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: 1233424
Sex: F
Age: 31
State: CO

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 04/20/2021
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: amoxicillin

Symptom List: Dysphagia, Epiglottitis

Symptoms: t + 3 hours: onset of arm pain and limited arm mobility t + ~5 hours: onset of join pain, body aches, fatigue, dizziness, reduced appetite. t +~7 hours: onset of muscle pain throughout body, chills/shivering/teeth chattering, muscle weakness and lack of coordination (dropping items, unable to hold items in hands), no appetite t + ~9 hours: extreme chills, teeth chattering, inability to keep warm even with lots of layers and blankets, confusion, dizziness, migraine, fever (temp unknown); took 400mg ibuprofen to reduce headache and body pain, exposure to light causes eye/head pain t+~12 hours: extreme weakness and muscle aches, moving at all causes waves of chills and pain throughout body, severe migraine with aura, moving or standing is very difficult to impossible, lack of balance and coordination, fever (temp unknown), profuse sweating enough to soak through clothes. Weakness such that a glass of water 1ft away cannot be lifted. Had to get up to go to bathroom, and had to prop myself up on furniture and walls to make it the 15ft to the bathroom from bed. t + ~24 hours: some muscle weakness, fever cleared, generally feeling well with some aches and tiredness. Felt sicker than I've ever been in my life -- like influenza but more extreme symptoms with shorter duration.

Other Meds: Sertraline 100mg daily; Methylphenidate ER tabs 18mg daily; adult multivitamin daily

Current Illness: none

ID: 1233425
Sex: M
Age: 43
State: CT

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 04/20/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Anxiety, Dyspnoea

Symptoms: Within a few hours my left should joint started to hurt. Within 8 hours I was in extreme pain and could not move my left arm. Any movement of my left arm resulted in strong stabbing pain in my shoulder. After three days it improved and after one week it was completely gone. The AE reminded me of calcific tendonitis flare up which I have in both shoulders. I went to urgent care as I could not sleep due to pain and they told me to wait a few days and take OTC pain meds.

Other Meds: Advair 100/50 Proventil Inhaler

Current Illness: None

ID: 1233427
Sex: F
Age: 47
State: IN

Vax Date: 04/13/2021
Onset Date: 04/13/2021
Rec V Date: 04/20/2021
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: Aspirin, Sulfamethoxazole, Iodine contrast dye

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

Symptoms: Dizziness: right after shot Arm soreness and couldn't lift my arm, facial flushing, chills : after approximately after 5 hours Severe facial itchiness with red patches on the face and neck: started next dat and last 3 days

Other Meds: Sertraline 100 MG daily, Nature's Bounty Probiotic 10 (Ultra strength) 1 per day, Clarintin 24hr 1 per day

Current Illness: Seasonal allergy

ID: 1233428
Sex: F
Age: 45
State: CO

Vax Date: 02/12/2021
Onset Date: 02/15/2021
Rec V Date: 04/20/2021
Hospital:

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

Lab Data:

Allergies: Unknown

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Patient had a headache and vision changes, went to ER. They ran tests and found it was "stroke."

Other Meds: Unknown

Current Illness: unknown

ID: 1233429
Sex: F
Age: 53
State: MI

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 04/20/2021
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: Patient was administered a Pfizer Covid-19 vaccine that was exposed to a temperature excursion. (Vaccine was between 8-14.5 degrees C for 7hrs and 48 minutes). Pfizer was contacted and advised the clinic to consider the dose as invalid and to revaccinate. Patient was revaccinated on 03/19/21 and has since received dose 2 on 04/09/21

Other Meds:

Current Illness:

ID: 1233430
Sex: M
Age: 63
State: IA

Vax Date: 04/09/2021
Onset Date: 04/10/2021
Rec V Date: 04/20/2021
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: penecillin

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

Symptoms: Woke up the following morning (1 AM) with fever, chills, and considerable discomfort. This subsided by morning. The following day I began seeing swelling, redness, itching and burning of extremities (mainly the hands, but also feet, ears, face). These symptoms seem to be triggered by the slightest exertions, but have also exhibited without physical activity. These appear to be getting more prevalent each day.

Other Meds: glucosamine, multi-vitamin, lipoflavinoid, fish oil.

Current Illness: N/A

ID: 1233433
Sex: M
Age: 40
State: NH

Vax Date: 04/01/2021
Onset Date: 04/08/2021
Rec V Date: 04/20/2021
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: Penicillin

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: I have a constant ringing in my ears and sometimes a ringing/reverberation sound when people talk or listening to almost anything. It has not improved overtime.

Other Meds: Montelukast Sodium Tabs, Naproxen Tabs, Flovent Diskus, Humira

Current Illness: no

ID: 1233434
Sex: F
Age: 72
State: WV

Vax Date: 04/14/2021
Onset Date: 04/16/2021
Rec V Date: 04/20/2021
Hospital:

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

Lab Data:

Allergies: PENICILLIN

Symptom List: Pharyngeal swelling

Symptoms: RASH AND WARMTH ABOVE ELBOW

Other Meds: XARELTO, LISINOPRIL,DIAZEPAM, PROTONIX

Current Illness: LUNG CANCER

ID: 1233435
Sex: F
Age: 54
State: CA

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 04/20/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: Pt c/o of lightheadedness, dizzy, throat closing

Other Meds: unknown

Current Illness: ASTHMA, UNSPECIFIED DM 2 HTN (HYPERTENSION) LONG TERM INSULIN THERAPY PANIC DISORDER DEPRESSIVE DISORDER ANXIETY DISORDER INSOMNIA SEASONAL ALLERGIC RHINITIS HX OF ARTHROSCOPIC SHOULDER SURGERY HX OF SUPRACERVICAL HYSTERECTOMY PHASE POPULATION MANAGEMENT PROGRAM RECTAL BLEEDING ABDOMINAL PAIN HEADACHE

ID: 1233436
Sex: M
Age: 76
State:

Vax Date: 02/10/2021
Onset Date: 02/18/2021
Rec V Date: 04/20/2021
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:

Symptom List: Diarrhoea, Nasal congestion

Symptoms: ED visit/Hospitalizations within 6 weeks of receiving COVID vaccination.

Other Meds:

Current Illness:

ID: 1233437
Sex: F
Age: 79
State: AZ

Vax Date: 04/03/2021
Onset Date: 04/05/2021
Rec V Date: 04/20/2021
Hospital:

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

Lab Data:

Allergies: erythromycin, tetanus vaccine, walnuts, codine

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

Symptoms: severe joint and muscular pain segueing into what appears to be severe sciatica. Could be coincidence but I don?t think so. I didn?t have the sciatica previous to the vaccine.

Other Meds: natural hormones, omeprazole, famotidine, elmiron, sam ee, tylenol

Current Illness: none

ID: 1233438
Sex: F
Age: 47
State: OH

Vax Date: 03/29/2021
Onset Date: 04/14/2021
Rec V Date: 04/20/2021
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: Rash all over body after week one prednisone for 7 days then feeling dizzy and faint hard to catch breath constant faint feeling

Other Meds:

Current Illness:

ID: 1233439
Sex: F
Age: 45
State: CO

Vax Date: 04/08/2021
Onset Date: 04/14/2021
Rec V Date: 04/20/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Not too many adverse symptoms the day of and after vaccine... tired at times and sensitivity to light but continued to eat and helped w energy. Also, warm left side of neck and slight red rash. Not expecting to have leg pain in my calf 6 days later then moved to quad muscle and entire left leg felt achy. CDC at this point said to check out any leg pain. Pain was not severe but bothersome... had STAT ultra sound at ER on day 7, turned out negative for blood clots. Returned to my physicians office day 8... still not feeling right with more of a rash on left side of neck and warm to the touch. Tired and slightly light headed and slight pain in left upper chest. Digestion not the best starting day 5 thru 10. Blood test returned normal for platelet levels but low eosinophils... either allergies or body is fighting the vaccine and creating antibodies (most likely). No known allergies besides maybe skin reaction to Timothy Bluegrass. Moderate headache day 9 and 10 which made me more fatigued (pain on both sides of head above ears and temples)... normally I do not get headaches. Also, loss of appetite or feeling slight nauseous on day 8, 9, and 10 after the vaccine. Now on day 11 and 12.. feeling better but still not quite right. Lightheaded and feeling fullness in head but more energy than day 9 and 10 by far. Never heard of people having symptoms after day 1 or 2 of the vaccine, so obviously I think this should be more documented for patients especially after blood clotting as a possibility 6 days after the vaccine.

Other Meds: 105mg NP Thyroid daily

Current Illness: None

ID: 1233440
Sex: F
Age: 72
State: AL

Vax Date: 03/11/2021
Onset Date: 03/12/2021
Rec V Date: 04/20/2021
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: Iodine.

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

Symptoms: She had the vaccine, when she woke up the next day her arm was really sore and kept bending it, and thought that she was going to be okay. Almost a week later it was swollen, parallel to it and big, beat red, and hot to touch. Over the next few days she was getting more and more tired, but the arm started getting stiffer. It kept getting more and more read and spreading to the elbow and wrist. When she got up over the weekend and kept putting it off thinking that it would go away and decided to touch it out. Then it started getting numb going into her fingers. On the following Saturday she could not move her arm up due to stiffness. She had some heart flutters, was not feeling right and decided she needed to see her doctor. She saw a NP and then she went to see her cardiologist the same day. He did an EKG and told her that she was fine. That is the provider that told her that whoever gave her the shot hit a blood vessel that caused all of her symptoms. The swelling was starting to go down and did some tests for blood testing, which she states was all negative. She went to an eye doctor who is now sending her to a neurologist. She has now recovered from it completely now.

Other Meds: Atorvastatin, Levothyroxine, Losartan/HCTZ, Lysine, multivitamin, baby aspirin., Glycinamide.

Current Illness: None.

ID: 1233441
Sex: F
Age: 65
State: KS

Vax Date: 02/25/2021
Onset Date: 02/26/2021
Rec V Date: 04/20/2021
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: penicillin

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

Symptoms: Balance was way off-hit right shoulder and left shoulder walking into bathroom with very narrow hallway. VERY very dizzy. Went back to bed and slept from 6am-1:30 pm. Felt better 24 hours later.

Other Meds: Synthroid, Diazapam, Welbutrin, Viibryd, Famatodine, Simvastain Glucosimine, probiotic,melatonin, Vitamin D, Dailey vitamin,

Current Illness: none; however had shoulder surgery for bone spur and arthritis two weeks prior.

ID: 1233442
Sex: F
Age: 60
State: WI

Vax Date: 04/14/2021
Onset Date: 04/16/2021
Rec V Date: 04/20/2021
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: Aspirin, bee stings

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

Symptoms: Client called Health Department on 4/19/21, states she received her second dose of Moderna COVID-19 vaccine series on 4/14/21 at mass vaccination clinic through the Health Department. On Friday 4/16/21, client developed "hives" from her neck down to her waist, on her stomach, back and arms. Client reports she took oral Benadryl and used Benadryl cream on the rashes as needed. Client states the hives improved with taking both forms of Benadryl. Client states she still has mild hives in the same area, but they significantly improved. Client reports she did not seek medical attention for the hives because she's had similar reaction to other medications in the past that also improved with Benadryl. Client states she will continue to monitor the symptoms and will seek medical attention if they become worse or do not resolve in the next week. Client states she did not have a reaction after the first Moderna COVID-19 vaccine in the series.

Other Meds: Unknown

Current Illness: None

ID: 1233443
Sex: F
Age: 30
State: MD

Vax Date: 04/10/2021
Onset Date: 04/10/2021
Rec V Date: 04/20/2021
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: N/A

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

Symptoms: Sever flu symptoms (fever, chills, fatigue) for 24 hours and back/kidney pain at times.

Other Meds: N/A

Current Illness: N/A

ID: 1233444
Sex: F
Age: 28
State: VA

Vax Date: 04/13/2021
Onset Date: 04/13/2021
Rec V Date: 04/20/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Extreme numbness and tingling in full body, including legs, arms, neck, and face. Started a few hours after getting the vaccine. Was consistent for 3-4 days follow. I now have numbness in waves. Sometimes now it is just parts of my body going numb. Not always my full body. But I have yet to go a day, or even a few hours without experiencing numbness or tingling.

Other Meds: Sprintec, Vistaril

Current Illness: None

Date Died: 04/02/2021

ID: 1233445
Sex: F
Age: 53
State: MD

Vax Date: 04/01/2021
Onset Date: 04/02/2021
Rec V Date: 04/20/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient found in pulseless arrest on stairwell of her apartment building on the night of 4/2/21. Patient transported via ambulance to hospital where she passed away.

Other Meds: albuterol (VENTOLIN HFA) 108 (90 BASE) mcg/act aerosol solution 18 g 0 4/6/2021 insulin aspart (INSULIN ASPART) 100 UNIT/ML solution cartridge 15 mL 2 4/1/2021 Sig: Inject 4 Units into the skin 3 times daily (before meals). Up to 4 u

Current Illness: Hypertension Gastroesophageal reflux disease without esophagitis Depression Cerebrovascular accident (CVA) (CMS/HCC) Tobacco use disorder Dental abscess of left lower mouth Aug 2013, complicated by temporal abscess requring several wash-outs and s/p drain placement Neuropathy Drug-seeking behavior Opioid type dependence, continuous (CMS/HCC) Psychosocial distress Syncope Hypotensive episode Type 2 diabetes mellitus with diabetic neuropathic arthropathy, with long-term current use of insulin (CMS/HCC) Cocaine dependence (CMS/HCC) Lower extremity edema Nephrotic syndrome Hyperkalemia Pulmonary hypertension due to left heart disease (CMS/HCC) Positive D dimer CKD (chronic kidney disease), stage III Normocytic anemia COVID-19 (HFpEF) heart failure with preserved ejection fraction (CMS/HCC)

ID: 1233446
Sex: F
Age: 46
State: FL

Vax Date: 04/18/2021
Onset Date: 04/20/2021
Rec V Date: 04/20/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Red rash on stomach and lower back.

Other Meds: Fluoxetine (40 mg), Trazadone (50 mg)

Current Illness: None

ID: 1233447
Sex: F
Age: 58
State: VA

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 04/20/2021
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: Aspirin, Penicillin, Erythromycin,

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

Symptoms: I felt an intense sensation of heat throughout my body, a strange sensation in my mouth and an odd taste. A lump formed in my throat with phlegm that caused me to need to cough to clear my throat. I felt very jittery. Staff at the clinic reported I felt clammy to touch and that I became pale. I was given oral Benadryl and staff reset the clock. I experienced several of these intense body-wide heat waves while at the clinic. Staff told me I was not having an allergic reaction but that my "body was reacting to a foreign substance introduced into my body." I was told to return for the 2nd shot on 5/5/21 and staff will premedicate me with Benadryl.

Other Meds: Crestor, Atenolol, Cardizem, Zoloft, Vitamin D, Magnesium

Current Illness: None

ID: 1233448
Sex: F
Age: 55
State: MI

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 04/20/2021
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 was administered a Pfizer Covid-19 vaccine that was exposed to a temperature excursion. (Vaccine was between 8-14.5 degrees C for 7hrs and 48 minutes). Pfizer was contacted and advised the clinic to consider the dose as invalid and to revaccinate. Patient was revaccinated on 03/19/21 and since had had dose 2 on 04/09/21

Other Meds:

Current Illness:

ID: 1233449
Sex: M
Age: 48
State: VA

Vax Date: 01/19/2021
Onset Date: 04/20/2021
Rec V Date: 04/20/2021
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: SECOND DOSE GIVEN AFTER 42 DAYS OF THE FIST DOSE

Other Meds: OMPRAZOLE

Current Illness:

ID: 1233450
Sex: M
Age: 50
State: MS

Vax Date: 03/19/2021
Onset Date: 04/01/2021
Rec V Date: 04/20/2021
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

Symptom List: Injection site pain, Pain

Symptoms: A week and a half after taking the Janssen COVID shot I had a knot and pain come up in my lower back. After going to the chiropractor two times the knot and pain ended up in my right leg. I then went to Urgent Care where they diagnosed me with a large blood clot. They sent me to imaging and after scanning the area confirmed that there was a blood clot in my right leg. Urgent Care then set me up with a specialist.

Other Meds: Flomax, Metformin

Current Illness: none

ID: 1233451
Sex: F
Age: 43
State: TX

Vax Date: 04/09/2021
Onset Date: 04/09/2021
Rec V Date: 04/20/2021
Hospital:

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

Lab Data:

Allergies: Acetaminophen, Percocet, Shellfish, Tegaderm transparent dressing, Tetracycline, Vicoprofen.

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient reports: "I received my covid 19 vaccine on Friday April 9th (J&J) and need to report my reactions afterward. Had the usual immediate arm pain after injection along with nausea. Took a Benadryl and napped when got home and woke up 6 hours after injection with a tingling and swollen lower lip and constricted breathing. Took 3 Benadryl in fear of going to hospital and waited it out. Once lip went back to normal as well as breathing went to bed since it was late and slept all day Saturday. Woke up Sunday in agony from lower back pain and tailbone. Now, thurs 4/15 still in extreme pain in my tailbone. Went twice to chiropractor to help and nothing is alleviating the pain and have been practically bed ridden since Sunday. Can?t work, can?t sit, can?t walk can?t stand can?t anything without extreme pain. Been taking ibuprofen everyday and not helping." She had a visit with us on 4/15/2021: "Patient here for extreme pain on her tailbone. She had the Johnson and Johnson vaccine about 6 days ago and about 6 hours later she woke up with a tingling and swollen lip, constricted breathing, and dizziness. She wanted to avoid the hospital, so she took benadryl 75 mg and it slowly resolved her symptoms. These symptoms have not returned since. She was finally able to fall asleep that night and then slept all day the next day. The following day she woke up and experienced extreme pain in her lower back and tailbone. She saw her chiropractor twice this past week, which helped to resolve her low back pain. Per patient her chiropractor noted that her back seemed very inflamed. However, she is still having extreme pain with her tailbone and is unable to sit, stand, bend or work for more than 20 minutes without extreme pain. The only thing that seems to improve her pain is laying on her back with several pillows tucked behind and all around her. However, she is only able to stay in this position for a period of time before her body becomes stiff from immobility. She has been taking ibuprofen 600 mg TID, flexeril PRN, icing and applying moist heat to her back, but none of these measures seem to improve her pain. Lastly she has noticed that when she sits/stands for too long, her buttocks start to spasm. Denies fever, chills, n/v, numbness, tingling, incontinence or loss of bowel/bladder function."

Other Meds: Vitamin D3, B12, Spironolactone, Triamcinolone acetonide topical cream, Hydroxyzine HCl, Clindamycin-Benzoyl peroxide topical gel, Tretinoin topical gel, Flonase Allergy Relief.

Current Illness: Seasonal allergic rhinitis

ID: 1233452
Sex: F
Age: 39
State: UT

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 04/20/2021
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: Peanut, Acetaminophen, Hydrocodone, Penicillins

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

Symptoms: Patient of complained of itching near injection site and a feeling of "throat swelling" and chest discomfort approximately 30 minutes after recieving vaccine. No medications were admistered by physician.

Other Meds: Albuterol, Omeprazole

Current Illness:

ID: 1233453
Sex: F
Age: 39
State: UT

Vax Date: 03/25/2021
Onset Date: 04/09/2021
Rec V Date: 04/20/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: New or easy bruising

Other Meds:

Current Illness: none

ID: 1233454
Sex: F
Age: 50
State: NC

Vax Date: 04/17/2021
Onset Date: 04/17/2021
Rec V Date: 04/20/2021
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: patient reports feeling lightheaded, nervous, anxious, fingers tingly and stomach feels funny. Patient reports same reaction after 1st dose. Benadryl given at 1:29pm. At 1:40pm, patient reports a sense of relief.

Other Meds:

Current Illness:

ID: 1233455
Sex: F
Age: 55
State: FL

Vax Date: 04/11/2021
Onset Date: 04/12/2021
Rec V Date: 04/20/2021
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: None

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

Symptoms: The patient had the COVID 19 vaccine on 4/11. The following day, she developed severe nonpositional vertigo and sudden deafness and tinnitus in the right ear. She went to an urgent care and was given methylprednisone dose pak and meclizine with some relief of the vertigo, however the deafness persisted. I saw her in clinic on 4/16 and obtained a hearing test which confirmed a profound sensorineural loss in the right ear. This along with the vertigo symptoms was suggestive of labyrinthine injury to the right ear. The patient was started on high dose steroids and will follow up with a repeat hearing test in 2 weeks.

Other Meds: Swiss Kriss Herbal Laxative

Current Illness: None

ID: 1233456
Sex: F
Age: 60
State: MA

Vax Date: 04/01/2021
Onset Date: 04/13/2021
Rec V Date: 04/20/2021
Hospital:

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

Lab Data:

Allergies: Sulfa

Symptom List: Nausea

Symptoms: Shingles - itchy and painful rash.

Other Meds: Probiotics, mutivitamins, fish oil, calcium+D Estrace Restasis

Current Illness: None

ID: 1233457
Sex: F
Age: 59
State: VA

Vax Date: 01/07/2021
Onset Date: 04/10/2021
Rec V Date: 04/20/2021
Hospital:

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

Lab Data:

Allergies: Claritin

Symptom List: Injection site pain

Symptoms: 3 months after receiving the Pfizer Covid Vaccine I developed a severe case of Shingles. I'm a pretty active and healthy individual, and I read that some patients are developing Shigles after gettinfg the vaccine. I want my case to be included in the repoting and the studies being done, I do think my case might be related to the vaccine. I don't have major health issues and this Shingles took me by surprise

Other Meds:

Current Illness: none

ID: 1233458
Sex: F
Age: 58
State: CA

Vax Date: 04/16/2021
Onset Date: 04/17/2021
Rec V Date: 04/20/2021
Hospital:

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

Lab Data:

Allergies: Septra

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

Symptoms: The day after the shot (Saturday), I started getting the chills and I was fatigued. My temp topped at 102.5. My arm at the injection site was very sore, hot and hard and had a rash about 3" in diameter. My fever came and went all day and into Sunday morning, then it seems to subside, though I was still tired. Monday, I thought I was fine and resumed my normal activity of gardening. At about 4pm, I got the chills again and had a low grade fever, 98.5. (I usually run about 96.9). Besides this, my arm was hot and the rash went down my arm. It was about 6" long and 4" wide. I marked the borders to make sure it didn't spread any more. This morning, Tuesday, The rash is still within the border and not as red, but still hot and itchy. I am also fatigued today.

Other Meds: None

Current Illness: Slight allergy to pollen.

ID: 1233459
Sex: F
Age: 39
State: IN

Vax Date: 04/11/2021
Onset Date: 04/14/2021
Rec V Date: 04/20/2021
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: None

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

Symptoms: Started feeling shortness of breath on 4/13/2021, got worse everyday. Went to clinic on 4/19/2021 and was diagnosed with pneumonia.

Other Meds: Nexplanon

Current Illness: None

ID: 1233460
Sex: M
Age: 56
State: MI

Vax Date: 03/12/2021
Onset Date: 03/12/2021
Rec V Date: 04/20/2021
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: Patient was administered a Pfizer Covid-19 vaccine that was exposed to a temperature excursion. (Vaccine was between 8-14.5 degrees C for 7hrs and 48 minutes). Pfizer was contacted and advised the clinic to consider the dose as invalid and to revaccinate. Patient was revaccinated on 03/19/21 and has since received dose 2 on 04/09/21

Other Meds:

Current Illness:

ID: 1233461
Sex: F
Age: 44
State: NC

Vax Date: 04/13/2021
Onset Date: 04/13/2021
Rec V Date: 04/20/2021
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: no

Symptom List: Erythema, Pruritus

Symptoms: extreme fatigue for at least a week worsens with effort for more than 5-10 mins. body aches lasting at least a week. Side effects still ongoing at this time.

Other Meds: wellbutrin 200mg

Current Illness: no

ID: 1233462
Sex: F
Age: 60
State: FL

Vax Date: 04/02/2021
Onset Date: 04/03/2021
Rec V Date: 04/20/2021
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: Sulfa

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

Symptoms: Lymph-node pain under arm (same as injected arm), radiated from underarm to under left breast; duration from 04-03-2021 through 04-07-2021 Metallic taste in mouth. Intermittent from day of injection to current date of this report (04-20-2021).

Other Meds: None

Current Illness: None

ID: 1233463
Sex: F
Age: 44
State: NY

Vax Date: 04/12/2021
Onset Date: 04/12/2021
Rec V Date: 04/20/2021
Hospital:

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

Lab Data:

Allergies: NKDA shellfish, wheat, dairy, latex

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

Symptoms: 2 hours after receiving the shot I developed large hives on my neck. The hives continued intermittently for 24 hours after the injection in various locations on the upper body.

Other Meds: Advair 250/50 Albuteral inhaler

Current Illness: none

ID: 1233464
Sex: M
Age: 39
State: IA

Vax Date: 03/11/2021
Onset Date: 03/12/2021
Rec V Date: 04/20/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: Following the 2nd shot, I noticed two adverse effects; the first was a fair amount of depression for up to a week. The second is a breakout of acne on my neck and both shoulders which has not subsided as of the date of this form (4/20/21).

Other Meds: Escitalopram

Current Illness: n/a

ID: 1233465
Sex: M
Age: 84
State:

Vax Date: 03/31/2021
Onset Date: 04/03/2021
Rec V Date: 04/20/2021
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: Patient hospitalized within 6 weeks of COVID vaccine

Other Meds:

Current Illness:

ID: 1233466
Sex: M
Age: 52
State: OK

Vax Date: 04/07/2021
Onset Date: 04/19/2021
Rec V Date: 04/20/2021
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

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

Symptoms: Acute onset knee pain, right knee, 2 weeks post injection

Other Meds: Omeprazole 40 mg/daily, Lipitor 20 mg/daily, Allegra 10 mg/daily, Naproxyn 500 mg/as needed, Multivitamin/daily

Current Illness: None

ID: 1233467
Sex: F
Age: 54
State: MA

Vax Date: 04/09/2021
Onset Date: 04/13/2021
Rec V Date: 04/20/2021
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: She had some mild symptoms 1-2 days after the vaccine that resolved. 4-5 days after the vaccine she developed a headache, describes it as constant. She has taken tylenol and advil OTC without much relief. She denies any vision changes, worse with position changes, nausea or vomiting. Today is is improved without intervention, but still present mildly.

Other Meds:

Current Illness:

ID: 1233468
Sex: F
Age: 39
State:

Vax Date: 04/17/2021
Onset Date: 04/17/2021
Rec V Date: 04/20/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient experienced dizziness, palpitations, weakness, shivers, chest pain/pressure. BP 161/98 -- > 155/99 -- > 138/92, HR 99 -- > 104 -- > 93, RR 28 -- > 24, O2=100%, T=98.4F. Vaccination given at 14:04, adverse event began at 14:20, 911 was called at 14:55, patient taken to emergency room.

Other Meds:

Current Illness:

ID: 1233469
Sex: F
Age: 51
State: OH

Vax Date: 03/16/2021
Onset Date: 03/21/2021
Rec V Date: 04/20/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: About 5 days after initial vaccine I began a period that was the heaviest I had ever had. After 10 days I contacted my Dr. who ordered blood work. Did blood work on 4/5, by this time period had finally slowed to spotting. Had 2nd vaccine on 4/6 and immediately started bleeding heavily again and about 4 days in had four or five clots the size of half dollars or larger. Saw Dr. on 4/14 and ordered another blood test and was prescribed iron pills for anemia. As of the date 4/20, I am still bleeding with no signs of stopping.

Other Meds: Losartan

Current Illness: None

ID: 1233470
Sex: M
Age: 49
State: VA

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 04/20/2021
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: no allergies

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

Symptoms: Within 3 minutes after vaccine administration at 11:00am, person had two seizures within 5 minutes of each other. Decreased pulse, blood pressure and oxygen saturation. Loss of consciousness for several minutes each time. Emergency measures initiated, including IV and oxygen. Transported by EMS to Emergency Department at 11:25am.

Other Meds: no medications

Current Illness: none known

ID: 1233471
Sex: F
Age: 58
State: MI

Vax Date: 04/16/2021
Onset Date: 04/18/2021
Rec V Date: 04/20/2021
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: Adhesive (bandaids, etc.)

Symptom List: Vomiting

Symptoms: Nodule of my lymph gland located above left collar bone (same side as vaccine arm). First felt it on 3rd day after vaccine. Size of a very large pea. Moveable and tender. Nothing found under armpit area, or any other areas. Did have a flushed sunburn looking face and areas of neck and scalp which lasted the entire second day, and "covid arm" at the injection site which has reduced significantly by day three - although still there. Fevers lasted throughout the 2nd day, maintaining at 99.2 after Tylenol; but ended on 3rd day. Fatigued until 4th day after vaccine. Nodule remains as of 04/20/2021.

Other Meds: Estrace, Vit D, Vit C, B-Complex

Current Illness: None

ID: 1233472
Sex: M
Age: 39
State: FL

Vax Date: 04/13/2021
Onset Date: 04/15/2021
Rec V Date: 04/20/2021
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: No known allergies

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: SCRATCH LIKE RASH NOTED TO BODY. Patient given Benadryl 50 mg IV x1,Pepcid 20 mg IV x1, and Solu-medrol 125 mg IV X1 in ER. Discharged on Diphenhydramine HCl [Benadryl 25 MG Caplet] 25 mg PO Q6HPRN PRN ;Famotidine [Pepcid] 20 mg PO BID for 10 Days ; Prednisone 20 mg PO BID for 10 days.

Other Meds:

Current Illness:

ID: 1233473
Sex: F
Age: 74
State: VA

Vax Date: 03/15/2021
Onset Date: 04/01/2021
Rec V Date: 04/20/2021
Hospital: Y

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

Lab Data:

Allergies: No known allergies

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

Symptoms: Patient presented with generalized weakness, malaise, shivering, chills, being off balance, worsening memory issues and subjective fevers. Upon admission found to have hyponatremia. Also found to have thrombocytopenia, leukopenia and diagnosed with Hemophagocytic lymphohistiocytosis (HLH), hypofibrinogenemia secondary to HLH. Patient remains hospitalized and has been started on etoposide & dexamethasone per HLH-94 protocol.

Other Meds: Aspirin 81 mg daily, Atorvastatin 20 mg daily, Calcium carbonate 1000 units daily, Citalopram 20 mg daily, Lisinopril 40 mg daily, Hydrochlorothiazide 25 mg daily , Omega 3 500 mg daily, vitamin B-12 500 mcg daily, Valacyclovir 1000 mg dai

Current Illness:

ID: 1233474
Sex: F
Age: 25
State: AZ

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 04/20/2021
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: none

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Vomiting, diarehea, severe chills and body pains throughout the night. Still ill today

Other Meds: none

Current Illness: none

ID: 1233475
Sex: F
Age: 54
State: IN

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 04/20/2021
Hospital:

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

Lab Data:

Allergies: No known allergies

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

Symptoms: Patient received vaccination in the left arm around 10:25am. Patient proceeded to sit down in the waiting area for the 15 minute period. During this period, patient was joking with her husband. Around 10:35 am, patient started feeling really dizzy and lightheaded. I was notified at this time about the dizziness. I rushed out into the waiting area and patient had lost consciousness. Patient did not gain immediate consciousness. Code white was called and 911 was also called. I kept tapping patient for response. Patient was breathing and I kept checking pulse. After at least one minute, patient regained consciousness and was able to speak to me. Patient stated she felt dizzy and hot. I had a technician grab ice bag packs and placed on her neck along with bottle of water. During this time, I checked patient's vitals and they were normal. Ambulance arrived and explained the situation to them and reported vitals. Patient was becoming dizzy and lightheaded again so patient was taken to emergency room.

Other Meds:

Current Illness: Patient stated had allergies last week but feeling better

ID: 1233476
Sex: F
Age: 52
State: MI

Vax Date: 03/28/2021
Onset Date: 03/28/2021
Rec V Date: 04/20/2021
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: None

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

Symptoms: Within minutes, I felt strange ... went to car and left side of face /eye went numb... and left hand ... lasted hour or so and felt ok... however the next day, I had 102.7 fever which lasted another day .

Other Meds: None

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm