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: 1058586
Sex: F
Age: 60
State: IL

Vax Date: 02/26/2021
Onset Date: 02/26/2021
Rec V Date: 02/26/2021
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: +h/o severe allergies

Symptom List: Dysphagia, Epiglottitis

Symptoms: throat closing, slight facial swelling epipen given. symptoms resolved. pt back to baseline.

Other Meds:

Current Illness:

ID: 1058587
Sex: M
Age: 78
State: KS

Vax Date: 02/19/2021
Onset Date: 02/26/2021
Rec V Date: 02/26/2021
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: fish,

Symptom List: Anxiety, Dyspnoea

Symptoms: pt stated that after he got his covid vax he had no symptoms so had normal activities. Pt woke up feeling bad and was constipated on 2/26/2021. He has 101.6 fever. Pts wife called the PCP but wasnt able to speak to anyone. She asked them to call back but office closed for the day and they did not get a CB. She will try to call back. Pt has taken decalux for the constipation.

Other Meds: vitamin D, atorvastatin 20mg x 2 daily, Trandolapril-Verapamil ER 4-40 mg, ferrous sulfate325mg, multivitamin, aspirin 81 mg, rabeprazole 20mg, hydrochlorothiazide 25mg, carvedilol 12.5 mg x 2 daily, iron,

Current Illness: no

ID: 1058588
Sex: F
Age: 68
State: CA

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 02/26/2021
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: No

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

Symptoms: At 10:15 p.m. I experienced extreme bodily cold that no matter how many blankets I put on, the coldness persisted throughout the night. I was not able to sleep all night. I had a low temperature (100 degrees)

Other Meds: N/A

Current Illness: Thyroid, cholesterol

ID: 1058589
Sex: F
Age: 68
State: FL

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 02/26/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Day 1: Nausea, headache 8 hrs. post injection. Day 2: Headache, fatigue, fever. Temp @ 9:30 am =100.1; Temp @ 4:15 pm=101.6 Ibuprofen 200mg X2 P.O. @4:20 pm Treatment evaluation ongoing

Other Meds: Armour, Progesterone, Bio-identical hormone, Zanax, multi-vitamin, Omega 2

Current Illness: IBS, Asthma, fibromyalgia

ID: 1058590
Sex: M
Age: 62
State: CA

Vax Date: 01/06/2021
Onset Date: 01/08/2021
Rec V Date: 02/26/2021
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: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Patient has had numbness and tingling both arms, weakness of legs and fatigue since 2 days after his Covid Vaccine Jan 6th. Has had 2 syncopal episodes since then. Had a syncopal episode Feb 15 and again 2/26/21

Other Meds: none

Current Illness: NONE

ID: 1058591
Sex: F
Age: 69
State: NJ

Vax Date: 02/12/2021
Onset Date: 02/22/2021
Rec V Date: 02/26/2021
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: Levaquin -

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

Symptoms: 10/11 days after vaccination I developed a red circular spot on my arm where the injection was given. About the size of a lemon. Only symptom was redness. No pain, swelling, heat,or itching. Now day 3, and beginning to fade. Have read about ?COVID vaccine arm?. Wanted to still report my symptoms. Feel fine. Plan to get 2nd shot in opposite arm.

Other Meds: Losartan- Allegra-Singulair-Amlodipine-Crestor- Symbicort

Current Illness: None

ID: 1058592
Sex: F
Age: 59
State: TN

Vax Date: 02/26/2021
Onset Date: 02/26/2021
Rec V Date: 02/26/2021
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: NKDA

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: approximately 1- 1 1/2 hours after receiving vaccine patient reported face feeling hot and noticed hives and rash on body

Other Meds: unknown

Current Illness: unknown

ID: 1058593
Sex: F
Age: 88
State: GA

Vax Date: 02/12/2021
Onset Date: 02/18/2021
Rec V Date: 02/26/2021
Hospital:

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

Lab Data:

Allergies: Allergic to cinnamon

Symptom List: Pharyngeal swelling

Symptoms: 2nd Shot Feb 12. No side effects till 6th day -Feb 18 lower back pain. Feb19 extreme cramping in upper right thigh and right calf by shinbone. Feb20 same cramping as above described plus pain had moved to outer right hip muscles. Pain improving Very slowly till feb 26 one week later. still have pain in hip muscles on right back outer area.

Other Meds: Levothyroxin 50 mg, vitamin D 1400 units, Vitamin C 500 mg, one Advil 200mg, B complex

Current Illness: Healthy

ID: 1058594
Sex: M
Age: 71
State: NY

Vax Date: 01/04/2021
Onset Date: 01/08/2021
Rec V Date: 02/26/2021
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: Allergic to Tree Nuts, Peanuts, Fentanyl, Dilaudid, Oxycodone, Hydrocodone, Johnson and Johnson Adhesive Tape,

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Total Kidney failure, Sepsis

Other Meds: Morphine, Singular, Mobic, Zyrtec, Paxil, Lisinopril, Mucinex, Vitamin C, Vitamin D, Multivitamin, Aspirin 81mg, Vistaril, Colace, Simvastatin, Krill Oil, and Flonase.

Current Illness: None

ID: 1058595
Sex: F
Age: 28
State: MA

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 02/26/2021
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: Latex, dust mites, cats, gluten, dairy, Diflucan,.

Symptom List: Diarrhoea, Nasal congestion

Symptoms: 3-5 minutes after receiving the vaccine, I felt a sense of panic and a tingling on my lips, that then spread to my mouth, throat, and tongue. I asked the nurse if my lips were swollen, and she said no. A few minutes later my heart rate increased and I felt really lightheaded. After 7-10 minutes I felt my tongue tingling and it had become swollen. I told the nurse that I think my tongue was swollen and she said it looked okay. I had a hard time talking because I wasn't used to be tongue being so large. The nurses stayed and talked to me for the rest of the 30 minute waiting period. I was able to talk and breath while making a conscious effort. I wasn't sure whether the high heart rate and lightheadedness were associated with my condition, Postural Orthostatic Tachycardia Syndrome. I kept checking my tongue to see how swollen it was. After the 30 minutes, the nurses had me stand up to see if I could. Once I could, they said I was all set to go. They did not get an Epi-pen for the swollen tongue or give me instructions on how to treat it. They were insensitive and dismissive of my symptoms. they kept repeating "I think your just nervous." Once I got home, I still had the swollen tongue and tingling, but was able to go up and down stairs and go about my day. It was a little difficult to swallow one of my pills when I got home, but I was able to. I checked my blood pressure around 4:30 p.m. and it was 121/84 and my pulse was 79 bpm sitting. I did not take anything to treat my swollen tongue. The swollen tongue and tingling feeling in my throat continued for another 2.5 hours, until 6:00 p.m. Once the swelling was down, my tongue felt like I burnt it on a hot beverage, almost a numb feeling. I also experienced more common side effects such as body aches, fatigue, and feeling feverish. After this episode I had extremely high anxiety where it was difficult for me to sleep the following night. I called a 24/7 nurse line and she said to talk to my doctor. I had less than 4 hours sleep the night after I had my vaccine. I called my doctor's office this morning and I spoke to a nurse who worked as a nurse on the COVID Vaccine hotline. She relayed the message to the doctor who was covering for my doctor while she's on medical leave. I received a call around 9:30 a.m. saying that the doctor on leave recommend I should talk to my PCP but that she thought I had an allergic reaction to the Pfizer vaccine and that I should not get the second dose. She said they were not sure how I would react with the second dose, and they're afraid that my allergic response might be more severe and life threatening. I hope this report helps other people who experience these symptoms.

Other Meds: Bupropion XCL 150 mg, Pepcid AC (OTC), Sumatriptan 10 days prior, Ativan (as needed), Traditional Chinese Herbal Medicine (daily): Radix Bupleuri, Rhizoma PInelliae, Radix Scutellariae, Rx/Rz Ginseng, Ramulus Cinnamomi, Radix Paeoniae Alb

Current Illness: Acid Reflux, yeast infection.

ID: 1058596
Sex: F
Age: 13
State: NV

Vax Date: 02/26/2021
Onset Date: 02/26/2021
Rec V Date: 02/26/2021
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: Vaccination site erythema, Vaccination site pruritus, Vaccination site swelling

Symptoms: Administered the Moderna COVID vaccine to a 13 year old patient where the vaccine is approved for 18 and older.

Other Meds: Adderal XR 30mg , Clonidine 0.2mg, Albuterol inhaler, Flonase nasal spray

Current Illness:

ID: 1058597
Sex: F
Age: 35
State: CA

Vax Date: 02/20/2021
Onset Date: 02/21/2021
Rec V Date: 02/26/2021
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: None

Symptom List: Rash, Urticaria

Symptoms: Started with pain in my arms then led to chest pains on the upper left region of my chest. Pain was extensive for about 48hours and still persist but only mildly.

Other Meds: None

Current Illness: None

ID: 1058598
Sex: F
Age: 77
State: NY

Vax Date: 02/25/2021
Onset Date: 02/26/2021
Rec V Date: 02/26/2021
Hospital:

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

Lab Data:

Allergies: no

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

Symptoms: High fever 101.7 Chills Muscle pain at injection site Fatigue

Other Meds: Plendil 10mg Atorvastatin Clopidogrel Meterpolol ( 2)Aspirin 81mg Calcium OTC Vitamin D OTC Mulltivitamins OTC

Current Illness:

ID: 1058599
Sex: F
Age: 71
State: CA

Vax Date: 02/12/2021
Onset Date: 02/19/2021
Rec V Date: 02/26/2021
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: sulfur in antibiotics msg

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

Symptoms: Rash on left arm where vaccine was administered

Other Meds: tamoxifen Caltrate (calcium w 600 D)

Current Illness: breast cancer in February 2020( radiation therapy)

ID: 1058600
Sex: F
Age: 87
State: ME

Vax Date: 02/26/2021
Onset Date: 02/26/2021
Rec V Date: 02/26/2021
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: Reports previous experience to hives in ears from fried clams, reports had lasagna at local restaurant

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

Symptoms: Spoke to who reports that she got her second covid vaccine this afternoon, reports she also had lasagna which she always gets when she is there, reports however, shortly after these events she has broke in hives. Reports hives though are located to her ears only, and ears are itchy. States took her allergra and by the time she got home to call to report this they have subsided almost completely and apologizes for calling, she was just not sure if she should have these symptoms reported as she read and was told to report any "reactions" to the covid vaccine. States did not experience the hives with her first dose and she reports the hives in her ears have occurred previously when she had fried clams. Denies fever, cough, shortness of breath, respiratory distress/concerns, nausea/vomiting/diarrhea, chest pain, hives elsewhere*

Other Meds: postassium chloride 10meQ, rosuvastatin calcium 40mg, amlodopine 5mg, prevagen 10mg, sertraline 100mg, eloquis 5mg, furosemide 20mg, losartan 100mg, nitrogycerin 0.4mg sublingual PRN, multi0vitamins, fexofenadine hcl 60mg

Current Illness: none reported

ID: 1058601
Sex: M
Age: 68
State: WA

Vax Date: 12/26/2020
Onset Date: 12/26/2020
Rec V Date: 02/26/2021
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: Penicillin's

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

Symptoms: Pt received his first dose of the Moderna Covid-19 vaccine 12/26/2020. That day he noticed a rash forming around the injection site. He was seen urgently in Dermatology 1/14/2021 stating that a week after his injection he noted more rash on the scalp, trunk, arms and buttock areas. He started treatment with oral antihistamines. Biopsies confirmed eczematous dermatitis. He was treated with topical and oral steroids. His second dose of the Moderna Covid-19 vaccine was 1/23/2021. He noted more flaring of the eczema after the second dose, but less severe.

Other Meds: Omeprazole 20 MG delayed release capsule, Sildenafil Citrate 100 MG tablet, pantoprazole 40 MG delayed release tablet, MetFORMIN 500 MG tablet, Rosuvastatin Calcium 10 MG tablet, Ibuprofen (IBU-200 PO), Semaglutide (OZEMPIC) 0.25 or 0.5 MG/

Current Illness: None

ID: 1058602
Sex: F
Age: 35
State: KS

Vax Date: 02/24/2021
Onset Date: 02/24/2021
Rec V Date: 02/26/2021
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:

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

Symptoms: Progress Notes PRN (Nurse Practitioner) Family Medicine Pt called for follow up s/p covid-19 vaccine done on 02/24/21. She reports doing well just feeling a little tired. She had a few periods of dizziness/lightheadedness yesterday but nothing that lasted long or caused syncope. She feels better today other than the slight tiredness. She is appreciative of the phone call. Denies any other questions or concerns. PRN Progress Notes APRN (Nurse Practitioner) Family Medicine Cosign Needed Expand AllCollapse All COVID VACCINE CLINIC 2/24/2021 Patient DOB: 3/3/1985 Date: 2/24/2021 Subjective Pt is a 35 y.o. female who was seen at SVH COVID Vaccine Clinic today for her first dose of the COVID 19 vaccination. She was given the Pfizer vaccination in the left deltoid muscle. During her 30 minute waiting period after the injection, the patient began to experience lightheadedness and dizziness. She denied rash, hives, welts, difficulty breathing, difficulty swallowing, wheezing, throat tightness, hoarseness, stridor, itching, facial swelling, lip swelling and tongue swelling. This provider was notified of patient reaction and she was then assessed in the emergency bay area. Monitored patient for severe reaction symptoms, including but not limited to blood pressure abnormality , hypotension, rapid progression of symptoms and respiratory distress. PMH of vagal symptoms. Not on any medications. ALLERGY REVIEW OF SYSTEMS: Patient complains of dizziness Patient denies chills, fever, malaise/fatigue, facial swelling, itching in ears, sore throat, frequent throat clearing, eyes watering, eyes itching, puffy eyes, eye redness, cough, chest tightness, shortness of breath, wheezing, rash, hives, eczema, itching of skin, vomiting, abdominal pain, muscle aches and headaches Previous Reactions: vagal. Allergies to morphine and paxil--breaks out in rash Pt ate this am around 6 am. She usually eats around 11 am. Objective Vitals Vitals: 02/24/21 1058 02/24/21 1114 BP: (!) 134/96 119/74 Pulse: 78 74 SpO2: 100% 100% Physical Exam Constitutional: General: She is not in acute distress. Appearance: Normal appearance. She is well-developed. She is not ill-appearing, toxic-appearing or diaphoretic. HENT: Mouth/Throat: Mouth: Mucous membranes are moist. Pharynx: Oropharynx is clear. Eyes: Conjunctiva/sclera: Conjunctivae normal. Pupils: Pupils are equal, round, and reactive to light. Neck: Thyroid: No thyromegaly. Cardiovascular: Rate and Rhythm: Normal rate and regular rhythm. Heart sounds: Normal heart sounds. Pulmonary: Effort: Pulmonary effort is normal. No respiratory distress. Breath sounds: Normal breath sounds. No wheezing. Musculoskeletal: Cervical back: Neck supple. Skin: General: Skin is warm and dry. Neurological: General: No focal deficit present. Mental Status: She is alert and oriented to person, place, and time. Psychiatric: Mood and Affect: Mood normal. Behavior: Behavior normal. Thought Content: Thought content normal. Judgment: Judgment normal. Assessment/Plan Treatment included: water and snacks Follow up response to treatment: excellent. Patient discharge: Stable to go home and follow up with PCP. Differential Diagnosis: Vaccine-Related Anxiety (include misc mental health) and Systemic reaction (hypoglycemia, hypotension, generalized rash) RN Electronically Signed 2/24/2021 1:06 PM

Other Meds:

Current Illness:

ID: 1058604
Sex: M
Age: 80
State: TX

Vax Date: 02/01/2021
Onset Date: 02/04/2021
Rec V Date: 02/26/2021
Hospital: Y

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

Lab Data:

Allergies: NKA

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient was found on bathroom floor by spouse @ approximately 02:30 am (2.5 days after receiving 2nd dose of Covid-19 vaccine). He had fallen and had an obvious head injury & demonstrated altered mentation from usual baseline. Family utilized 911 to transport him to local ED. He was febrile upon arrival to ED and admitted for severe sepsis with unknown etiology. He was found to have positive SIRS criteria and elevated LA. He was admitted to hospital and received IV antibiotics for 11 days (spent 7 days as an inpatient and completed remaining infusions in home environment)

Other Meds: donepezil, b12, duloxetine, tramadol, multivitamin

Current Illness: none

ID: 1058605
Sex: F
Age: 69
State: TN

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 02/26/2021
Hospital:

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

Lab Data:

Allergies: No Know Drug Allergies

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Pt alert and coherent. Anxiety reaction, resulted in asthma attack, slight wheezing Described that she felt like she got anxious and started having an asthma attack. Patient treatment: 2:35pm BP: 140/92, Pulse OX 100%, 92 pulse, treatment given Albuterol HFA 90mg, pt. own Famotidine 10 mg, lowered BP pulse improved 2:40 pm BP: 136/86, 72 pulse -Treatment given: Benadryl 25 mg - as prophylaxes, pt. monitored for 1 hr. after no symptoms, then went home with instructions to call 911 if anything else occurred 5:00 pm follow up, patient at home, no symptoms Pt primary prescriber contacted with hour of monitoring, and agree patient could be released home.

Other Meds: Albuterol HFA Benadryl 25mg Famotidine 10 mg

Current Illness: None

ID: 1058606
Sex: F
Age: 80
State: GA

Vax Date: 02/12/2021
Onset Date: 02/18/2021
Rec V Date: 02/26/2021
Hospital:

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

Lab Data:

Allergies: No known allergies

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

Symptoms: Large red rash with itching . Began below injection site, moved above injection site and after 6 days, moved below injection site At largest 6 x 4 inches, Applialsoed hydrocortisone cream twice a day. Tender to touch

Other Meds: Aldactone, Synthroid, KCL, Bisoprolol, Clopidogrel, Furosemide, Baby Aspirin, Singulair,, Pepcid, Centrum multi-vitamin, Gabapentin, metformin

Current Illness: none

ID: 1058607
Sex: F
Age: 32
State: TX

Vax Date: 01/26/2021
Onset Date: 01/28/2021
Rec V Date: 02/26/2021
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

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

Symptoms: i had menstrual spotting for four hours in the middle of my cycle. spotting was at day 15 of my cycle

Other Meds: Trintellix

Current Illness: none

ID: 1058608
Sex: F
Age: 42
State: NM

Vax Date: 02/10/2021
Onset Date: 02/10/2021
Rec V Date: 02/26/2021
Hospital:

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

Lab Data:

Allergies: Unknown

Symptom List: Unevaluable event

Symptoms: 13:10-Patient on gurney in observation after vaccine for hx of nausea/lightheadedness with 1st dose of vaccine x 1.5 days. PMHx: HTN, Gastroparesis, IBS Meds: Flagyl, Glyburide VS: B/P-148/110, RR 16, SaO2: 96% on RA, CBG: 133 1327 repeat VS: B/P-138/104, RR 16, HR 90, SaO2: 98% on RA Cool cloths to neck and forehead with HOB flat. Slight improvement. Daughter accompanied patient today is able to drive her home. 1415: patient released by Provider on duty and EMS. Patient educated to follow up if her symptoms should worsen. Patient communicated understanding at time of discharge home with daughter.

Other Meds: Flagyl, Glyburide

Current Illness: Unknown

ID: 1058609
Sex: F
Age: 57
State: GA

Vax Date: 02/24/2021
Onset Date: 02/25/2021
Rec V Date: 02/26/2021
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: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: Chills, fever, headache, malaise, fatigue. Stayed in bed most of day after shot. Awoken at night by chills. *NOTE: This is nearly everyone's experience I've spoken with but they are never going to take the time to fill out this form. There needs to be active interviewing post-vaccine going on. I know of someone who had a ministroke after their vaccine and others who became very ill. None of them are reporting, because they don't know how, and it's a difficult reporting system. *

Other Meds: topical steroid, multivitamin, minoxidil

Current Illness: none

ID: 1058610
Sex: M
Age: 64
State: TX

Vax Date: 01/29/2021
Onset Date: 02/09/2021
Rec V Date: 02/26/2021
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: None

Symptom List: Injection site pain, Pain

Symptoms: Right side Lips, face became numb. Right eye drooped, along with corner of mouth right side Right side of tongue became numb, swelling of right jaw lymph node, ear ache, dry mouth.

Other Meds: HydroCHLOROthiaz TAB 25MG LISINOPRIL TAB 40MG ATORVASTATIN 40MG DilTIAZem CD CAP 480MG/24HR

Current Illness: None

ID: 1058611
Sex: F
Age: 53
State: AZ

Vax Date: 02/25/2021
Onset Date: 02/26/2021
Rec V Date: 02/26/2021
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: Injection site pain, Menorrhagia

Symptoms: Arm went numb within first hour after dose, continued up through neck. Next morning I felt flu-like symptoms, Achy muscles and joints, fever that varies between 100? and 101.6?, bad headache, severe fatigue.

Other Meds: None

Current Illness: I had a bad case of Covid 2 months earlier. Not hospitalized, but very sick for 14 days, so possible that I still have a lot of antibodies.

ID: 1058612
Sex: F
Age: 42
State: CA

Vax Date: 01/27/2021
Onset Date: 01/28/2021
Rec V Date: 02/26/2021
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: No

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

Symptoms: On 1/28/2021 in the morning I was feeling chills, body aches, muscle aches & no fever. Then around 11pm I had the non stressing appointment with my OBGYN the baby heart rate was around 170s 180s & usually it was always at the 140s it was not reactive it was just high, My doctor sent me to the hospital for observation I was there for 6-7hrs & then I was released. The baby heart rate came back down.

Other Meds: Asprin Symbicort Insulin

Current Illness: No

ID: 1058613
Sex: F
Age: 51
State: AZ

Vax Date: 02/24/2021
Onset Date: 02/25/2021
Rec V Date: 02/26/2021
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: I had the usual flu-like symptoms starting around 9 pm the day of the vaccination 24th) - headache, chills, lethargy, loss of appetite, injection site pain. I didn't notice anything else overnight, exception injection site pain increased. The next morning I got up around 6:45 am to feed my pets. I felt woozy walking about 25 m from the bedroom to the pet food location, and also very flushed and hot. I started sweating copiously while I was getting the food out, and then I fainted. I don't know how long I was unconscious but I suspect not more than a minute or two. I didn't seem to injure myself when I fell, other than a bruised elbow and hip I was able to finish feeding the pets, crawl to the bathroom (I had a strong accompanying urge to evacuate my bowels), and then get into bed. I went back to sleep at around 7:15 am and by 10:00 am I felt more normal, still with some chills and headache, general lethargy, and not much appetite. Those symptoms lasted through the evening until I went to bed at 9:00 pm, gradually decreasing. Today I feel mostly fine, although dehydrated. I did not record my temperature during the fever spike, nor receive medical attention.

Other Meds: Celebrex 200 mg

Current Illness: None

ID: 1058614
Sex: F
Age: 77
State: CA

Vax Date: 02/17/2021
Onset Date: 02/24/2021
Rec V Date: 02/26/2021
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: Rash

Other Meds: Lisinopril, famitidine, vitamin D, zinc, magnesium, potassium.

Current Illness: None

ID: 1058615
Sex: F
Age: 70
State: TX

Vax Date: 01/29/2021
Onset Date: 02/20/2021
Rec V Date: 02/26/2021
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: No

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

Symptoms: I received my 1st dose January 29,2021, Approximately February 20, 4:00 PM I started to notice a b!otchy rash. On my lower thigh front of legs Above and below my knees and on my elbows above and below and below both elbows. To very large blotches on each elbow, and Several Medium On my legs, Totally about 14.

Other Meds: None

Current Illness: No

ID: 1058616
Sex: F
Age: 71
State: VA

Vax Date: 02/24/2021
Onset Date: 02/24/2021
Rec V Date: 02/26/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Nausea

Symptoms: Client received first dose on 2/8/2021 and second dose on 2/24/2021. Second dose was administered out ide of recommended vaccination time.

Other Meds: N/A

Current Illness: N/A

ID: 1058617
Sex: M
Age: 48
State: FL

Vax Date: 02/19/2021
Onset Date: 02/19/2021
Rec V Date: 02/26/2021
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: It's been a week since the 2d dose. Last week, I had site soreness, swelling, and light rash. I also had headache (similar to sinus infection pain) and 100F for about 24 hours. All symptoms subsided within 72 hours.

Other Meds: Flonase Flovent Claritin

Current Illness: None

ID: 1058618
Sex: M
Age: 85
State: HI

Vax Date: 02/19/2021
Onset Date: 02/21/2021
Rec V Date: 02/26/2021
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

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

Symptoms: Papular erythematous rash on left forearm with clear discharge. Rash is itchy. Started applying bacitracin, reports decreasing itchiness after 4 days of treatment, started on 02.22.21. Started on clindamycin, mupirocin ointment today for secondary bacterial infection on 02/26/21.

Other Meds: Simvastatin

Current Illness: None

ID: 1058619
Sex: F
Age: 76
State: CO

Vax Date: 01/29/2021
Onset Date: 01/30/2021
Rec V Date: 02/26/2021
Hospital: Y

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

Lab Data:

Allergies: raspberries, strawberries

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

Symptoms: Pt received dose #2 Pfizer COVID vaccine 1/29/21 @ MAC vaccine clinic. Reported flu like symptoms over the next two days (fatigue, nausea, anorexia). 2/2/21 awoke with abdominal pain and distension. Presented to MHN ED 2/2/21 @ 1100 for workup and initially declined admission and went home. Was called and asked to return for admission and further workup, admitted to MHN 2/2/21 @ 1750. Fever, myalgias, headache. CT abd/pelvis "There is mild diffuse mesenteric edema surrounding the abdominal aorta and proximal branches. Additionally, there is mild bowel wall thickening involving the stomach without discrete mass. This is nonspecific and may represent infectious versus inflammatory changes." Per provider note "flu-like sx over the weekend that easily coincide with the timing of the COVID Pfizer vaccine. In addition, I wonder if her CT scan findings might also be related to the vaccine." Discharged home the next day.

Other Meds:

Current Illness:

ID: 1058620
Sex: F
Age: 64
State: VA

Vax Date: 02/11/2021
Onset Date: 02/11/2021
Rec V Date: 02/26/2021
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: Iodine, penicillin, latex

Symptom List: Tremor

Symptoms: Patient mentioned general itching (not localized); said it wasn't bad but she was still itching today and believes the event is related to the vaccine. She said she reported the information to an agency and said they are checking on her periodically. She said she has tried Claritin and it hasn't helped much. We recommended Benadryl or Hydrocortisone cream and let her know that she may have an allergy to an ingredient of the vaccine and since the reaction was not severe it should not affect her second dose. She will let us or her primary care doctor know how the Benadryl works for her or if she needs further treatment.

Other Meds:

Current Illness:

ID: 1058621
Sex: F
Age: 44
State: WA

Vax Date: 01/27/2021
Onset Date: 01/28/2021
Rec V Date: 02/26/2021
Hospital: Y

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

Lab Data:

Allergies: Penicillin, Amoxicillin, Sumatriptan, Butabarbital, Chlorine, Bleach

Symptom List: Erythema, Pruritus

Symptoms: The day of vaccine, I felt a little tired. The next morning, I ended up have a lethargy reaction (9:00 am) - it was like I was a robot and I hd powered down. I couldn't sleep but I was sitting up and thought I was sleeping. I couldn't really talk. My co-workers were very concerned. Lasted a couple hours and I went home and I went to sleep and slept about 16 hours . I called off work the third day - I had slept so much after that night before I had a (first) gall bladder attack (in the middle of that 16 hours) it was very bad (the gall bladder attack). I had gall bladder attacks occur for the next few days. I ended up getting my gall bladder out last Friday - about a week ago. It was inflamed and full of pus. It was an emergent situation and I was hospitalized 18th and surgery on the February 19th. Lethargy eventually subsided (lasted a handful of hours) and was then fatigued with no energy for about a week .

Other Meds: Daily: 1500mg Gabapentine, 450mg Buproprion, 200mcg Levothyroxine, 6000iu Vitamin D3, 1950mg Calcium Citrate, 50mg Nortriptyline, 2.5mg Eliquis, Fluticasone spray, 10mg THC

Current Illness: Experienced adverse symptoms dose 1 of Moderna vaccine -December 29- January 15th, 2021

ID: 1058622
Sex: F
Age: 59
State: AZ

Vax Date: 02/26/2021
Onset Date: 02/26/2021
Rec V Date: 02/26/2021
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: Lisinopril

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

Symptoms: immediately after the MA gave injection a rash occurred B/L arms, edematous orbital rash appeared, B/L face swelling, followed by rash on back of neck

Other Meds:

Current Illness:

ID: 1058623
Sex: F
Age: 35
State: NJ

Vax Date: 02/25/2021
Onset Date: 02/26/2021
Rec V Date: 02/26/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Fever (102.8), headache

Other Meds: None

Current Illness: Head cold 2 weeks ago

ID: 1058624
Sex: F
Age: 70
State: DC

Vax Date: 02/15/2021
Onset Date: 02/26/2021
Rec V Date: 02/26/2021
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: Codean

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: On February 23 at 5am I was waken to a ich on my right shoulder and I scratched it , and looked in the mirror at my right shoulder and it was red and swollen with a itch around the injection area with some pain, as i try to continue sleeping until about 8Pm .

Other Meds: None

Current Illness: I BS Blocked sinus infection

ID: 1058625
Sex: F
Age: 75
State: NY

Vax Date: 02/25/2021
Onset Date: 02/26/2021
Rec V Date: 02/26/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Head ache, 102 fever

Other Meds: Glucosamine & Chondroitin, CoQ10, Calcium, Hair, Skin & Nails Gummies, low-dose aspirin, Vitamin D

Current Illness: None

ID: 1058626
Sex: F
Age: 62
State: AL

Vax Date: 02/18/2021
Onset Date: 02/19/2021
Rec V Date: 02/26/2021
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: None

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

Symptoms: Sore arm for 8 days, headache and sore throat for 6 days, intermittent fever for 6 days, sometimes in excess of 100 degrees. Temperature for last 3 days has been normal in the mornings but patient runs low grade fever on a daily basis beginning early, to mid afternoon.

Other Meds: Vitamin C, Zinc, Vitamin D3, Iron, B12, Omeprezole

Current Illness: None

ID: 1058628
Sex: M
Age: 54
State: KS

Vax Date: 02/22/2021
Onset Date: 02/22/2021
Rec V Date: 02/26/2021
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: Pollen

Symptom List: Pain in extremity

Symptoms: Patient received 2nd dose of Moderna Covid Vaccine at 1pm. At 2:30pm he started to develop chest pain and left side neck and arm pain. He was admitted to the hospital for further work-up. While in the hospital the patient had relief only from sitting up and forward. The doctor decided to transfer the patient to another facility that had specialist. At the next hospital it was determined that the patient had Viral Pericarditis, associated with the Covid Vaccine.

Other Meds: Uroxatral 10mg daily Zyrtec 10mg daily

Current Illness:

ID: 1058629
Sex: F
Age: 82
State: OH

Vax Date: 02/20/2021
Onset Date: 02/21/2021
Rec V Date: 02/26/2021
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: patient called pharmacy on 2/26/2021 to report that on 2/21/2021 arm became "really sore, red, swollen, itchy and warm to the touch" and she had a fever and chills; patient states she took Tylenol for the fever and applied Benadryl gel for the itching; patient states color is back to normal today (redness lasted until 2/25/2021), slight itch (1 on scale of 1 to 10) remains today

Other Meds:

Current Illness:

ID: 1058630
Sex: M
Age: 62
State: WA

Vax Date: 01/21/2021
Onset Date: 02/04/2021
Rec V Date: 02/26/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: PATIENT STATES THAT HE WOKE UP ON THE MORNING OF FEB. WITH HIS EYE SWOLLEN SHUT. HE WENT INTO SEE

Other Meds: DOXYCYCLIN, DUTASTERIDE, TAMSULOSIN

Current Illness:

ID: 1058631
Sex: F
Age: 66
State: CA

Vax Date: 02/17/2021
Onset Date: 02/26/2021
Rec V Date: 02/26/2021
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: Penicillin Have had anaphylaxis several times in my life, though not for at least 4 decades: white fish, raw sage (the herb seasoning) hot dogs (possibly from nitrates?)

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

Symptoms: No adverse events until today 2/26/21 (10 days after injection.) Hot red rash 2" x 2.5", slightly swollen, and itchy; discovered about an hour after waking at 9:45 a.m.

Other Meds: No RX Vitamins: C, B Complex, D3, B-12, Omega-3

Current Illness: None

ID: 1058632
Sex: M
Age: 75
State: AZ

Vax Date: 02/25/2021
Onset Date: 02/26/2021
Rec V Date: 02/26/2021
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: Relatively severe body aches & chills, but body temperature is averaging 95F. Feels like getting a bad dose of the flue. No runny nose, no unusual body functions other than the body feels very nervous and shaky.

Other Meds: Metoprolol Tartrate 25MG /day, Atorvastatin Calcium 40MG/day, Baby Aspirin 81MG/Day, Vitamin B-12 2500Mcg/Day, Centrum Multi vitamin/Day, Vitamin D3 125Mcg/Day.

Current Illness: No other illnesses suspected at time of vaccination. All appeared normal at that time.

ID: 1058633
Sex: F
Age: 46
State: KY

Vax Date: 02/26/2021
Onset Date: 02/26/2021
Rec V Date: 02/26/2021
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: none

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: PT HAD NO CONTRAINDICATIONS NOTED. PT TOLERATED DOSE #1 ON 1/29/2021 WELL, WITHOUT ANY COMPLICATIONS NOTED. PT BEGAN TO FEEL FLUSHED AND HOT BETWEEN 3 TO 5 MINUTES POST VACCINE. PT WAS TAKEN OUTSIDE TO GET SOME FRESH AIR. PT DENIED SHORTNESS OF AIR/ DIFFICULTY BREATHING. A RED RASH WAS NOTED TO PT'S LUQ OF THE ARM. PT TOOK 20 MLS OF BENADRYL HCL PO. PT'S DOING VITALS WNL. PT REFUSES MEDICAL ATTENTION FROM EMS.

Other Meds: None

Current Illness: none

ID: 1058634
Sex: F
Age: 66
State: NJ

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 02/26/2021
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: Colchicine

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

Symptoms: For 24 hours Shivering Chills Trouble breathing Fever Headache Weakness Fatigue After 24 hours Weakness and fatigue

Other Meds: Pantoprazole 40 mg/Protonix simvastatin 40 mg/Zocor Levothyroxine 75 MCG/Monograph Sertraline HCL 50 mg/Zoloft Enalapril maleate 10 mg/Vasotec Cranberry capsules with vitamin C 500 mg Vitamin D 50 MCG?s Fish oil 2000 mg

Current Illness: N/A

ID: 1058635
Sex: F
Age: 20
State: AR

Vax Date: 02/23/2021
Onset Date: 02/23/2021
Rec V Date: 02/26/2021
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: NKA

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Vaccine was given at 8am. She started running fever at 3;30pm that day. She took Tylenol and Ibuprofen for the fever. She felt bad and at 10:30pm it felt like she someone sitting on her chest and she had SOB. She went to ER- She said that they told her her throat was closing and -They started an IV She said that she was given Prednisone, Benadryl and a breathing treatment in the ER. She was sent home from ER and has had no further issues.

Other Meds: Slynd

Current Illness: none

ID: 1058636
Sex: M
Age: 51
State: OR

Vax Date: 02/19/2021
Onset Date: 02/19/2021
Rec V Date: 02/26/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: Dose preparation error; the 0.5 mL dose given to this patient was drawn from the residual amount left in two used vials. At the time of error detection, no sign/symptoms of injection site reaction or infection have been reported by the patient.

Other Meds: Amlodipine-benazepril 10-20 mg PO QDay Atenolol 100 mg PO QDay

Current Illness: HTN BPH

ID: 1058637
Sex: F
Age: 30
State: MN

Vax Date: 02/18/2021
Onset Date: 02/19/2021
Rec V Date: 02/26/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Shortness of breath, low tolerance for physical activity (winded walking up & down stairs or talking for periods of time) fatigue has improved, nausea is improving but worsens with exertion. Reaction to first dose was similar, took about a month to feel completely better. First dose lot #032H20A Left arm, IM, 1/21/21.

Other Meds: Wellbutrin; Prozac

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm