Multivitamin, Systane Oral, Restasis, Simvastatin 20 mg, baby aspirin

Current Illness: Parkinson's Like disease

ID: 1025132
Sex: M
Age: 52
State: FL

Vax Date: 02/09/2021
Onset Date:
Rec V Date: 02/12/2021
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: dust mites

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

Symptoms: Date and time of vaccination: (list both if they received both shots): 1-12-2021 @ approx 2pm Moderna LOT # 012L20A 2-9-2021 @ approx 2pm Moderna LOT # 029K20A

Other Meds: Vyvanse 60mg Daily amlodipine 5mg Daily chlorthalidone 25mg Daily famotidine 20mg BID vitamin B complex Daily Vit D3 Daily

Current Illness:

ID: 1025133
Sex: F
Age: 36
State: NY

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/12/2021
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: weakness post vaccine

Other Meds:

Current Illness:

ID: 1025134
Sex: F
Age: 41
State: NE

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/12/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Joint pain, muscle aches, fatigue, chills

Other Meds: Tylenol 2 capsules

Current Illness:

ID: 1025135
Sex: F
Age: 46
State: MA

Vax Date: 01/29/2021
Onset Date: 02/06/2021
Rec V Date: 02/12/2021
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: A delayed reaction - large oval rash around injection site appeared more than a week after shot

Other Meds: Probiotics, biotin

Current Illness:

ID: 1025136
Sex: F
Age: 72
State: TX

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/12/2021
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: Fossamax; Codeine

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

Symptoms: Began about 6 pm, all joints aching & burning, hurt to walk on feet, shoulders, elbows, wrists, all joints in hands, couldn't pick up things. Bad headaches, took Tylenol, no effect. My left knee felt like it was broken for about 9 hours. Feet sore to walk until about 6 pm 02/11/2021. Felt better when awoke on 02/12/2021, then severe diarrhea started.

Other Meds: Edarbyclor40-25; Levothyroxin; Atorvastatin;Raloxifene;Potassi

Current Illness: none

ID: 1025138
Sex: F
Age: 32
State: AR

Vax Date: 02/10/2021
Onset Date: 02/11/2021
Rec V Date: 02/12/2021
Hospital:

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

Lab Data:

Allergies: Clindamycin

Symptom List: Pain in extremity

Symptoms: Fever greater than 100.0 Body aches Joint pain Shortness of breath Tenderness/soreness at injection site

Other Meds: Lisinopril Sertraline Diclofenac

Current Illness: None

ID: 1025139
Sex: F
Age: 50
State: OH

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

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

Lab Data:

Allergies: Sulfa drug, environmental and seasonal allergies, bee stings

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

Symptoms: Fatigue, low grade fever and injection site soreness starting day 1 after shot and thru day 3 after shot. Starting day 8 after shot, itching at injection site. Days 9 thru current day 11 post injection there is redness, swelling, warmth, hard welt, itching, tenderness at injection site. Redness and welt are approximately three inches in diameter. Also, between 130-330 am on day 10 post injection was severe nausea and chills. Trying Benadryl and topical creams for the welt and itching. No real relief. Just hoping it subsides soon. Notified family doc of side effects/reactions.

Other Meds: Losartan, Benadryl, melatonin

Current Illness: None other than the blood pressure controlled with losartan.

ID: 1025141
Sex: M
Age: 39
State: IL

Vax Date: 02/10/2021
Onset Date: 02/12/2021
Rec V Date: 02/12/2021
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: Basil

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

Symptoms: Swelling, unable to lift 2 pounds, restrictive movement

Other Meds: St. John wort, ipbrofen

Current Illness: Na

ID: 1025142
Sex: F
Age: 54
State: NY

Vax Date: 02/10/2021
Onset Date: 02/11/2021
Rec V Date: 02/12/2021
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: Headache; Muscle and joint ache; Low grade temp

Other Meds:

Current Illness:

ID: 1025143
Sex: F
Age: 29
State: CT

Vax Date: 02/10/2021
Onset Date: 02/12/2021
Rec V Date: 02/12/2021
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: Woke up around 4am this morning and had vertigo associated with nausea when lying on the left or right side. Ive eaten and drank a glass of water and still have general sense of feeling spacy and slight nausea. BP normal upon checking today.

Other Meds: amethia tablets, vitamin d

Current Illness: none

ID: 1025144
Sex: F
Age: 72
State: FL

Vax Date: 02/02/2021
Onset Date: 02/02/2021
Rec V Date: 02/12/2021
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: flu likesymptoms, body aches, chills , patient is no longer feeling those symptoms but last week started experiencing"insides shaking". Patient voiced still feeling like "insides shaking" Date and time of vaccination: (list both if they received both shots):1/12/21 11:00, 2/2/21, 11:00 Brand and lot of vaccine:1 vaccine Pfizer lot# EL1283, 2nd vaccine: Pfizer lot #EN5318

Other Meds: Lipitor, Singular, Lexapro, Prilosec

Current Illness:

ID: 1025145
Sex: F
Age: 37
State: AL

Vax Date: 01/31/2021
Onset Date: 02/05/2021
Rec V Date: 02/12/2021
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: NKA

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

Symptoms: Rash at injection site that is red, itchy, warm that is worsening as the days progress. It is shaped like a ring. Suspect it is "COVID Arm".

Other Meds: Atenelol Nexium D3 B12 Vitamin C

Current Illness: None.

ID: 1025146
Sex: F
Age: 34
State: NY

Vax Date: 01/27/2021
Onset Date: 01/27/2021
Rec V Date: 02/12/2021
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: n/a

Symptom List: Injection site swelling, Limb discomfort

Symptoms: At approximately 15:00 on day of 2nd Moderna Vaccination Shot (given in LEFT UPPER ARM), I developed posterior mid-thoracic level back pain (atypical for me) which was extremely tender to palpation and 'dull, achy pain' at around the T7-T9 region and mainly located within T7-T8 and T8-T9 intervertebral joint region. At approximately 23:00, the evening of the 2nd Moderna Vaccine Shot (evening of 1/27/21), I developed a fever of 101.0 F. At around 01:00 AM on 1/28/21, my fever spiked to over 102.2 F and I was vigorously shaking with 3 layers of sweatpants, 3 layers of sweatshirts and 3 heavy blankets over me. I also developed RIGHT sided lower 'tooth/jaw' discomfort, as if I had an abscess in my lower posterior teeth on the RIGHT side. The fever broke to around 100.0 F at around 9 AM the morning after my 2nd Moderna Vaccine. But, again, at ~15:00 on day post-2nd shot (1/28/21), I developed a 101.0 F fever and was exhausted. By 9:00 AM on 1/29/21, I felt 100% better and remained asymptomatic. I have never, in my life, experienced anything like what I experienced the night of and the early morning of the day after my 2nd Moderna vaccine. I have been sick before, hospitalized with high fever, and I have never felt the way I felt during the post-vaccine period. I also believe I was somewhat 'delusional' as I remember waking up at around ~3:00 AM on 1/28/21 and I was screaming, for no reason what so ever, which was quite worrisome.

Other Meds: EluRyng (Continuous Contraceptive via Vaginal Ring- for Endometriosis) Adderall (30mg XR BID) Adult Multivitamin Gummies (2 gummies/day)

Current Illness: n/a

ID: 1025147
Sex: M
Age: 69
State:

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 02/12/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: severe nose bleed 30 minutes

Other Meds:

Current Illness:

ID: 1025148
Sex: F
Age: 70
State: AL

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/12/2021
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: Penicillin

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

Symptoms: About 4:30 PM on the 10th started feeling really tired and I went to go lay down. I fell asleep and for about 1-1.5 hour. I woke up and had a bad headache and took two Excedrin. Then I went to lay back down. Then I started having diarrhea, vomiting and chills. This lasted all night Wednesday. Thursday I stayed in bed all day with same symptoms. Today I am not as weak but still not feeling myself. I am also having body weakness.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm