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: 1070515
Sex: M
Age:
State: MO

Vax Date: 01/30/2021
Onset Date: 01/01/2021
Rec V Date: 03/03/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: his INR measured 2.1 which has been lower than it has been in 5 years; his arm hurt a little bit; This is a spontaneous report from a contactable consumer (patient). A 74-year-old male patient received the first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number: EL9264, expiry date: 31May2021), via an unspecified route of administration (at the age of 74-years-old) on 30Jan2021 09:30 at a single dose in right upper arm for COVID-19 immunization. Medical history included Mechanical heart valve from Feb2000 and ongoing, Parkinson's disease, heart rate abnormal, blood pressure abnormal, penicillin and sulfonamide allergy, cholesterol, and rashes. Concomitant medication included warfarin from 2000 and ongoing for Mechanical heart valve and blood thinner for mechanical heart valve, carbidopa, levodopa (CARBIDOPA/LEVODOPA) for Parkinson's disease, carvedilol for Heart rate, hydrochlorothiazide for blood pressure (unknown, thinks it is blood pressure), simvastatin for Blood pressure or cholesterol, not sure which, lisinopril for Blood pressure, pramipexole for Parkinson's disease, macrogol 3350 (MIRALAX) as Laxative, docusate sodium (COLACE) as Stool softener. The patient previously took BACTRIM and experienced allergies. The patient experienced his arm hurt a little bit on Jan2021 with outcome of unknown and his INR measured 2.1 which has been lower than it has been in 5 years on 01Feb2021 with outcome of unknown. The patient and his wife received the 1st dose of the vaccine this past Saturday, 30Jan2021 and is scheduled to take the 2nd dose on 20Feb2021. He mentioned that his arm hurt a little bit, but other than that he was fine. He has been taking warfarin for 20 years and has been Home Monitoring his INR for 5 years. This morning his INR measured 2.1 which has been lower than it has been in 5 years. His usual range is 2.5 - 3.0 and he is worried that the lower INR might risk him for clotting diseases and a stroke. He is asking if there is an interaction with warfarin and the vaccine and will it be safe for him to take the 2nd dose. He has a mechanical heart valve placed year 2000 that he takes Warfarin sodium daily for as a blood thinner. He reported that today: 01Feb2021 at 09:05 his INR level is lower than he has ever recorded in last 5 years: 2.1. He asked if the Pfizer COVID-19 Vaccine can affect the Warfarin sodium or affect blood thinning. Adverse events did not require a visit to Emergency Room or Physician Office. No hospitalization. No prior Vaccinations (within 4 weeks). No adverse event following prior vaccinations. Years ago, he recovered completely from all medication reactions. Further described as he thinks all the reactions were rashes. Medications he had reactions to include Penicillin, Bactrim and Sulfa drugs.

Other Meds: WARFARIN; CARBIDOPA/LEVODOPA; CARVEDILOL; HYDROCHLOROTHIAZIDE; SIMVASTATIN; LISINOPRIL; PRAMIPEXOLE; MIRALAX; COLACE

Current Illness: Heart valve replacement

ID: 1070516
Sex: F
Age:
State:

Vax Date: 01/27/2021
Onset Date:
Rec V Date: 03/03/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: she experienced rapid heartbeat/ her heart rate kept fluctuating from her natural 50-60bpm to 135 and 110 bpm; This is a spontaneous report from a contactable consumer (patient). A female patient of an unspecified age received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE; lot/batch number and expiry date unknown), via an unspecified route of administration on 27Jan2021 at single dose for COVID-19 immunization. The patient's medical history and concomitant medications were not reported. Patient experienced rapid heartbeat and went to the ER as directed by the Fact Sheet for Recipients. She said that she had these tests: EKG, X-ray, and some blood test on an unspecified date with unknown results. She mentioned that her heart rate kept fluctuating from her natural 50-60bpm to 135 and 110 bpm. She wanted to know if she should take the second dose considering this adverse event. The outcome of the event was unknown Information on the lot/batch number has been requested.

Other Meds:

Current Illness:

ID: 1070517
Sex: F
Age:
State:

Vax Date: 01/11/2021
Onset Date: 01/18/2021
Rec V Date: 03/03/2021
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: Had symptoms of COVID/COVID infection; This is a spontaneous report from a contactable pharmacist (patient). A 42-year-old female patient received her first dose of bnt162b2 (BNT162B2) at unknown vaccination age via an unspecified route of administration on 11Jan2021 at SINGLE DOSE for covid-19 immunization. The patient's medical history and concomitant medications were not reported. The patient inquired if she can get the second dose if she got COVID19 after first dose. The pharmacist reported that she received the first dose of the Pfizer COVID 19 on 11Jan2021 and had symptoms of COVID on 18Jan2021. It has resolved and she has no symptoms in over a week. Today was day 15 (01Feb2021) since COVID infection so she was out of the isolation period. She added that her second dose is scheduled for tomorrow (02Feb2021). She declined safety report noting she feels the vaccine may have reduced her symptoms. She wanted to speak with a Medical Director for further discussion of clinical trial data. HCP requested information on published data on the phase 3 trial of those 39 patients in the clinical trials that received the first dose of the Pfizer Covid vaccine and were tested positive for covid. She is requesting the safety profile, their antibodies level and how did they tolerated the second dose. The outcome of the event was recovered on an unspecified date in 2021. Information on the lot/batch number has been requested.

Other Meds:

Current Illness:

ID: 1070518
Sex: F
Age:
State: CA

Vax Date: 01/30/2021
Onset Date: 01/30/2021
Rec V Date: 03/03/2021
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: sore arm and bruising at injection site; sore arm and bruising at injection site; This is a spontaneous report from a contactable consumer. A 54-year-old female patient received first dose of bnt162b2 (BNT162B2), lot number not reported, via an unspecified route of administration on 30Jan2021 12:00 as SINGLE DOSE for COVID-19 immunisation. The patient's medical history and concomitant medications were not reported. On 30Jan2021, the patient experienced sore arm and bruising at injection site. The patient is not pregnant at the time of vaccination. The outcome of the events was recovered. No treatment was given for the events. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient has not been tested for COVID-19. Information on the lot/batch number has been requested.

Other Meds:

Current Illness:

ID: 1070519
Sex: F
Age:
State: NY

Vax Date: 12/19/2020
Onset Date: 12/01/2020
Rec V Date: 03/03/2021
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: chest pain; her lips were swollen/it is on and off; Palpitations off and on; she had a rash on her arms; she had an abnormal feeling in her throat/abnormal feeling in her throat comes and goes, off and on; maybe she is nervous and anxious; maybe she is nervous and anxious; This is a spontaneous report received from a contactable consumer (patient). A 52-year-old female patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number and expiry date unknown), via an unspecified route of administration on the left deltoid, on 19Dec2020, at single dose, for prevention/COVID-19 immunization, at the hospital. Medical history included allergies and allergies to propylene glycol 3350, polysorbate 20, polysulfate 20. It was reported that the patient had a "quick test" and confirmed she has allergies to propylene glycol and polysulfate 20. Her allergist gave her a list of things to stay away from and said to avoid those ingredients. She stated that COVID-19 vaccine has propylene glycol 3350. She clarified and said her allergist told her to stay away from propylene glycol products. Her allergist told her not to use the COVAX. On 19Dec2021, the patient got her first vaccine shot. Within 3 minutes of getting the vaccine, she had rash on her arms. 3 hours later, she had an abnormal feeling in her throat. She was told to go the emergency room and she was given a quick medicine (unspecified). The patient was unable to clarify what medication she received at the emergency room. On 20Dec2021 (the next day), her lips were swollen, on and off. The patient stated she uses dark shampoo and conditioners and maybe it has PEG in it or maybe she is touching something at the hospital. On 20Dec2020, the patient experienced palpitations. She asked the doctors and nurses about her palpitations and they said maybe she was nervous and anxious since she had a COVID patient in the unit. The patient reported that she thinks palpitation started when she went to pick up over the counter medications on 20Dec2020. On 02Jan2021, the patient experienced chest pain. The outcome of rash and palpitations were recovering; oropharyngeal discomfort, lip swelling, and chest pain were not recovered; and nervousness and anxiety were unknown. Information on the Lot/batch number has been requested.

Other Meds:

Current Illness:

ID: 1070520
Sex: M
Age:
State: FL

Vax Date:
Onset Date:
Rec V Date: 03/03/2021
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: His arm was a little sore, but not bad; The initial case was missing the following minimum criteria: no adverse effect. Upon receipt of follow-up information on 01Feb2021, this case now contains all required information to be considered valid. This is a spontaneous report from a contactable consumer (patient). A male patient of an unspecified age received his first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number and expiration date were not provided), via an unspecified route of administration on an unspecified date at single dose for COVID-19 immunization. The patient's medical history was not reported. Concomitant medication included ongoing acetylsalicylic acid (ASPIRIN) as blood thinner and unspecified medications. The patient got his first shot of COVID vaccine on an unspecified date and is going to get the second shot 18Feb2021. He took acetylsalicylic acid 4 hours before the first shot. He was wondering if he should acetylsalicylic acid before or after the shot. He had no reaction from taking acetylsalicylic acid. He was on 81 mg, one a day of acetylsalicylic acid as a blood thinner. He didn't think it was a problem. He has read the things about paracetamol (TYLENOL), but he doesn't take that. The patient was just curious because he has been reading up on the COVID vaccine. It said to wait to take paracetamol. He was glad he got the vaccine from Pfizer. His arm was a little sore on an unspecified date, but not bad. The outcome of the event was unknown. Information on the lot/batch number has been requested.

Other Meds: ASPIRIN [ACETYLSALICYLIC ACID]

Current Illness:

ID: 1070521
Sex: M
Age: 52
State: TN

Vax Date: 02/28/2021
Onset Date: 03/01/2021
Rec V Date: 03/03/2021
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: Ibuprofen

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Under arm knot as big as a baseball

Other Meds: None

Current Illness: None

ID: 1070522
Sex: M
Age: 58
State: TX

Vax Date: 02/04/2021
Onset Date: 02/24/2021
Rec V Date: 03/03/2021
Hospital:

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

Lab Data:

Allergies: sulfa

Symptom List: Pharyngeal swelling

Symptoms: Pt states that he started with his numbing sensation on his left side of his mouth on Feb. 24 2021, for the next 3 days he had the same symptoms. By the third day he had the same sensation and now has traveled to his left side of his ear. Mouth started to droop on left side.

Other Meds: none

Current Illness:

ID: 1070523
Sex: F
Age: 65
State: MD

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

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

Lab Data:

Allergies: Latex,penicillan, dulaidid, codiene,sulfa

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Hives, throat got sore and felt itchy and tight

Other Meds: Rosuvastin, Valsartin, Carvedilol

Current Illness: N/a

ID: 1070524
Sex: F
Age: 59
State: CA

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

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

Lab Data:

Allergies: Amoxicillin

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Rash in middle of back then neck, shoulders, legs and forehead. Went to the ER, and was some medicine, Zyrtec and EpiPen.

Other Meds: Prilosec

Current Illness: no

ID: 1070525
Sex: F
Age: 85
State:

Vax Date: 02/08/2021
Onset Date: 02/09/2021
Rec V Date: 03/03/2021
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: loose stools since vaccination.

Other Meds:

Current Illness:

ID: 1070526
Sex: F
Age:
State: GA

Vax Date: 01/29/2021
Onset Date: 02/01/2021
Rec V Date: 03/03/2021
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: severe dizziness; This is a spontaneous report from a contactable consumer (patient). A 67-year-old female patient received the first dose of BNT162B2 (Pfizer-BioNTech COVID-19 vaccine, lot number: EL3248, expiry date unknown), via an unspecified route of administration on 29Jan2021 at 10:30 at a single dose on the left arm for COVID-19 immunization. Medical history included ongoing diabetes from an unspecified date for about 3 years and ongoing Hashimoto's thyroiditis from an unspecified date for about 15 years. There were no concomitant medications. The patient did not other vaccinations within 4 weeks prior to the COVID vaccine. The patient reported that in the morning of 01Feb2021, 2 hours before calling, she started having severe dizziness to the point she was laying down, because she has to lay still. She can't go out of the room. She called her doctor and her doctor called in meclizine 25mg for her which she has not started yet. The patient was asking if this was safe to take and if it is counterintuitive to the shot. She has not picked it up yet. Her doctor didn't know anything about the vaccine other than she knows that the patient took the vaccine. The outcome of the event was not recovered.

Other Meds:

Current Illness: Diabetes (she had this about 3 years); Hashimoto's thyroiditis (she had this for about 15 years)

ID: 1070527
Sex: M
Age: 74
State: GA

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

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

Lab Data:

Allergies:

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

Symptoms: temperature 101.2-101.8; chills; increased blood pressure (144/75) HR 95

Other Meds:

Current Illness:

ID: 1070528
Sex: M
Age: 32
State: NY

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/03/2021
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: Ceclor

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

Symptoms: Pt felt dizzy lightheaded and diaphoretic 15 min post vaccination Reports similar symptoms with other vaccinations/shots placed on the stretcher, 1 can of orange juice provided patient felt better after resting and orange juice

Other Meds: Abilify, Neurontin, Prozac, Omeprazole

Current Illness: OSA, Anxiety, Bipolar Schizophrenia

ID: 1070529
Sex: F
Age: 75
State: CA

Vax Date: 02/26/2021
Onset Date: 02/26/2021
Rec V Date: 03/03/2021
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: s/p vaccine complained of shortness of breath. No interventions. Resolved spontaneously

Other Meds:

Current Illness:

ID: 1070530
Sex: M
Age: 50
State:

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

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

Lab Data:

Allergies:

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

Symptoms: Patient did "not feel well" while sitting in observation area after receiving shot. No complaints of dizziness or lightheadedness. Patient didn't eat breakfast. Taking pravastatin, losartan and metformin. Didn't take medications today - will do so after eating a full meal at lunch. History of hypertension. Vitals taken x2 - stable. Offered powerade and granola bar, which patient drank and ate. Patient felt much better after eating and drinking. Conversing and laughing with clinic staff. Left clinic area after 30 minutes. Observed steady gait when leaving site.

Other Meds:

Current Illness:

ID: 1070531
Sex: F
Age: 41
State: WY

Vax Date: 02/13/2021
Onset Date: 02/13/2021
Rec V Date: 03/03/2021
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: After 15 minutes of my first vaccine, I experienced hives in my right arm and left arm. The hives also radiated to my back, face and chest. I felt my chest and throat closing up on me. Every once in awhile I get an itchy spot where the first dose vaccine was injected. I did not get my 2nd dose vaccine due to my first dose symptoms.

Other Meds: Migraine medication, Toradol injection

Current Illness: Migraines, Fusion at L4-L5

ID: 1070532
Sex: F
Age: 51
State:

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

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Vaccine administration at 2pm. Patient complaint of nausea at213pm. Vital signs within normal. Patient felt water after drinking water. Discharged home at 1423.

Other Meds:

Current Illness:

ID: 1070533
Sex: M
Age: 46
State: CA

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

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Right arm pain, BP 135/78, pulse 100, 100% O2 sat.

Other Meds:

Current Illness:

ID: 1070534
Sex: F
Age:
State: CA

Vax Date: 02/24/2021
Onset Date: 02/01/2021
Rec V Date: 03/03/2021
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: Dizziness; This is a spontaneous report from a contactable consumer reporting for herself. An 84-year-old female patient received the 1st dose of bnt162b2 (BNT162B2, Manufacturer Pfizer-BioNTech), via an unspecified route of administration, on 24Feb2021, at single dose, for COVID-19 immunisation. Medical history included sinus disorder. Concomitant medications were not reported. The patient experienced dizziness in Feb2021, 3-4 days after vaccination. on an unspecified date with outcome of recovering. The patient did not know if the dizziness was due to the COVID-19 vaccine or her sinus disorder. The information on the lot/batch number has been requested.

Other Meds:

Current Illness:

ID: 1070535
Sex: F
Age: 32
State: WI

Vax Date: 03/01/2021
Onset Date: 03/03/2021
Rec V Date: 03/03/2021
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: Redness, swelling, itchiness, and sensitivity around injection site, roughly 2 inches in diameter. Developed around 20 hours after injection.

Other Meds:

Current Illness:

ID: 1070536
Sex: F
Age: 63
State:

Vax Date: 02/19/2021
Onset Date: 02/24/2021
Rec V Date: 03/03/2021
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: Unevaluable event

Symptoms: Rash left side of my body. Itching. Nodule under the clavicle (collarbone). Fever. Joint pain. Headache.

Other Meds: Vitamin C, Magnesium, Prozac, olmesartan medox 40mg., Tylenol

Current Illness: No

ID: 1070537
Sex: M
Age: 49
State: MO

Vax Date: 03/02/2021
Onset Date: 03/02/2021
Rec V Date: 03/03/2021
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: Administered Moderna vaccination at 1746 and patient stated that he has experienced vagal responses to injections in the past. Patient remained in the vaccination chair for 5 minutes after injection and he reported feeling well and moved to the observation chair without any problems [~10ft]. After being the observation chair patient stood up and took 4-5 steps toward the wall and sat down on the floor. The patient stated he felt dizzy and then became limp & slumped to the right side, eyes remained open with dilation of pupil fixed at 2mm with no blinking noted. Patient's breathing pattern became shallow & snoring sounds noted. Patient did not respond when spoken to nor did he respond to soft shaking of shoulders. Patient began to demonstrate large jerky body movements similar to seizure activity. The seizure like activity continued for 3-4 minutes before the patient was able to become aware of surroundings and answer orientation questions. BP 120/72, HR 64, O2 sats 99%, RR 20. Patient was diaphoretic, pale, shaking of hands and arms, restlessness of lower limbs with frequent repositioning/twitching of legs. EMS arrived to find the patient regaining stability. Patient reported to EMS that his is familiar with this type of response and declined to be taken to

Other Meds:

Current Illness:

ID: 1070538
Sex: F
Age: 33
State: MP

Vax Date: 01/11/2021
Onset Date: 01/11/2021
Rec V Date: 03/03/2021
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: Penicillin Ibuprofen

Symptom List: Injection site pain, Pain

Symptoms: I started feeling sick 7 hrs after the vaccine I developed chills, fevers, fatigue. My fever went up to 102.9, my eyes started to swell, I felt congestion. I went to the ER on 1/11/201 at around 11pm they gave me medications. The next day I also had diarrhea. The fevers resolved by the following day the body aches & the chills lasted for 1 week & the diarrhea lasted for 1 day. Fatigue is still going on & off it has not completely resolved.

Other Meds: Symbicort Cetirizine

Current Illness:

ID: 1070539
Sex: F
Age: 67
State: TX

Vax Date: 02/25/2021
Onset Date: 03/04/2021
Rec V Date: 03/03/2021
Hospital:

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

Lab Data:

Allergies: PCN

Symptom List: Injection site pain, Menorrhagia

Symptoms: Swollen redness at the site of vaccination. Hard and warm to touch and itchy.

Other Meds: Vit D, Zinc, Alive vitamin, Vit B complex drops

Current Illness: copd, Bronchiectasis

ID: 1070540
Sex: F
Age: 56
State: TX

Vax Date: 02/25/2021
Onset Date: 02/27/2021
Rec V Date: 03/03/2021
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: Lymphadenopathy Very swollen, sore and red lymph nodes on the left side of the neck

Other Meds: Progesterone 200mg Montelukast sod 10 mg Singulair Niacin 1000 mg

Current Illness: None

ID: 1070541
Sex: U
Age:
State:

Vax Date: 01/28/2021
Onset Date:
Rec V Date: 03/03/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Got a keloid (scar) in the injection spot; This is a spontaneous report from a contactable pharmacist. A patient of unspecified age and gender received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, lot number and expiration date were not reported), via an unspecified route of administration on 28Jan2021 at single dose for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. The patient experienced got a keloid (scar) in the injection spot on 2021. The outcome of event was unknown. Information about lot/batch number has been requested.

Other Meds:

Current Illness:

ID: 1070542
Sex: F
Age: 68
State: TN

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

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: FEELING FAIINT APPROX 20 MINUTES AFTER VACCINATION. B/P FLUCTUATING, AMBULANCE CALLED

Other Meds:

Current Illness:

ID: 1070543
Sex: F
Age: 38
State: NY

Vax Date: 02/02/2021
Onset Date: 02/03/2021
Rec V Date: 03/03/2021
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: sulfa, penicillin

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

Symptoms: 2/2/2021 vaccination 2/3/2021 24 hours later, I was getting really fatigue at work. Got to the point where hard time keeping eyes open, muscle stiffness, HA, chills, temp 100.5 was the highest. 3 days i felt run down, terrible body aches, HA. *other symptoms have subsided EXCEPT the HA. I wake up daily with HA. I try to alternate between Excedrin, Tylenol and hot compress. **1st vaccine; 'Covid arm'

Other Meds: yasbmin BC, Atorvastatin, amlodapine, omeprazole, lexapro

Current Illness: n/a

ID: 1070544
Sex: F
Age: 69
State: MI

Vax Date: 02/25/2021
Onset Date: 02/26/2021
Rec V Date: 03/03/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Nausea

Symptoms: All over body rash the afternoon after getting the vaccine. Extremely itchy legs. Symptoms dissipated by mid-morning the next day. Went to urgent care. Only had a little bit of rash at that time. Doctor suggested Benadryl and Zyrtec. Had a bad flare-up of redness on the back and under the arms on the way home from the appointment. Took Benadryl when I got home. That helped a lot. Took Zyrtec in the morning and Benadryl in the PM for the next 2 days. No more rash, just a little bit of itchiness.

Other Meds: Armour Thyroid, Pravastatin, multi-vitamin, fish oil, vitamin D-3

Current Illness: None

ID: 1070545
Sex: F
Age: 60
State: CO

Vax Date: 02/02/2021
Onset Date: 02/09/2021
Rec V Date: 03/03/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: 7 days post-vaccination, patient states that the injection site had redness, itching and swelling. Patient notified her primary care provider and was informed that this is a common side effect.

Other Meds:

Current Illness:

ID: 1070546
Sex: M
Age: 26
State: NE

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/03/2021
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 induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: Immediate burning in both arms. Unable to hold a pencil to fill out card after receiving vaccine. Weakness in upper extremities. Tingling, pain and numbness in both arms, red streaks appeared on the left arm going further up on to the shoulder, the were visible and painful for about 90 mins. Sweating. Nausea. Blurred vision. Loss of consciousness. Headache behind the eyes.

Other Meds: Vitamin D3 gummies 200mcg PO QD

Current Illness: None

ID: 1070547
Sex: F
Age: 36
State: CA

Vax Date: 02/27/2021
Onset Date: 02/27/2021
Rec V Date: 03/03/2021
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: Promethazine Reglan

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

Symptoms: presents to the hospital due to acute R sided weakness and numbness which developed a few minutes after receiving her 1st Covid-19 vaccine. Got 1st shot at POD. Patient not sure if it was the Pfizer or Moderna vaccine. Patient developed RUE weakness, R face and arm numbness and dysarthria shortly after receiving her vaccination. Mild hives were also observed along chest in the ED. Patient received Diphenhydramine and tenecteplase

Other Meds: norelgestromin/ethin.estradiol (Xulane) 150-35 mcg/24 hr TD Weekly Patch Propranolol (INDERAL) 10 mg Oral Tab 2 x day Zyprexa

Current Illness:

ID: 1070548
Sex: M
Age: 33
State: PA

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

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

Lab Data:

Allergies: None

Symptom List: Tremor

Symptoms: within 15 minutes of immunization, patient experienced a feeling of fainting, lightheadedness, and ringing of the ears. Patient laid on the floor for an additional 30 minutes and was then released after feeling better.

Other Meds:

Current Illness:

ID: 1070549
Sex: F
Age: 77
State: ID

Vax Date: 03/01/2021
Onset Date: 03/01/2021
Rec V Date: 03/03/2021
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: Eye doctor dilating drops causes blurry vision for 6-8 hours, has a hard time waking up from anesthesia after procedures like colonoscopy.

Symptom List: Erythema, Pruritus

Symptoms: Got the vaccine, she went home around 3:30, and was very tired. She woke up after 6:00 PM. This morning she had swelling in her arms, real bumpy about 2 1/2" in diameter, looks like rocks, red/pink area 1 1/2". It is very painful throbbing area on her arms, getting worse. She has been taking Tylenol. She felt a little relief of the pain with the Tylenol. She rested all day yesterday. She left at 10:00 for her bridge club and that's where she noticed the reaction and has gotten home around 3:00 and not feeling well. They told her to call us as they did not have any side effects from the vaccine. She does have an appointment on 3/11/21 with her PCP.

Other Meds: Lisinopril, Rosuvastatin.

Current Illness: None.

ID: 1070550
Sex: M
Age:
State: MD

Vax Date: 01/31/2021
Onset Date: 02/01/2021
Rec V Date: 03/03/2021
Hospital:

Vax Type: UNK
Manufacturer: UNKNOWN MANUFACTURER
Vax Name: VACCINE NOT SPECIFIED (NO BRAND NAME)
Lot:
Dose Series: UNK
Vax Route: SYR
Vax Site: UN

Lab Data:

Allergies:

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

Symptoms: felt like i had the flu; arm got sore; threw up" in middle of night; achy weakness; achy weakness; low grade temp; chills; This is a spontaneous report from a contactable consumer. A male patient of an unspecified age received BNT162b2 ((Pfizer-BIONTECH Covid-19 Vaccine) , via an unspecified route of administration on 31Jan2021, as a single dose for COVID-19 immunization. Medical history and concomitant medications were not reported. The patient received 1st dose of vaccine on 31Jan2021 and was "fine for 2 days" then felt the effects in Feb2021: "threw up" in middle of night, achy weakness, chills, low grade temp. He stated, "soreness in arm, Achy and weak this morning when I got up. I am feeling better now." The patient reported that , "'my arm got sore and I felt like I had the flu for about 24 hrs.-took Tylenol" and was asking if he should be concerned the symptoms started more than 36 hours after getting the 1st dose. The outcome of the events was not reported. Information on lot/batch number has been requested.

Other Meds:

Current Illness:

ID: 1070551
Sex: F
Age: 62
State: AZ

Vax Date: 03/01/2021
Onset Date: 03/01/2021
Rec V Date: 03/03/2021
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: About 40 minutes after receiving the vaccine, I experienced shortness of breath for about 2 minutes, followed by flushing at which time the breathing returned to normal and has not reoccurred. No other symptoms have been experienced at this time.

Other Meds: Atorvastaton, Baclophen, Gabapentin, Metropolol, Zoloft, Isosorbide mononitrate, clopidegrel, multivitamin, Vitamin D, Omega 3, asprin

Current Illness: None

ID: 1070552
Sex: M
Age: 62
State: WA

Vax Date: 01/21/2021
Onset Date: 02/03/2021
Rec V Date: 03/03/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Woke up on 2/3/2021 and my right eye was blurry, with a lot of black spots floating around in my eye. Went to my eye doctor on 2/4/2021 and he did a series of tests, he was said my pressure in my eye was high and recommend that I go to a retinal specialist. I went a retinal specialist and he was not able to determine the problem and sent me to hospital. The doctor said I had acute retinal necrosis. I developed the HSV-1 virus in my right eye. The Doctor said it was maybe a coincidence that it happen

Other Meds: Doxyycycline Hyclate, Tamsulosin, Omeprazole, Durasteride

Current Illness: none

ID: 1070553
Sex: F
Age: 24
State: CA

Vax Date: 02/26/2021
Onset Date: 02/27/2021
Rec V Date: 03/03/2021
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: Norco - causes nausea

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

Symptoms: First day after - muscle fatigue, dizziness, general fatigue (not localized), lower back pain Five days after - vertigo, nausea

Other Meds: Fluoxetine (Prozac), birth control

Current Illness:

ID: 1070554
Sex: F
Age: 75
State: IL

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/03/2021
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: Mixed inhalants, dander, birds, cats , dogs, dust

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

Symptoms: headache, dizziness

Other Meds: Flovent 44mcg 2 puffs twice a day Ventolin90 mcg as needed (not taken in several months) Montelukast 10 mg once a day Fexofenadine HCl 60mg (Allegra) once a day in spring and summer (taking now) Furosemide 40 mg once a day Spironolactone 2

Current Illness: none

ID: 1070555
Sex: F
Age: 54
State:

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/03/2021
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: Pain in extremity

Symptoms: Patient started feeling lightheaded while walking from vaccination station to post observation area. Patient then started feeling nauseated while sitting in post observation area. Patient ate breakfast this morning. Not on any medication. Conversing with clinic staff and wondering if feeling lightheaded is normal after receiving the shot. Vital signs taken x2 - stable. Offered water but declined. Offered yoga mat to lay down but declined. Feeling better. Looking at phone. Conversing with clinic staff. Nausea resolved but still feeling "a little lightheaded." Steady gait after leaving clinic at 10:15 am.

Other Meds:

Current Illness:

ID: 1070556
Sex: F
Age: 84
State: AL

Vax Date: 02/19/2021
Onset Date: 02/20/2021
Rec V Date: 03/03/2021
Hospital:

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

Lab Data:

Allergies: All-cillins, Keflex, ACEI, ARDS, Procardia, Demerol, Novocaine, Tramadol, Robaxin, Surgical tape

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

Symptoms: 02/20/2021 at 6:30am when getting up, dizziness, nausea, vomiting, fainted, fell and hurt back. 9:00am when getting up a second time, again - dizziness, nausea, fainting , falling and hitting head in bathroom. During day , hematoma over left eye, swelling, no Headache, no blurred vision, back pain increased. Treated with heat.

Other Meds: Bystolic, TRIAM/HCTZ, Amlodipine, Protonix, Claritine, Calcium/ Vit. D, Vitamin B complex. , Glucosamine/MSM, Tumeric, ASA 81mg, Azelastine HCL, Proair inhaler, Melatonin, Tylenol, Prednisone PRN

Current Illness: controlled Hypertension. Asthma

ID: 1070557
Sex: M
Age:
State: IL

Vax Date: 01/13/2021
Onset Date: 01/24/2021
Rec V Date: 03/03/2021
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: COVID-19 confirmed by positive COVID-19 test; This is spontaneous report from a contactable patient. A 30-years-old male patient received the first dose on bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE Batch/lot number: EL3247), via an unspecified route of administration on 13Jan2021 at single dose for COVID-19 immunisation, when 30 years old. Medical history was none. The patient's concomitant medications were not reported. The patient experienced got the first dose and then on 24Jan2021 tested positive for covid with outcome of unknown. The patient wanted to know when he could receive the second dose. The patient was treated with Tylenol.

Other Meds:

Current Illness:

ID: 1070558
Sex: F
Age: 51
State: GA

Vax Date: 03/01/2021
Onset Date: 03/01/2021
Rec V Date: 03/03/2021
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: Ace inhibitors

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

Symptoms: High fever, chills, body aches, headache, sore arm, swollen arm, red rash on arm, lasted almost 48 hours. Worse than when I actually had covid in early January 2021. Arm still swollen and painful.

Other Meds: Valsartan, Effexor X-ray, Zyrtec

Current Illness: None

ID: 1070559
Sex: F
Age: 52
State: CA

Vax Date: 02/26/2021
Onset Date: 02/26/2021
Rec V Date: 03/03/2021
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: Buckwheat, Kiwi, Almonds, Figs

Symptom List: Vomiting

Symptoms: Pain at injection site within hours same date Pain in armpit on same side of inject developing on first day but more severe day 2 (2/27)and resolving by end of day 3 (2/28) Body aches and fatigue day 2 (2/27) managed with 800mg ibuprofen resolved mostly by afternoon Virtigo from early morning on day 4(3/1) -day 5(3/2) worse while laying down when turn head Woke with left sided flank pain this morning (3/3) but had a physically stressful day prior while moving so not sure if this is related to vaccine, moving or UTI will notify primary if persists.

Other Meds: Multi Vitamin

Current Illness:

ID: 1070560
Sex: F
Age: 40
State: MN

Vax Date: 02/23/2021
Onset Date: 02/28/2021
Rec V Date: 03/03/2021
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: Following my vaccination on 2/23-I awoke at 5 am on 2/24/21 fever, body aches, chills, fatigue. On Sunday 2/28 in the evening, I developed a rash on my right buttock which at first just looked like a simple rash. As Monday 3/1 and Tuesday 3/2 progressed, the rash became, very painful, hot and it hurt to sit or even have clothing touch it. I went to the doctor today, 3/3/21 at 3 pm and was diagnosed with Shingles. I have been prescribed an anti-viral medication to treat the Shingles.

Other Meds: None

Current Illness: None

ID: 1070561
Sex: M
Age: 73
State: FL

Vax Date: 02/23/2021
Onset Date: 02/25/2021
Rec V Date: 03/03/2021
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: Codene, keflex, penicillan and all statins

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

Symptoms: Burning sensation throughout body. Some tightness in throat difficult swallowing at times. Feel like my Blood is boiling. Watery eyes some. burning feeling not going away.

Other Meds: Metoprolol, Baby asprin and Pantoprazole and Boost supplement.

Current Illness: surgery on back near right shoulder. Cancer spot removed three weeks prior.

Date Died: 03/02/2021

ID: 1070562
Sex: M
Age: 77
State: CA

Vax Date: 03/01/2021
Onset Date: 03/02/2021
Rec V Date: 03/03/2021
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:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: The coroner called Dr. on 3.2.2021 to advise that he had a witnessed collapse and Mr. was taken to the ED where he was pronounced.

Other Meds:

Current Illness:

ID: 1070563
Sex: F
Age:
State:

Vax Date: 01/01/2021
Onset Date: 01/01/2021
Rec V Date: 03/03/2021
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: flu-like symptoms; head ache; This is a spontaneous report from a contactable consumer. A female patient of an unspecified age received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection, lot number and expiration date were not reported), via an unspecified route of administration on Jan2021 at single dose for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. The patient experienced that after her first dose on Jan2021, about 4 weeks ago, she experienced flu-like symptoms and head ache for about 4 days. The outcome of the events was recovered on Jan2021. Information on the lot/batch number has been requested.

Other Meds:

Current Illness:

ID: 1070564
Sex: F
Age: 54
State: TX

Vax Date: 02/28/2021
Onset Date: 02/28/2021
Rec V Date: 03/03/2021
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: Sulpha

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

Symptoms: I experienced bad chills and body aches like having the flu and when I previously had Covid 19; headaches have been really bad. Chills and body aches are better as of today, 03/03/2021 but the headaches remains.

Other Meds: Flecinaide, Metropol

Current Illness: Bronchitis

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm