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: 1104643
Sex: F
Age: 54
State: PR

Vax Date: 12/16/2020
Onset Date: 12/01/2020
Rec V Date: 03/16/2021
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: Penicillin, Codeine, Sulfa and clindamycin.

Symptom List: Dysphagia, Epiglottitis

Symptoms: Memory loss and difficulty concentrating, light vaginal bleeding, Shortness of breath and the chills, Intense pain in both legs on the night, Insomnia 2 hours later after going to bed, Tiredness and sleepiness, Bruises on right leg.

Other Meds: Synthroid 200 mg everyday.

Current Illness: Hypothyroidism.

ID: 1104644
Sex: F
Age: 23
State: VT

Vax Date: 02/22/2021
Onset Date: 03/01/2021
Rec V Date: 03/16/2021
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: amoxicillin

Symptom List: Anxiety, Dyspnoea

Symptoms: A week after my first shot, I developed a rash. It was on my injection site, both of my upper arms, and my butt. The rash is kind of red and blotchy, and very itch. It also first looked like hives. It started to go away after a couple of days, but then came back on my arms and chest. It has been about two weeks now and the rash has not gone away.

Other Meds: Zoloft and birth control pill

Current Illness: none

ID: 1104645
Sex: F
Age: 39
State: WA

Vax Date: 03/06/2021
Onset Date: 03/06/2021
Rec V Date: 03/16/2021
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: Penicillin

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

Symptoms: 39 YO F AT COVID 19 SHOT CLINIC OBSERVATION AREA C/O ALL OVER TINGLING AND NUMBNESS WITH MILD NAUSEA. DENIES SOB, WHEEZING, DIFFICULTYSWALLOWING, HOARSENESS, ITCHING, HIVES, RASH, NAUSEA OR OTHER C/O. FOUND PT IN PASSENGER SEAT OF CAR APPEARING ANXIOUS WITH ABOVE C/O. HEENT - PERRL, NO JVD, NORM SOUNDING VOICE, NO SIGNS OF ANGIOEDEMA, NOSTRIDOR TO TRACHEA WITH AUSCULTATION, CX - LS =/CLEAR BILAT, NO RASH/HIVES TO CHEST OR BACK. EXTREM - PWD, GOOD PMS X4, MOVES ALL WITH PURPOSE.

Other Meds:

Current Illness:

ID: 1104646
Sex: M
Age: 71
State: WI

Vax Date: 03/08/2021
Onset Date: 03/09/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: lorsartin

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Extreme dizziness

Other Meds: levothyroxine, metformin. metapropolol, pantorposol, sertraline, low dose aspirin,

Current Illness: none

ID: 1104649
Sex: F
Age: 51
State: NC

Vax Date: 03/12/2021
Onset Date: 03/13/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: PCN; MACROBID; MACRODANTIN

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

Symptoms: THE DAY AFTER THE FIRST DOSE OF VACCINE (3/13/2021) MY HEART RATE STARTING RACING EVERY TIME I WAS IN AN UPRIGHT STANDING POSITION. AFTER 15 MIN OF BEING UPRIGHT I WOULD HAVE TO LAY BACK DOWN UNTIL HEART RATE WAS BACK TO NORMAL. THE NEXT DAY (3/14/2021) I WAS EXPERIENCING CHEST PAINS ALONG WITH A GALLOPING HEART WHEN WALKING AROUND. THE CHEST PAINS WERE ONLY BEING EXPERIENCED ALONG WITH EXERCISE.

Other Meds: SYNTHROID 150 MCG; FIBER; VITAMIN D; MULTI VITAMIN; MAGNESIUM

Current Illness: N/A

ID: 1104650
Sex: M
Age: 68
State: IL

Vax Date: 01/21/2021
Onset Date: 01/25/2021
Rec V Date: 03/16/2021
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: None

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

Symptoms: I have had severe, watery diarrhea for the past 8 weeks following the first vaccination and continuing through second vaccination. Vomiting has also occurred with weight loss of 20 pounds.

Other Meds: doxycycline, omeprazole,gabapentin.simvastatin,metoprolol,calcium,multivitamins

Current Illness: None related to adverse effect

ID: 1104651
Sex: F
Age: 59
State: CA

Vax Date: 03/15/2021
Onset Date: 03/15/2021
Rec V Date: 03/16/2021
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: n/a

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Patient states my throat feels numb, rashes noted around neck and chest. Patient evaluated by paramedics on site. Monitored patient for 30 minutes. Patient referred to ER due to elevated BP. Patient refused and signed AMA. Patient A&O x3, accompanied by husband.

Other Meds: lisinopril levothyroxine

Current Illness: hypertension

ID: 1104652
Sex: F
Age: 65
State: IL

Vax Date: 03/02/2021
Onset Date: 03/03/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: NONE REPORTED

Symptom List: Pharyngeal swelling

Symptoms: On 03/15/2021, patient reported that about 24 hours post vaccination she experienced the normal site of injection discomfort along with warmth and redness. The area spread, was itchy and enlarged over a 1 week period. At that time the patient sought medical attention with her PCP on 03/13/2021. She was prescribed a course of CEPHALEXIN 500MG TID for 7 days and PREDNISONE 20MG d for 3 days, then 10MG d for 4 days.

Other Meds: NONE REPORTED

Current Illness: NONE REPORTED

ID: 1104656
Sex: F
Age: 52
State: IL

Vax Date: 03/11/2021
Onset Date: 03/13/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Aside from the typical Flu-like symptoms, very high fever, sore arm, etc. Heart palpitations and shortness of breath began two days following the second dose of the vaccine. My heart was racing and I was trying to catch my breath. It was very intense for 2 days and has since subsided.

Other Meds: Armour Thyroid Vit D Vit C Zinc Multivitamin

Current Illness: None

ID: 1104657
Sex: F
Age: 60
State: OH

Vax Date: 03/08/2021
Onset Date: 03/14/2021
Rec V Date: 03/16/2021
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: penicillin, latex

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Received my vaccine on March 8. I had immediate sore arm which lasted for about 60 hours. On March 14 my arm started to itch at the point of vaccination. On March 16 I noticed the area around shot was swollen and red and warm to the touch.

Other Meds: 1200 mg fish oil

Current Illness:

ID: 1104658
Sex: F
Age: 72
State: MD

Vax Date: 02/24/2021
Onset Date: 02/24/2021
Rec V Date: 03/16/2021
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: ALLERGIES: Latex, Cipro, Floxin, Levaquin

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

Symptoms: I am reporting the below as everything written has NEVER happened to me before in my 72 years of living. This has all taken place since I have had the Vaccine Injection on Wednesday, February 24th. I am attributing all of this as a possible reaction to the vaccine or maybe coincidence. I wanted to report what has taken place so you all can assess if this is a possible adverse reaction, a direct effect from the vaccine or just coincidence. Please let me know if anything like this has been reported and what your thoughts about the matter. Wednesday, February 24th 11:15am Pfizer Vaccine right arm ?about an hour later discomfort on shot side that went from the shoulder up the right side of the neck. Was gone by next day. Thursday, February 25th Day seemed to be normal. When I went to bed that evening a pressure and pounding on the left top side of the head, on the part line. Lasted 5-6 hours and then went away for that episode. Friday, February 26th Day started off OK, walked 2 miles and then ran some errands. *3:00pm I bent down to pick up something and when I came up I had extreme light headedness like I have never had before. I was able to get myself collected and then continued to get ready to go out. *6:00pm I just sat in a chair in the restaurant and BAM the room started spinning at about 500 miles (that is the speed that it felt like) an hour. My arms were flailing as I was trying to grab something to old onto. Just when I was about to fall off of the chair my husband walked up and grabbed me as he could see that something was going on and he said that I was white as a sheet. Once I got somewhat collected, I knew immediately that I had to throw up. My husband took me to the restroom. I had severe dry heaves that just would not stop. I wasn?t breathing properly so my hands and feet were numb, tingly and very white in color. Then I had to have a bowel movement. We phoned for the ambulance to take me to the hospital jus to make sure that I did not have a stroke, or it was my heart, or a vessel had burst in the head. The Paramedic tested me for a stroke and I passed the test. *8:00pm or so I had another episode with room going around at top speed and I started having dry heaves. Nurse gave me medicine in the IV for nausea. My Doctor said that everything was Benign. He said that the CT patient scan was negative and all other tests were OK. Saturday, February 27th I was released from the hospital and went home. I did very little that day. I slept that night from 10:00pm until 10:00am the next day. Sunday, February 28th I was lightheaded, had a headache, and ears ringing all day. I just did not feel myself at all. Tuesday, March 9th Around noon I had a severe lightheadedness/spinning episode, eyes felt like they were spinning. Laid down for about 2 hours and when I got up I was able to function and the spinning had gotten better. Headache all night long, ears ringing, feeling of lightheadedness. Wednesday, March 10th Not quite as dizzy, headache all day, back of neck and left side of head sore to touch. Pounding on left top side of head ? along the part line, where I had the same discomfort the 2nd day after the vaccine. Thursday, March 11th Having discomfort on left side of head. To the right of the left ear, going down to the neck. I can touch those areas and add to the discomfort. Friday, March 12th On Monday, March 7th I noticed a red spot on the right side behind where I was given the injection. I tried to treat it myself but my remedies were not helping. Contacted my Dermatologist on Thursday, March 11th. She saw me today, Friday, March 12th. She is not sure if it is a possible aftermath of the vaccine or something else. Had some bloodwork run to rule how Shingles. Prescribed some medication for Shingles to take until Monday when the bloodwork report is due for review. Blood work was negative for Shingles. Ever since the episode on February 26th I have NOT felt myself at all. Lightheaded, nausea, headache, pressure in head and feels heavy, not steady on my feet, discomfort in back of head near neckline, on/off discomfort in the top of the head with a pounding force. BLOOD PRESSURE IS NOW HIGHER THAN NORMAL ESPECIALLY WITH BOTTOM NUMBER BEING HIGH. I have never had a Blood Pressure problem, although as I have aged the top number has elevated but not enough to take medicine. However, the lower number is now elevated (high 80-?s, low mid range 90?s) and Cardiologist is going to make a decision on whether I should start on a low dose medicine. I am to take my 2nd Pfizer shot tomorrow ? Wednesday, March 17th at 11:00am. Thank You for reviewing the above writings. I look forward to the conclusion VAERS makes on my situation.

Other Meds: PRESCRIBED MEDICINES: Aciphex, Carafate, Elavil, Premarin, Estrace Cream, Cosentyz, Atrovent Nasal Spray SUPPLEMENTS: Vitamin C, Vitamin D3, Multi-Vitamin, Vital Proteins-Collagen Peptides Powde in OJ, Shaklee-Energizing Soy Protein in

Current Illness: None

ID: 1104659
Sex: F
Age: 34
State: CA

Vax Date: 03/15/2021
Onset Date: 03/15/2021
Rec V Date: 03/16/2021
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: NKDA

Symptom List: Rash, Urticaria

Symptoms: SOB, BP 107/68, HR 82, O2 100%, No progression of Symptoms, SOB resolving, Ate crackers/juice. Patient provided wheelchair transport to parking lot. Doing fine per patient.

Other Meds: Prozac, Zoloft, Keppra, Topmax

Current Illness:

ID: 1104660
Sex: F
Age: 58
State: GA

Vax Date: 03/04/2021
Onset Date: 03/05/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: Aspirin

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

Symptoms: The adverse event occurred the next morning when the pain from the injection sight on the left upper arm felt like it moved into my armpit and left side lymph nodes. Very painful accompanied it. The day after that the lymph nodes in my left collarbone area became swollen and painful with an increased fever, chills, headache that lasted for a week. I got the vaccine on a Thursday (3/4/21) and went to my doctor on Monday (3/8/21) to get checked out. This was only my first vaccine. I had a bad case of Covid-19 in June-July 2020 and my husband passed from Covid-19 at that time. I still have swelling in my left collarbone lymph nodes today.

Other Meds: none

Current Illness: none

ID: 1104661
Sex: F
Age: 17
State: VA

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 03/16/2021
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 was administered a second dose of Moderna vaccine following PCP prescription authorization. She had received the first dose mistakenly and was finishing the series

Other Meds:

Current Illness:

ID: 1104663
Sex: F
Age: 49
State: CA

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 03/16/2021
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: NKA

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

Symptoms: Approximately 1/2 dose was wasted 2/2 accidental needle disconection. RN contacted pharmacy, and after discussion with the patient, determined that she would not like a secondary 1/2 dose to supplement what was lost.

Other Meds: UTD

Current Illness: n/a

ID: 1104664
Sex: M
Age: 58
State: UT

Vax Date: 03/15/2021
Onset Date: 03/15/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Received first vaccine shot 9:00 am. Left shoulder. Felt fine all day. Went to bed that evening about 10 pm. Woke up at 11:15 pm with severe shivering, and was extremely cold. My temperature was 98.6. Turned my heat up to 74, added blankets to my bed, could not get warm. Finally had to add a large heat pack to my bed to alleviate shivering. My left shoulder and arm hurt. Abnormally bad sleep. Woke up this morning at 9:30am and am lethargic and very tired. I feel like I was hit by a truck.

Other Meds: Omeprazole Cimetidine Neupro Nuvigil Vitamin D Vitamin C

Current Illness: None

ID: 1104665
Sex: M
Age: 67
State: ME

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/16/2021
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: History of anaphylaxis to morphine IV

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

Symptoms: Itching skin under chin and throat

Other Meds: None known

Current Illness: s/P Aortic dissection S/P repair PFO 3 weeks ago

Date Died: 03/16/2021

ID: 1104666
Sex: F
Age: 79
State: GA

Vax Date: 01/14/2021
Onset Date: 03/05/2021
Rec V Date: 03/16/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient presented with dyspnea and found to have COVID 19 infection. Treated with steroids and oxygen but clinically deteriorated and died

Other Meds:

Current Illness:

ID: 1104667
Sex: F
Age: 17
State: WI

Vax Date: 03/11/2021
Onset Date: 03/11/2021
Rec V Date: 03/16/2021
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: Patient is 17 and was inadvertently vaccinated.

Other Meds:

Current Illness:

ID: 1104668
Sex: M
Age: 70
State: TX

Vax Date: 03/14/2021
Onset Date: 03/16/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: Cipro

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

Symptoms: Red Rash on both right and left underarms

Other Meds: Tylenol, naproxen, losartan, ziac, arorvastatin, low dose aspirin, super B complex vitamin, fish oil, turmeric

Current Illness: One

ID: 1104669
Sex: F
Age: 57
State: NC

Vax Date: 03/05/2021
Onset Date: 03/13/2021
Rec V Date: 03/16/2021
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: Sulfa, codiene, kiwi, chocolate, lactose intolerant,

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

Symptoms: Sore injection site for 2 days, 7/8 days after injection developed a large red splotch on left arm near injection site - is very red, hard and warm to the touch, some soreness and itching.

Other Meds: Levothyroxine 100 mcg qd, Vitamin D3 2,000 iu and Coenzyme B-Complex Caps qd, Benadryl prn

Current Illness: Papillary Thyroid Cancer recurrence, localized, no spread. Removed in January 2021.

Date Died: 03/13/2021

ID: 1104671
Sex: M
Age: 39
State: MI

Vax Date: 03/12/2021
Onset Date: 03/13/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: IV lactated ringers, midazolam, morphine, vancomycin

Symptom List: Unevaluable event

Symptoms: Patient has a long history of seizures. He has seizures on a daily basis. He lives with his family, who are his primary caregivers, they family provides all of his activities of daily living. Patient received vaccine on Friday morning, feeling well throughout the day according to the father. Went to bed, during the night in bed he had seizures which is typical for him, and during the episode the father noticed that he had stopped breathing. called 911 who came to the house and the patient died in the house. I do not believe he went to the hospital.

Other Meds: CoQ-10 200 mg twice a day, diazepam 10mg one as needed for seizures, Dilantin Infatabs 50mg 1 tab every morning. lamictal 150mg 2 tabs twice a day, midodrine 2.5mg 1 tab twice a day, vitamin D3 400IU daily.

Current Illness: Seizure disorder, severe mitochondrial myopathy, gastroesophageal reflux disease

ID: 1104672
Sex: F
Age: 76
State: NC

Vax Date: 02/25/2021
Onset Date: 02/25/2021
Rec V Date: 03/16/2021
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: Penicillin, lidocaine, Novocain, most antibiotics, yellow jackets, wasps, shrimp

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

Symptoms: Headache first and 2nd day. A week later woke me up 2 nights in a row but only lasted 12-15 minutes. Skipped heart beats day after and the next am, none since. Rash of red irregular dots about the size of a pencil eraser with bumpy raised flesh directly on veins. started 2 weeks after, lasted 4 days, loss of appetite, much more intense joint pain and sleeplessness which comes and goes.

Other Meds: None

Current Illness: Osteoarthritis

ID: 1104673
Sex: F
Age: 74
State: VA

Vax Date: 03/05/2021
Onset Date: 03/15/2021
Rec V Date: 03/16/2021
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: Sulphur antibiotics,

Symptom List: Injection site pain, Pain

Symptoms: Yesterday, March 15th, I woke with a rash on my neck and swollen eye lids, just like an allergic reaction. I have not eaten anything new, nor taken any new medications or over-the counter supplements since I received my shot. Could I have a delayed allergic reaction?

Other Meds: Glipizide 5 mg; Escitalopram 10 mg; Lisinopril 5 mg; Rosuvastatin 10 mg; Metoprolol 50 mg; Calcium w/Vitamin D; Super B Complex; COQ10; Tumeric; Biotin; Fiber Con; Magnesium; Potassium; 81 mg Aspirin; Coconut Oil; Flonase; and Benadryl.

Current Illness: None

ID: 1104674
Sex: F
Age: 86
State: FL

Vax Date: 03/11/2021
Onset Date: 03/14/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List: Injection site pain, Menorrhagia

Symptoms: 2nd day soar arm, 3rd day fatigue no appitite nauseaus. By 9:30 pm vomiting and diarhia once.had 100.7 fever . Went to bed ,from12:30 am to 4:00 am , vomited every hour on the hour. Slept til 8:00am 4thday . Drank pedialyte, gatorade water slowley. Ate a cracker toast 1/2 bannana. 9:00 pm diareaha again. Slept threw night. Fatigued on 5 th day. Today am monitoring. What should i expect after 2nd shot?,worried.

Other Meds: Carbadopa/levidopa, busipirone, midodrine, nuepro patch,donepizol,citalopram, resperidone, vitamin d

Current Illness: None

ID: 1104675
Sex: F
Age: 51
State: MD

Vax Date: 03/06/2021
Onset Date: 03/06/2021
Rec V Date: 03/16/2021
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: Iodine Dye Shell Fish Percocet

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

Symptoms: 3 Hours after vaccination, I experienced swelling around my Left ear and Left Lower Jaw with a burning sensation. The burning stopped with the fir dose of Benadryl 25mg (which I took every 8 hours for 3 additional doses) The swelling eventually decreased after 3-4 days.

Other Meds: Glipizide Amlodipine Atorvastatin

Current Illness: Hypertension Diabetes Hycholesterol

ID: 1104676
Sex: F
Age: 59
State: FL

Vax Date: 03/07/2021
Onset Date: 03/07/2021
Rec V Date: 03/16/2021
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: Poison Wood

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Fever of 101 Chills Nausea Headaches Muscle aches Extreme fatigue Swelling of forehead

Other Meds: Alendronate 70mg Lisinopril-hctz 20/12.5mg Simvastatin 10mg Metoprolol 12.5mg Aspirin 81mg D3. 4000 iu Folic Acid 800 mcg CoQ-10 Vitamin C 500 mg Zinc 50mg Turmeric/curcumin. Calcium 1200mg Fish oil 2000 mg

Current Illness:

ID: 1104677
Sex: F
Age: 77
State: FL

Vax Date: 03/08/2021
Onset Date: 03/08/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: sensitive to most antibiotics, environmental allergies, cannot tolerate vitamin D3, calcium,

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Day 1 sore injection site moved to shoulder and upper back, dizziness Day 2 exhaustion, dizziness, headache Day 3 exhaustion dizziness, headache Day 4 continuing headache, joint aches Day 5 back pain, pain in back of head, joint aches Day 6 back pain more severe, pain in back of head, joint aches Day 7 lessening back pain, spasms,, joint aches

Other Meds: Advil dual

Current Illness: IBS

ID: 1104678
Sex: M
Age: 76
State: WA

Vax Date: 03/06/2021
Onset Date: 03/06/2021
Rec V Date: 03/16/2021
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: Oxycodone, Tetracycline

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

Symptoms: 76 YO M C/O LEFT SIDE RING AND LITTLE FINGER HAS GONE NUMB AFTER COVID 19 SHOT (PFIZER) WHILE WAITING IN THE OBSERVATION AREA. PT HAS NO OTHER C/OOR SX. NUMBNESS IS IMPROVING AFTER MOVING ARM AROUND. DENIES ALL SX RELATIVE TO ALLERGIC/ANAPHYLACTIC REACTIONS.FOUND ABOVE PT SITTING A/O X4, NO DISTRESS, CX - GOOD RESP EFFORT, WITHOUT C/O. EXTREM - GOOD PMS X4 WITH EXCEPTION OF LITTLE AND RING FINGER OFLEFT HAND. R/O TEMPORARY NUMBNESS OF RING AND LITTLE FINGER OF LEFT HAND SECONDARY TO ULNAR NERVE COMPRESSION. EXAM, T&R WITH INSTRUCTIONS TO FOLLOW UP IF NUMBNESS DOESNT GO AWAY.

Other Meds: Metformin

Current Illness:

ID: 1104679
Sex: F
Age: 79
State: MI

Vax Date: 03/06/2021
Onset Date: 03/15/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: Penicillin Antibiotics Sulpha

Symptom List: Nausea

Symptoms: Redness, itching and hard spot at vaccine site. Started as hives at vaccine spot

Other Meds: None

Current Illness: Heptocellular carcinoma

ID: 1104680
Sex: M
Age: 68
State: TX

Vax Date: 02/22/2021
Onset Date: 03/12/2021
Rec V Date: 03/16/2021
Hospital: Y

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

Lab Data:

Allergies: None.

Symptom List: Injection site pain

Symptoms: On 03/12/2021 at 0630 fell out of bed, wife witnessed tonic clonic seizure of 5+ minutes duration, when EMS arrived patient was postictal (confusion).

Other Meds: Losartan 50 mg, once daily, OTC Multivitamin, once daily, OYC Zinc 15mg, once daily.

Current Illness: Hypertension.

ID: 1104681
Sex: F
Age: 35
State: VA

Vax Date: 03/13/2021
Onset Date: 03/14/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: Codeine

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

Symptoms: Extreme pain at injection site and extreme fatigue for 24 hours.

Other Meds: OTC prenatal vitamins

Current Illness: Had COVID 1 month prior

ID: 1104682
Sex: F
Age: 90
State: MD

Vax Date: 03/05/2021
Onset Date: 03/12/2021
Rec V Date: 03/16/2021
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:

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

Symptoms: 3/12/2021 Presented to the hospital with altered mental status, and was ultimately diagnosed with a urinary tract infection. The patient was admitted for IV antibiotics with resolution of the patient's mental status.

Other Meds:

Current Illness:

ID: 1104683
Sex: F
Age: 36
State: CA

Vax Date: 03/13/2021
Onset Date: 03/13/2021
Rec V Date: 03/16/2021
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: N/A

Symptom List: Tremor

Symptoms: EXTREME tiredness, couldn't keep eyes open by 7pm. Woke up with a terrible headache and slept the entire next day. Jittery, fast heartbeat, mild confusion/forgetfulness, feeling scattered, anxious and weepy all lasted into the 3rd day following the injection.

Other Meds: N/A

Current Illness: N/A

ID: 1104685
Sex: F
Age: 29
State: CA

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/16/2021
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: Felt faint/sweaty 15 minutes after the vaccine was given. Pale and moist appearing. BP 80/40 (pulse 66), O2 sat 99%. Given water and felt better after rest. BP 132/76 (pulse 74).

Other Meds:

Current Illness:

ID: 1104686
Sex: F
Age: 51
State: WA

Vax Date: 02/26/2021
Onset Date: 03/12/2021
Rec V Date: 03/16/2021
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: 02/27/21: Full body aches, fever, chills, nausea x 18 hours 03/12/21: 14 days post vaccination. Body rash that started on neck, chest and back, progressed, despite taking Benadryl and Hydrocortisone cream. Seen in urgent care at hospital when entire body covered in red rash all over torso, neck, head and extremities. Itchy. Prescribed Prednisone and Benadryl. Rash ongoing as this is being reported.

Other Meds: Terbinafine (started 2/25/21; baby aspirin qd; OTC MultiVitamin, Tumeric, Melatonin, Vitamen D.

Current Illness: None

ID: 1104687
Sex: F
Age: 29
State: IL

Vax Date: 03/16/2021
Onset Date: 03/16/2021
Rec V Date: 03/16/2021
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: Aspirin, advocados

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

Symptoms: Anxiety episode : duration 10-15 minutes tachycardia tachypnea

Other Meds: Albuterol

Current Illness: asthma, anxiety

ID: 1104688
Sex: F
Age: 33
State: NJ

Vax Date: 02/02/2021
Onset Date: 02/22/2021
Rec V Date: 03/16/2021
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: Penicillin

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Vertigo, intermittent, daily

Other Meds:

Current Illness:

ID: 1104689
Sex: F
Age: 65
State: NJ

Vax Date: 02/24/2021
Onset Date: 03/01/2021
Rec V Date: 03/16/2021
Hospital: Y

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: Had serious hive, rash, swelling of tongue, lips, throat, beginning on 3/1/21 early am. Ended up in hospital on 3/1/21 as throat closed up, needed medical attention. Was hospitalized over night and then had another severe attach where breathing was obstructed and was taken to hospital by squad on 03/04/21 was treated and given an EpiPen.was on Prednisone, Benadryl, Xyzal etc.

Other Meds: Synthroid & Simvastatin

Current Illness: After my 1st Moderna COVID shot on 01/26/2021 had some small blister type hive and itching but did not realize it was from the shot.

ID: 1104690
Sex: M
Age: 56
State: MS

Vax Date: 03/09/2021
Onset Date: 03/09/2021
Rec V Date: 03/16/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EK9231
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

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

Symptoms: TINNITUS

Other Meds: none

Current Illness: none

ID: 1104691
Sex: F
Age: 66
State: NC

Vax Date: 03/08/2021
Onset Date: 03/08/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: none known

Symptom List: Pain in extremity

Symptoms: Pfizer COVID-19 vaccine given as first dose; Moderna COVID-19 vaccine given as second dose. No known adverse reactions have occurred to date.

Other Meds: unknown

Current Illness: none

ID: 1104692
Sex: M
Age: 57
State: WA

Vax Date: 03/06/2021
Onset Date: 03/06/2021
Rec V Date: 03/16/2021
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: 57 YO M C/O POSS ALLERGIC REACTION TO COVID 19 VACCINE. PT RECIEVED VACCINE 8 MINUTES BEFORE WE CONTACTED HIM IN THE OBSERVATION AREA. PT C/O ANUMB TONGUE GOING INTO THE THROAT WITH A RED RASH ACROSS UPPER CHEST WITH REDNESS GOING UP HIS NECK THAT HIS WIFE STATES IS NOT NORMAL FORHIM. PT DENIES DIFFICULTY SWALLOWING BUT STATES TONGUE FEELS LARGER THAN NORMAL. DENIES SOB, CHANGE TO VOICE, DIFFICULTY SWALLOWING, OR OTHERSENSATIONS OF SWELLING. ALSO DENIES NAUSEA. FOUND PT IN PASSENGER SEAT OF CAR A/O X4 IN NO OBV DISTRESS,. HEENT - PERRL, NO JVD, SPEAKS IN CLEAR VOICE IN FULL SENTENCES, NO STRIDOR TOASUSCULTATION OF TRACHEA, RED RASH BILAT ACROSS NECK THAT WIFE STATES IS NOT NORM - PT SAYS IT IS NORM TO SOME DEGREE BUT NOT NORMALLY THISRED. NO SIGNS OF ANGIOEDEMA OR OTHER ABNORMALITIES. CX - LS = CLEAR BILAT ALL, REDNESS/RASHY LOOKING PATCH ACROSS UPPER CHEST. EXTREM - PWD,GOOD PMS X4, MOVES ALL WITH PURPOSE. R/O MILD VACCINE REACTION/ALLERGIC REACTIONEXAM, VS, O2 SAT, ER VIA AMBULANCE

Other Meds:

Current Illness:

ID: 1104693
Sex: M
Age: 69
State: PA

Vax Date: 02/26/2021
Onset Date: 02/26/2021
Rec V Date: 03/16/2021
Hospital: Y

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

Symptoms: Light-headedness for several hours following vaccine, followed by massive heart attack.

Other Meds: Triumeq, calcium, vitamin D3

Current Illness: none

ID: 1104694
Sex: F
Age: 62
State: VA

Vax Date: 03/07/2021
Onset Date: 03/07/2021
Rec V Date: 03/16/2021
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: Ultram, latex.

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

Symptoms: Got the vaccine, and a few minutes or so she felt like a funny sensation up around/left side of her head, like something was crawling inside her head, like something bulging. Throbbing type pressure sensation. She did not say anything at the time, and went home. She went home and still felt the feeling on her head. She did also notice that her hot flashes got a little worse than usual. Had a sore arm for a couple of days. When she laid down at night she could feel that sensation/throbbing in her head a little more. She put a ice compress on it but could feel it a little bit, not as bad as it was as of today 3/16/21. She called the pharmacy on Wednesday 3/10/21 who advised her to go see her PCP. She went to the UC last Friday 3/12/21 as she could not see her PCP. They checked her scalp and did not see any rashes or anything, and advised her to take Motrin intermittently with Ibuprofen. She also told her to check back if she continued to have problems, but she decided to see her regular PCP.

Other Meds: Lisinopril/HCTZ, Buspirone, saline nasal spray, multivitamin, Pinnsaid topical.

Current Illness: Sinus issues in February.

ID: 1104695
Sex: F
Age: 75
State: IL

Vax Date: 03/11/2021
Onset Date: 03/11/2021
Rec V Date: 03/16/2021
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: Penicillins, Sulfa, Erythromycin, Fexofenadine, Metronidazole, Levofloxacin, Moxifloxacin, Montelukast, Regadenoson, Fluticaone Propionate Salmeterol, Iodated Contrast Media, Influenza Virus Vaccine 9/9/2014

Symptom List: Vomiting

Symptoms: Sharp pain at and surrounding the injection site began within hours of receiving the vaccine. 12 hours after receiving injection: sharp, stabbing, searing pain along all the nerves that radiate from L4, L5, through both hips, down and around both legs. Sharp, stabbing, searing pain in the upper back. Intense knee pain - unable to walk. Temperature of 100.2 degrees. Headache. Brain Fog. Nausea. Extreme fatigue. Loss of balance. Loss of appetite. These symptoms lasted about 36 hours. After 36 hours muscle pain all over and fatigue. At the injection site on my left arm, the pain gradually subsided and eased over a period of 96 hours.

Other Meds: Losartan, Fluticasone, Azelastine, Doxycycline, Vitamin B12, Vitamin D3, Ibuprofen

Current Illness: Sinus infection

ID: 1104696
Sex: F
Age: 66
State: IL

Vax Date: 01/31/2021
Onset Date: 01/31/2021
Rec V Date: 03/16/2021
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: FIRST SHOT BODY ACHES SWOLLEN INJECTION SIGHT AND HEADACHE FOR 3 DAYS SECOND SHOT SWOLLEN REDNESS IN INJECTION SIGHT, SEVERE CHILLS WITHIN 24 HOURS, FATIGUE, HEADACHE FOR 6 DAYS

Other Meds: Daily vitamin

Current Illness: none

ID: 1104697
Sex: F
Age: 68
State: IL

Vax Date: 03/15/2021
Onset Date: 03/16/2021
Rec V Date: 03/16/2021
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: .Dilauded. Lilacs, snow ball flowers, pineapple and coconut

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

Symptoms: Enlarged lymph node and pain at collarbone after receiving first Dose 1 on 2/22/2021. Pain and swelling had alleviated itself after 7 days. Then after Dose 2 on 3/15/2021 same incident occurred, but more severe. Waiting to see if the pain and swelling goes away.

Other Meds: Biotin 5000mg for hair & nails

Current Illness: Enlarged lymph node near collar bone.

Date Died: 03/15/2021

ID: 1104698
Sex: F
Age: 66
State:

Vax Date: 02/03/2021
Onset Date: 03/03/2021
Rec V Date: 03/16/2021
Hospital: Y

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: RESPIRATORY DISTRESS Death

Other Meds:

Current Illness:

Date Died: 02/12/2021

ID: 1104699
Sex: M
Age: 85
State: KS

Vax Date: 02/05/2021
Onset Date: 02/06/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies: Quinolone (oral)

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

Symptoms: Patient had been admitted to hospice care on 11/3/20. He reportedly declined in health and died 2/12/21.

Other Meds: Guaifenesin Lorazepam Morphine Ipratropium-Albuterol Venlafaxine Phenazopyridine Amoxicillin Divalproex Sodium Albuterol Omeprazole Furosemide Meloxicam Donepezil Budesonide-Formoterol Memantine

Current Illness: Pneumonia 1/15/21

ID: 1104700
Sex: F
Age: 45
State: MA

Vax Date: 03/15/2021
Onset Date: 03/16/2021
Rec V Date: 03/16/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: SEVERE muscle aches, every single muscle in my body hurts down to my fingertips, jaw and toes. Extreme fatigue, extreme chills, severe headache so much so that tylenol is not even cutting it

Other Meds: Armor thyroid 60mcg Slend birth control pill B12, D, Magnesium, sink, folate

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm