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: 1088453
Sex: F
Age: 78
State: PA

Vax Date: 03/05/2021
Onset Date: 03/05/2021
Rec V Date: 03/10/2021
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: Atenolol Metoprolol

Symptom List: Dysphagia, Epiglottitis

Symptoms: Experienced Shortness of Breath about 3 minutes after the vaccine was admistered. BP 168/80 - O2 sats 99. STated feeling better and slight notice of breathing. Shortly thereafter HR 34-40 briefly and not feeling right. EMS called. HR quickly returned to baseline in the 80s. BP 173/80. Patient has a history of HTN and did not take BP meds that Am. Given a lighter surgical mask as patient's mask felt "thicker than normal". EMS arrived, vitals were stable. Patient was feeling better, no more SOB. Patient cleared and released.

Other Meds: unknown

Current Illness: unknown

ID: 1088454
Sex: F
Age: 29
State: VA

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 03/10/2021
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: Wheat, Rye Barley Dairy

Symptom List: Anxiety, Dyspnoea

Symptoms: Lightheaded Nausea

Other Meds: Birth Control Adderall

Current Illness: Celiac Disease Depression/Anxiety Anemia

ID: 1088455
Sex: F
Age: 64
State: KY

Vax Date: 02/22/2021
Onset Date: 02/22/2021
Rec V Date: 03/10/2021
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: Cymbalta,levaquin,multaq,pradaxa, xarelto, coumadin,neurotic,placid, questran.

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

Symptoms: The brand was what I got the pfizer dose. 45 minutes after having the vaccine I had very bad blurred vision in my right eye only while driving which lasted 3 hours and only subsided once I put my eye drops in .I saw Dr. today and he advised me not to have the second vaccine on March 15th. It left no damage to the eye thank God.

Other Meds: Pemarin 0.9mg, atorvastatin 40 mg,eliquis 5 mg, Irbesartan 300 mg, Hctz 12.5, Tramadol 50 mg, Baclofen 10 mg, Metroprolol succinate er 25 mg, flonase nasal spray 50 mcg, restasis 0.05%, tylenol arthritis 650 mg,

Current Illness: None

ID: 1088456
Sex: F
Age: 54
State: NY

Vax Date: 03/03/2021
Onset Date: 03/04/2021
Rec V Date: 03/10/2021
Hospital:

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

Lab Data:

Allergies: pava

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: pt states that when she woke up the next day after getting the vax she woke chills, sweats and body aches. Temp was 101.4. Pt states that her symptoms lasted 6 days. Pt is feeling better today.

Other Meds: ferriprox 1000mg x 2 tabs x 3 daily, levothyroxine 150 mcg, tresiva insulin 32 un, flexaril 5mg, Xanax 0.5 mg, multivitamin, Vitamin C, D, Calcium,

Current Illness: cataract surgery on 1/28/2021

ID: 1088457
Sex: M
Age: 53
State: TX

Vax Date: 02/08/2021
Onset Date: 03/01/2021
Rec V Date: 03/10/2021
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: NKA

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

Symptoms: Diagnosed with Covid-19 on 03/01/2021. Admitted to hospital ICU on 03/01/2021. Presented with dyspnea, fatigue, shortness of breath. Patient had skipped dialysis treatments for an unknown amount of days. DIscharged from hospital on 03/04/2021. Total number of days: 4. Treated with Vitamin C, Vitamin E, Vit D, zithromax 500mg daily x 7 days; Zinc 50mg; dexamethasone 4mg x 10 days; Tussin DM; acetaminophen 500mg as needed. Currently in isolation for 21 days (03/01/2021 to 03/22/2021). Pt reported Symptoms resolved on 03/04/2021. Continues with Dialysis although schedule days have temporarily changed to Tuesday, Thursday and Saturdays until cleared from Covid-19.

Other Meds: Velphoro 500mg chew 2 tablets everyday with meals

Current Illness: Rhinovirus; Treated for Cough on 2/23/2021

ID: 1088458
Sex: F
Age: 70
State: GA

Vax Date: 02/27/2021
Onset Date: 02/27/2021
Rec V Date: 03/10/2021
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: Saliylates Iodine NSAIDS

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

Symptoms: Moderna COVID-19 Vaccine. Site of vaccine is still very red, with a rash, and slightly swollen in the area of vaccination, down just past her elbow. Patient also describes intermittent headaches, nightly insomnia, chills, and a cold feeling daily since her vaccination in February.

Other Meds: Zetia 10MG Amlodipine 5mg Soma 350mg Valium 5mg Norco 10-325mg

Current Illness:

ID: 1088459
Sex: F
Age: 75
State: CA

Vax Date: 03/04/2021
Onset Date: 03/07/2021
Rec V Date: 03/10/2021
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: Pyrexia, White blood cell count decreased

Symptoms: Rash, lump upper arm causing itching and increasing daily

Other Meds: Pradaxa, Pravastatin, Metoprol Tartrate, Calcium Citrate, D-3, Spriva, vitamins E, Fish Oil, B-12, CoQ10, Tumeric, Biotin, Hammer Tissue Rejuvinator.heart

Current Illness: None

ID: 1088460
Sex: M
Age: 26
State: NJ

Vax Date: 03/09/2021
Onset Date: 03/09/2021
Rec V Date: 03/10/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: Systemic: Fainting / Unresponsive-Severe, Additional Details: Patient remembered sitting down in a chair for observation, then slumped forward while on his phone. He did not remember falling over and was alert and oriented right away. Emergency services were called as he sustained an injury during his fall.

Other Meds:

Current Illness:

ID: 1088461
Sex: F
Age: 68
State: CO

Vax Date: 03/02/2021
Onset Date: 03/09/2021
Rec V Date: 03/10/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Red rash at injection site a week after the injection.

Other Meds: Metformin, Acyclovir, multi vitamin, calcium, B complex, chromium picolinate, iron

Current Illness: None

ID: 1088462
Sex: F
Age: 27
State: VA

Vax Date: 01/11/2021
Onset Date: 01/11/2021
Rec V Date: 03/10/2021
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: avocados

Symptom List: Diarrhoea, Nasal congestion

Symptoms: 1/11 vaccination By 10pm, started to feel achy, HA. Went to bed 1/12 woke up with dry cough, chills, no fever, achy. took some medication, went to work. Informed staff. Took Rapid test; negative. Was not feeling well. Took rest of the day off. Tested again the following day; standard and rapid covid test; negative. Employee health consulted. Symptoms lasted for 48 hours.

Other Meds: Provigil 200 mg 2x daily

Current Illness: n/a

ID: 1088463
Sex: F
Age: 61
State: TX

Vax Date: 12/31/2020
Onset Date: 01/06/2021
Rec V Date: 03/10/2021
Hospital: Y

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

Lab Data:

Allergies: Gentamicin

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

Symptoms: I started with headache then got nausea and started running fever. Over 24 hr period I was constantly vomiting. I went to the hospital on Sunday stayed for 5 days.

Other Meds: Vit D, Zanaflex, Plavix, Estradiol, Nifedipine, Crestor,Temazepam, Pantoprazole, Metoprolol, Irbesartan, Mser,Msir

Current Illness: No

ID: 1088464
Sex: F
Age: 74
State: FL

Vax Date: 03/01/2021
Onset Date: 03/02/2021
Rec V Date: 03/10/2021
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: loss of hearing, patient has hx of wearing hearing aids, hearing worsened after vaccination. Patient went to ENT doctor today, was advised to call CDC per ENT doctor. Spoke to pt's daughter because mom has lost 80% of her hearing and she is taking all of her calls. They went to audiologist for hearing test, then to ENT who prescribed Prednisone for 10days but was unsure about her situation and told her to call the CDC. Their main concern is does she take her 2nd shot and risk loosing more or all of her hearing if it was a result of the vaccine. The daughter said that they received new hearing aids a week before the vaccine. I told her that we will follow up with her in about a week to see if the steroids are helping and to find out the results from her ENT follow up appt.

Other Meds: metformin, lisinopril

Current Illness:

ID: 1088465
Sex: F
Age: 67
State: NC

Vax Date: 02/24/2021
Onset Date: 02/24/2021
Rec V Date: 03/10/2021
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: Error: Wrong Dose of Vaccine - Too High

Other Meds:

Current Illness:

ID: 1088466
Sex: M
Age: 28
State:

Vax Date: 02/24/2021
Onset Date: 02/24/2021
Rec V Date: 03/10/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Patient experienced itchy/scratchy throat after receiving second dose of Covid vaccine. No other signs of distress.

Other Meds:

Current Illness:

ID: 1088467
Sex: M
Age: 37
State: KS

Vax Date: 02/26/2021
Onset Date: 02/26/2021
Rec V Date: 03/10/2021
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: Progress Notes (Nurse Practitioner) ? ? Family Medicine Cosigned by: MD at 2/28/2021 7:38 AM Expand AllCollapse All COVID VACCINE CLINIC 2/26/2021 Patient: Date: 2/26/2021 Subjective is a 37 y.o. male who was seen at COVID Vaccine Clinic today for his first dose of the COVID 19 vaccination. He was given the Pfizer vaccination in the left deltoid muscle. During his 15 minute waiting period after the injection, the patient began to experience flush feeling with chest pain to L lower chest. He denied rash, hives, welts, difficulty breathing, difficulty swallowing, wheezing, throat tightness, hoarseness, stridor, itching, lightheadedness, dizziness, facial swelling, lip swelling and tongue swelling. This provider was notified of patient reaction and he was then assessed in the emergency area. Monitored patient for severe reaction symptoms, including but not limited to blood pressure abnormality and rapid progression of symptoms. PMH: none. Ate a "big baked potato" about an hour an half before coming in . ALLERGY REVIEW OF SYSTEMS: Patient denies chills, fever, malaise/fatigue, ear pain, sore throat, frequent throat clearing, eyes itching, eye redness, cough, chest tightness, shortness of breath, wheezing, rash, hives, eczema, itching of skin, muscle aches, joint pain, dizziness and headaches No vision changes: + lightheaded. : Previous Reactions: none Objective Vitals Vitals: 02/26/21 1624 02/26/21 1635 BP: 137/88 123/73 Pulse: 59 62 SpO2: 100% 100% Physical Exam Constitutional: General: He is not in acute distress. Appearance: He is well-developed. He is not diaphoretic. HENT: Mouth/Throat: Mouth: Mucous membranes are moist. Eyes: General: Right eye: No discharge. Left eye: No discharge. Extraocular Movements: Extraocular movements intact. Conjunctiva/sclera: Conjunctivae normal. Pupils: Pupils are equal, round, and reactive to light. 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. Skin: General: Skin is warm and dry. Neurological: Mental Status: He is alert and oriented to person, place, and time. Gait: Gait normal. Psychiatric: Attention and Perception: Attention normal. Mood and Affect: Mood is anxious (slightly). Behavior: Behavior normal. Thought Content: Thought content normal. Judgment: Judgment normal. Chest pain and symptoms resolved after taking off mask and eating/drinking. 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 Red flag symptoms (CP, SOB, NVD, Visual/Neuro concerns) Monitored for approx 15 minutes. Pt greatly improved. CP resolved within 1 minute of being in the bay after drinking. VS stable/improved. Pt ambulated out of the medical bay w/o assistance. Recommended protein based food and hydration 30 minutes prior to next vaccination. Follow up with pcp as needed. Pt voiced understanding and is appreciative of today's evaluation. APRN Electronically Signed 2/26/2021 4:28 PM

Other Meds:

Current Illness:

ID: 1088468
Sex: F
Age: 70
State: IN

Vax Date: 03/08/2021
Onset Date: 03/08/2021
Rec V Date: 03/10/2021
Hospital:

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

Lab Data:

Allergies: sulfa based drugs

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

Symptoms: Had headache, some joint pain in knees and hands, extremely tired. Symptoms last for about two days. Injection site was sore so applied ice off and on.

Other Meds: Atrovastatin, metoprolol, losartan potassium, low dose asprin,

Current Illness: none

ID: 1088469
Sex: F
Age: 60
State:

Vax Date: 03/09/2021
Onset Date: 03/09/2021
Rec V Date: 03/10/2021
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: pt became flush and had trouble breathing and fainted

Other Meds:

Current Illness:

ID: 1088470
Sex: F
Age: 62
State: IN

Vax Date: 03/04/2021
Onset Date: 03/04/2021
Rec V Date: 03/10/2021
Hospital:

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

Lab Data:

Allergies: latex, adhesive tape

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Moderna COVID-19 Vaccine EUA Within minutes of receiving vaccine, I developed itchiness at injection site. Within 5 minutes, developed itchy lips and scalp, and my asthma cough. No rash or shortness of breath. Went home after the 15 minute waiting/observation period. Developed nasal congestion when arrived home (5 min). Took 25 mg benadryl and my albuterol inhaler. All symptoms resolved in 90 minutes.

Other Meds: carvedilol, losartan, isosorbide, trelegy, albuterol, famotidine, atorvastatin, metformin mutivitamin,

Current Illness: none

ID: 1088471
Sex: F
Age: 78
State: MO

Vax Date: 02/25/2021
Onset Date: 02/27/2021
Rec V Date: 03/10/2021
Hospital:

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

Lab Data:

Allergies: No

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Hard knot at injection site with soreness, and redness 2 days after vaccination. Per patient site symptoms decreased over 3-4 days and now infection site is hot, red, sore in area approximate 5 inch circular area of lt upper arm.

Other Meds:

Current Illness: No

ID: 1088472
Sex: F
Age: 56
State: NC

Vax Date: 03/02/2021
Onset Date: 03/09/2021
Rec V Date: 03/10/2021
Hospital:

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

Lab Data:

Allergies: Allergic to aloha galactose (mammal meat)

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

Symptoms: Late day 7, a red area developed at the injection site, similar to an insect bite. Very itchy.

Other Meds: Synthroid, Zyrtec, magnesium, saw palmetto, vitamin D

Current Illness: N/A

ID: 1088473
Sex: F
Age: 45
State: TX

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 03/10/2021
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: latex, Sudafed, amoxicillin, inhaled lidocaine

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

Symptoms: At 9:30 am felt warm, lower lip started to itch/burn, and scratchy throat. Flushed in face, ears, neck, upper chest, and shoulders. Was given .3mg Epinephrine IM with immediate results. Flushing and itchiness went away.

Other Meds: singular 10 mg daily, xyzal 20 mg BID, Mucinex 1200 mg BID, Pepcid 40 mg daily, budesonide .5 mg daily, Xopenex .63 every 6 hours PRN, Flonase daily, Xolair 300 mg sq every 4 weeks, chlorpheniramine, dextromethorphan

Current Illness: asthma, bronchitis, chronic idiopathic urticaria, dermatographias, atopic dermatitis, 2nd adrenal insufficiency

ID: 1088474
Sex: F
Age: 70
State: IL

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

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: Patient complained that it "felt like her throat was closing up." Pt was not visibly struggling to breath or any change in skin tone. Asked if she had experienced any other allergic type reactions before and if this was a similar feeling and she stated yes. Offered an Epi-Pen and calling an ambulance and pt denied stating she would rather try Benadryl first. Gave pt #2 25mg Benadryl with some water and pt sat with her companion while we observed. After 15 minutes pt stated she was feeling much better and as she had a driver we sent her home. Instructed to contact her MD before her second dosage.

Other Meds:

Current Illness:

ID: 1088475
Sex: F
Age: 43
State: NY

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/10/2021
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: After waiting the 15 minutes after vaccine she was leaving and started with shaking in both legs and she stated " I feel dizzy and legs are jelly". Had her lay down on mat, gave water and cookies, declined and placed cool pack on her neck. She was shaking from feet to her arms. No complaint of shortness of breath or chest pains, wasn't cold or sweating. Stated she had eaten before she received vaccine. She refused to have Ambulance come and check her out. 8:15pm vitals Bp 110/62 R 16 P74. Stated she felt better to sit up, sat up on floor mat for 5 minutes, moved to wheelchair and after 5 minutes stood up no shaking. Wheeled her out to truck with her husband. Advised if symptoms come back and don't resolve call 911 to be evaluated.

Other Meds: none

Current Illness: none

ID: 1088476
Sex: F
Age: 74
State: IN

Vax Date: 02/25/2021
Onset Date: 02/26/2021
Rec V Date: 03/10/2021
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: dust, trees, grass, sulpha, vioxx,

Symptom List: Injection site pain, Pain

Symptoms: Sore arm about 5 days, 1.5 temp 2 days, tired about 4 days

Other Meds: Thyroid, cholesterol

Current Illness:

ID: 1088477
Sex: M
Age: 67
State: MN

Vax Date: 03/02/2021
Onset Date: 03/06/2021
Rec V Date: 03/10/2021
Hospital:

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

Lab Data:

Allergies: Codeine

Symptom List: Injection site pain, Menorrhagia

Symptoms: Moderna Covid 19 Vaccine EUA Woke up 3/6/21 with drippy left eye and runny nose nothing else until Sunday afternoon 3/7/21 noticed droopy left eye, cheek and mouth. We to hospital ER for stroke protocol. Dr diagnosed BellsPalsy and not stroke. Advised me to contact a neurologist. Received prescription for Prednisone

Other Meds: Tramadol, Lisinopril, Amlodipine, Metoprolol, Aleve, Multi Vitamin, Stool softener

Current Illness:

ID: 1088478
Sex: F
Age: 59
State: FL

Vax Date: 03/05/2021
Onset Date: 03/08/2021
Rec V Date: 03/10/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Arm itchy and bumpy. Scratched area. Silver dollar size. Zyrtec taken and sx 90 % subsided. Plan to follow-up with PCP.

Other Meds:

Current Illness:

ID: 1088479
Sex: F
Age: 51
State: CA

Vax Date: 03/10/2021
Onset Date: 03/10/2021
Rec V Date: 03/10/2021
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: Codeine, Penicillins

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Here for Covid 19 vaccine at 0850 observed for 30 minutes prior to going home at 0930. Complain of throat tightness-able to speak in full sentences, able to swallow-report history of throat swelling in the past from codiene and limbs swelling with PCN

Other Meds: none

Current Illness: none

ID: 1088481
Sex: F
Age: 63
State:

Vax Date: 03/09/2021
Onset Date: 03/10/2021
Rec V Date: 03/10/2021
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: Chills, achy, fatigue. No fever. Treating with tylenol

Other Meds:

Current Illness:

ID: 1088482
Sex: F
Age: 49
State: DE

Vax Date: 03/08/2021
Onset Date: 03/08/2021
Rec V Date: 03/10/2021
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: Non reported

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

Symptoms: 49 year old female c/o nausea following vaccine administration. Brought to first aid area. V/S: Temp 97.2, HR 78, BP 138/87, Resp 16. No s/s of acute distress noted. Pt. denied SOB, difficulty swallowing, rash, or itching. Pt. kept in first aid for 25 minutes and then denied any further nausea or symptoms. Pt. left clinic with spouse and was advised to follow up with PCP or emergency medical services if further adverse reactions occur.

Other Meds: N/A

Current Illness: None reported

ID: 1088483
Sex: M
Age: 75
State: MN

Vax Date: 03/02/2021
Onset Date: 03/04/2021
Rec V Date: 03/10/2021
Hospital:

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

Lab Data:

Allergies: Seafood, Halcion

Symptom List: Nausea

Symptoms: Swelling and redness in left arm, just below the vaccination site. After one week the swelling and redness seem to be somewhat reduced

Other Meds: Warfarin, Losartin, Sotolol, Atorvastin, Zolpidem (Ambien), Senior Vitamins supplements, Healthy Eyes

Current Illness: COVID diagnosis on December 5, 2020

ID: 1088504
Sex: F
Age:
State: MD

Vax Date: 11/03/2009
Onset Date:
Rec V Date: 03/10/2021
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: Suffered skin lesions in breast and chest and severe ear pain and was diagnosed with shingles and post herpetic neuralgia; Suffered skin lesions in breast and chest and severe ear pain and was diagnosed with shingles and post herpetic neuralgia; This initial spontaneous report was received from a lawyer regarding a case in litigation and refers to a female patient of unknown age. No information was provided regarding medical history, concurrent conditions, or concomitant medications. In or around 03-NOV-2009, the patient was vaccinated (inoculated) with zoster vaccine live (ZOSTAVAX) (lot#, expiration date, dose, dose# and route not specified) for routine health maintenance and for its intended purpose: the prevention of shingles (prophylaxis). Shortly after receiving zoster vaccine live (ZOSTAVAX) the patient suffered skin lesions in breast and chest and severe ear pain and was diagnosed with shingles and post herpetic neuralgia. As a direct and proximate result of the patient's use of the vaccine live (ZOSTAVAX) vaccine, the patient had resulted in physical limitations do not present prior to using the product. Also, experienced mental and emotional distress due to resulting physical limitations and seriousness condition. As a result of the manufacture, marketing, advertising, promotion, distribution and sale of zoster vaccine live (ZOSTAVAX), the patient sustained severe and permanent personal injuries. Further, as a tragic consequence, the patient suffered serious, progressive, permanent, and incurable injuries, as well as significant conscious pain and suffering, mental anguish, emotional distress, loss of enjoyment of life, physical impairment, and injury. As a direct and proximate results of defendant's conduct, the patient suffered and incurred damages, including medical expenses; the loss of accumulation; and other economic and non-economic damages. The outcome of the event s was reported as not recovered. Therefore, the causality for the event was related to zoster vaccine live (ZOSTAVAX). The lawyer considered the shingles and post herpetic neuralgia to be disability events.

Other Meds:

Current Illness: Routine health maintenance

ID: 1088505
Sex: M
Age:
State: SC

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

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

Lab Data:

Allergies:

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

Symptoms: Pneumonia; This spontaneous report was received from a lawyer referring to an elderly male patient (pt) of unknown age with high blood pressure (HBP) and neuropathy. The pt had been diagnosed with chicken pox in approximately 1950 at 2-5 years old, but did not receive the chicken pox vaccine. The pt had smoked or used tobacco products from 1960 to 2015 (3 packs a day). Concomitant therapy included losartan. In 2015, the patient was vaccinated with pneumococcal vaccine, polyvalent (23-valent) (manufacturer unknown) (strength, dose, route, lot # and expiration date were not reported) for prophylaxis which caused pneumonia in 2015. The patient was treated with steroids or corticosteroids. The outcome of pneumonia was unknown. The reporter considered pneumonia to be related to pneumococcal vaccine, polyvalent (23-valent) (manufacturer unknown). Upon internal review, event pneumonia was considered to be medically significant. This case was split from a legal case regarding the same patient.; Sender's Comments: US-009507513-2008USA002306:

Other Meds: losartan

Current Illness: Blood pressure high (received treatment since 2013); Neuropathy (received treatment since 2013)

ID: 1088508
Sex: M
Age:
State: MI

Vax Date: 02/23/2021
Onset Date: 02/24/2021
Rec V Date: 03/10/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: diarrhea; 12 hours after injection - fainted in bathroom/fainted 2nd time; woozieness when trying to walk/just felt woozy; headache; chills; This is a spontaneous report from contactable consumers (patient and wife). This 67-year-old male patient received second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Lot number: EN6202) in right arm on 23Feb2021 05:00pm at single dose for COVID-19 immunisation. Medical history included high cholesterol, acid reflux (esophageal). The patient had no known allergies. Concomitant medications in two weeks included atorvastatin for high cholesterol, ongoing omeprazole for acid reflux (esophageal), and ongoing multivitamins (1 tablet a day for men over 50 by mouth as supplementation therapy). The patient did not receive other vaccine in four weeks. The patient previously received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Lot number: EM9810) at the age of 67-year on 02Feb2021 at 05:00PM in left arm at single dose for COVID-19 immunisation, had no reaction with the first dose, had no issues in the waiting period or while shopping afterwards; received influenza vaccine (FLU) and pneumonia shot for immunization on an unknown date a couple of months ago. The patient did not have COVID prior vaccination, COVID was not tested post vaccination. The patient received second dose of the Covid-19 Vaccine, then on 24Feb2021, fainted twice 12 hours after receiving the second dose, fainted in the morning of 24Feb2021 around 05:20, he got up because he had diarrhea and that was when he first fainted in the bathroom. He also had chills and a headache in the morning of 24Feb2021 at 05:15, but she reported that he did not have a fever. Temperature was normal on 24Feb2021. The patient reported that he just felt woozy, wooziness when trying to walk/just felt woozy in the morning of 24Feb2021 at 05:15. She said that he fainted for a second time just minutes after he fainted the first time when the reporter was helping the patient get back from the bathroom to the bedroom, the patient collapsed on the floor and reporter got him up. He developed the diarrhea around 05:30 in the morning of 24Feb2021. He took some ibuprofen to treat the headache. It was unknown if the treatment received for the other events. He has been resting since he had the diarrhea. Outcome of the events faint and diarrhea was unknown, wooziness when trying to walk/just felt woozy was recovering, while other events was recovered on 24Feb2021.

Other Meds: ATORVASTATIN; OMEPRAZOLE

Current Illness:

ID: 1088509
Sex: F
Age:
State: CT

Vax Date: 01/18/2021
Onset Date: 01/18/2021
Rec V Date: 03/10/2021
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: Tremor

Symptoms: Lost consciousness; palms began to itch, then soles of feet; This is a spontaneous report from a consumer (patient). A 76-year-old female patient received first dose of BNT162B2 (lot number was EL8982 and expiration date was unknown) via an unspecified route of administration at left arm 18Jan2021 14:30 at single dose for COVID-19 immunisation, amoxicillin via an unspecified route of administration from 18Jan2021 at 14:50 at 4 DF for dental apt, procaine hydrochloride (NOVOCAIN) via an unspecified route of administration from 18Jan2021 at unknown dosing regimen for an unspecified indication. Medical history included 3 joint replacements and known allergies to raw celery, clover honey and ragweed. Concomitant medication included atorvastatin calcium (ATORVASTIN), brimonidine tartrate, timolol maleate (COMBIGAN), levothyroxine, tolterodine. There was no other vaccine in four weeks. Patient did not have COVID prior vaccination. The patient had no reaction in first 15 minutes. Within 20 minutes of shot, patient took 4 amoxicillin for dental apt (as reported), then received procaine hydrochloride (Novocain). 45 min after shot, her palms began to itch, then soles of feet. Then she total loss of sight on 18Jan2021 at 15:30. Patient lost consciousness at emergency room check-in. Patient visited emergency room/department or urgent care. Patient received epinephrine injection as treatment. She also had CT scan of head and chest in Jan2021. She did not have COVID tested post vaccination. The outcome of events was recovered in 2021. The action taken in response to the events for amoxicillin and procaine hydrochloride was unknown.

Other Meds: ATORVASTIN; COMBIGAN; LEVOTHYROXINE; TOLTERODINE; Amoxicillin; NOVOCAINE

Current Illness:

ID: 1088510
Sex: U
Age:
State:

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

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

Lab Data:

Allergies:

Symptom List: Erythema, Pruritus

Symptoms: ended up with paralysis; got last flu shot in 1976 and was very sick for many days; Initial information was received on 01-Mar-2021 regarding an unsolicited valid serious case from a consumer or non-healthcare professional (under reference number: US-SA-SAC20210304000371). This case involves an adult patient who experienced ended up with paralysis (paralysis) and got last flu shot in 1976 and was very sick for many days (illness), while the patient received INFLUENZA VACCINE. Medical history, medical treatment, vaccination, concomitant medication and family history were not provided. On an unknown date, the patient received a dose of suspect INFLUENZA VACCINE produced by unknown manufacturer [lot number and expiry date not reported] via an unknown route at an unknown administration site for prophylactic vaccination. On an unknown date, the patient developed a paralysis unknown latency following the administration of INFLUENZA VACCINE. This event was assessed as medically significant. On an unknown date, the patient got last flu shot in 1976 and was very sick for many days (illness) unknown latency following the administration of INFLUENZA VACCINE. Details of laboratory data was not reported. It was not reported if the patient received a corrective treatment. At the time of reporting, the event outcome is unknown for both the events. Information on batch number is requested.; Sender's Comments: This case involves an adult patient who experienced paralysis and illness (unknown latency) after vaccination with INFLUENZA VACCINE (produced by unknown manufacturer). The time to onset was unknown. Further information regarding concurrent condition during vaccination, previous vaccination and tolerance, laboratory investigations excluding alternative etiologies for the reported event are needed to fully assess this case. Based upon the reported information, the role of the suspect vaccine cannot be assessed.

Other Meds:

Current Illness:

ID: 1088511
Sex: M
Age: 65
State: AZ

Vax Date: 03/09/2021
Onset Date: 03/09/2021
Rec V Date: 03/10/2021
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: none

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

Symptoms: fever in excess of 100 degrees for about 6 hours accompanied by chills, headache

Other Meds: valsartan/hctz 320mg/25mg, omeprazole 20mg, loratadine 10mg, montelukast 10mg, cetrizine 10mg, walgreens multivitamin 50+, nature made b-complex vitamin, walgreen's vitamin 180mg, panax ginseng 1000mg

Current Illness: none

ID: 1088512
Sex: F
Age: 76
State:

Vax Date: 03/08/2021
Onset Date: 03/08/2021
Rec V Date: 03/10/2021
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, headache, fatigue, body aches, weakness, loss of appetite. Lasted about 24 hours.

Other Meds: Losartan, amlodopine. Metropolis, pradaxa, centrum silver

Current Illness:

ID: 1088513
Sex: F
Age: 27
State: NY

Vax Date: 03/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/10/2021
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: Bee, peanut, codeine

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Swelling of the hands and lips, treated with Benadryl by next morning swelling had decreased some. By day 2 all of swelling had resolved

Other Meds: Fiber gummies, gabapentin

Current Illness: N/A

ID: 1088514
Sex: F
Age: 54
State:

Vax Date: 02/23/2021
Onset Date: 02/26/2021
Rec V Date: 03/10/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Severe rash and itching on right arm and around fingers. Steroid shot

Other Meds:

Current Illness:

ID: 1088515
Sex: M
Age: 21
State: NY

Vax Date: 03/09/2021
Onset Date: 03/09/2021
Rec V Date: 03/10/2021
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: Penicillin, amoxicillin

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

Symptoms: Muscle aches and pains, fever, headache

Other Meds: N/A

Current Illness: N/A

ID: 1088516
Sex: M
Age: 62
State: WI

Vax Date: 03/08/2021
Onset Date: 03/09/2021
Rec V Date: 03/10/2021
Hospital: Y

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

Lab Data:

Allergies: none

Symptom List: Pain in extremity

Symptoms: hospitalization for cough, fever and acute change in mental status

Other Meds: APAP, aspirin, vitamin B complex, melatonin

Current Illness: recent hospitalization for pneumonia, recent PE on warfarin, covid diagnosed on 1/21

ID: 1088518
Sex: F
Age:
State: FL

Vax Date:
Onset Date: 03/08/2021
Rec V Date: 03/10/2021
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: H/A, body ache & feel warm; suggested to take Tylenol or ibuprofen as recommended. Hydrate well and call poison center if any questions or concerns.

Other Meds:

Current Illness:

ID: 1088519
Sex: F
Age: 77
State: WI

Vax Date: 02/11/2021
Onset Date: 02/12/2021
Rec V Date: 03/10/2021
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: Nothing

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

Symptoms: Experienced a retriggering of concussion symptoms: intense head pain, vision issues, nausea.

Other Meds: Synthroid, Restasis, eye vitamin,

Current Illness: none

ID: 1088520
Sex: M
Age: 45
State: IA

Vax Date: 03/09/2021
Onset Date: 03/09/2021
Rec V Date: 03/10/2021
Hospital:

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

Lab Data:

Allergies: NONE

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

Symptoms: Vaccine at 11:30, at 12:30 he started feeling faint, light headed, heavy legs, little nausea. Monitored blood pressure from 12:40 to 1:50, ranged 142/93 to 163/113. Pt has high blood pressure. Had he sit and recline until he felt better.

Other Meds: ENALAPRIL 10MG DAILY, PROTONIX, BABY ASA, VITAMIN B

Current Illness: NO

ID: 1088521
Sex: F
Age: 69
State: CT

Vax Date: 02/14/2021
Onset Date: 02/22/2021
Rec V Date: 03/10/2021
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: NKA

Symptom List: Vomiting

Symptoms: First noticed itchiness around injection site. Later it became hot, red, sore and hard. For two days, I didn't feel well - chilling, fatigued. Symptoms disappeared after about four days.

Other Meds: Omeprazole, Lisinopril/HCTZ, Simvastatin, multivitamin, calcium, ASA, naproxen

Current Illness: None

ID: 1088522
Sex: M
Age: 18
State: MO

Vax Date: 03/09/2021
Onset Date: 03/10/2021
Rec V Date: 03/10/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: vertigo, lethargy, tinnitus, malaise, mild diaphoresis, confusion, nausea & vomiting

Other Meds:

Current Illness:

ID: 1088523
Sex: F
Age: 26
State: KY

Vax Date: 03/09/2021
Onset Date: 03/09/2021
Rec V Date: 03/10/2021
Hospital:

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

Lab Data:

Allergies: NKA

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

Symptoms: Pt reported that approximately five hours after vaccination, she experienced uncontrollable tremors, fainting, vomiting, chest pain and tightness. Today, extremely fatigued and has some chest tightness. She has a history of chest tightness. Did not seek emergency care last night, but called physician this morning who was not in office and referred to local health dept. Advised that it would be best to consult with local emergency facility and if anything worsens she needs emergency care.

Other Meds: unknown

Current Illness: not at time of vaccination, but unknown for prior month

ID: 1088524
Sex: F
Age: 56
State: TX

Vax Date: 03/02/2021
Onset Date: 03/02/2021
Rec V Date: 03/10/2021
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: PCN; iodine; codeine; shellfish; shrimp

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Rash on arm with main large red hot welt at injection site on day 1-6, no rash on day 7-8 and welt was no longer red raised or hot, rash returned on day 9. Large raised red hot itchy welt on day 9.

Other Meds: None

Current Illness: None

ID: 1088525
Sex: F
Age: 76
State: KS

Vax Date: 01/13/2021
Onset Date: 02/03/2021
Rec V Date: 03/10/2021
Hospital: Y

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: 2nd vaccine dose received on 2/3/21. Pt tested positive for COVID-19 on 2/8/21 and was hospitalized. Our has little information regarding this patient due to her living in a long-term care facility.

Other Meds:

Current Illness:

ID: 1088526
Sex: F
Age: 73
State: NJ

Vax Date: 03/01/2021
Onset Date: 03/06/2021
Rec V Date: 03/10/2021
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: Bactrim

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

Symptoms: Shivers, temp, head pressure, fatigue , sore arm

Other Meds:

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm