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: 1233579
Sex: F
Age: 51
State: IL

Vax Date: 04/11/2021
Onset Date: 04/11/2021
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: NKA

Symptom List: Dysphagia, Epiglottitis

Symptoms: Patient experienced shortness of breath and anxiety post vaccination, recovered and released.

Other Meds: Unknown

Current Illness: None known

ID: 1233580
Sex: F
Age: 32
State: MO

Vax Date: 04/16/2021
Onset Date: 04/16/2021
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: Milk, Strawberries

Symptom List: Anxiety, Dyspnoea

Symptoms: Full body convulsions and Paralysis. Left-arm went numb first and traveled throughout the body. Convulsions started in left hand and also traveled throughout the body. It took six minutes from the shot to the first convulsion. Convulsions didn't stop until lorazepam was administered. Benadryl was administered immediately on-site in pill form. The hospital also gave additional Benadryl as well. Blood sugar dropped to 50 within the first half-hour. Extreme eye sensitivity to light and extreme exhaustion afterward. Pain felt extreme as well. Many side effects such as very low pain tolerance, head ache, light sensitivity, confusion, loss of memory, severe muscle pains, muscle numbness throughout body, blood sugar dropping, etc.

Other Meds: B-12 Vitamin Birth Control

Current Illness: Asthma

ID: 1233581
Sex: F
Age: 62
State: NY

Vax Date: 04/16/2021
Onset Date: 04/16/2021
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: None

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

Symptoms: The expected soreness in my arm developed throughout the afternoon of the morning (Friday) I had the shot along with a fever. I had fever and chills all night - my teeth chattered all night. The fever continued throughout Saturday and my nose was congested. My chest felt tight. Of most concern my neck was so stiff Saturday and Sunday that I could not move it or turn it in the slightest. The pain radiated down through the shoulders but no further. The overwhelming fatigue I had felt when I had Covid in late March-early April was back. I could not stand long without having to sit down and walking around made me feel breathless. I stayed in bed all weekend. The fever broke Sunday night and by Monday morning I could move my neck, but it was very tender and I did not have my normal range of motion. My congestion turned into a runny nose on Monday which cleared on Tuesday. By Tuesday my energy level was close to normal and I had full range of neck motion, although still tender. I never had a headache at any point over those four days.

Other Meds: Wellbutrin 450 mg

Current Illness: None

ID: 1233582
Sex: M
Age: 43
State: WA

Vax Date: 02/16/2021
Onset Date: 02/18/2021
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: Codine makes me sick to my stomach

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: The same day, I was exhausted. It lasted 2 days. After that, on the 2nd or 3rd day after my shot, my right calf began to hurt. I knew it was connected to the vaccine, but I figured it would go away. Once the information came out about blood clots and my calf still hurt and didn't get better, I decided to go and get it checked out.

Other Meds: NA

Current Illness: NA

ID: 1233583
Sex: F
Age: 36
State: NY

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: IM
Vax Site: LA

Lab Data:

Allergies: Biaxin Effexor Imitrex levothyroxine Sulfa (Sulfonamide Antibiotics) Zoloft

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

Symptoms: Patient reports received J&J vaccine on 4/9. Later that day developed a minor headache and dizziness. Woke up on 4/10 still feeling dizzy, and this has been persistent since. Patient states it comes in waves, and at times feels her vision is a little blurry. Denies vomiting, diarrhea, headaches today. Patient states also feels chest may be a little heavier today- "sensation of wearing a shirt that is too tight" but denies difficulty breathing or SOB. Pt denies any leg pain/redness/swelling/warmth.

Other Meds: meclizine 25 mg tablet Take 1 tablet 3 times a day by oral route as needed. NP Thyroid 15 mg tablet TAKE ONE TABLET BY MOUTH EVERY MORNING ProAir HFA 90 mcg/actuation aerosol inhaler Inhale 2 puff(s) every 4 hours by inhalation route as

Current Illness: none

ID: 1233584
Sex: F
Age: 43
State: CA

Vax Date: 04/15/2021
Onset Date: 04/15/2021
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:

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

Symptoms: Severe diarrhea and chills approximately 12 hours post vaccination.

Other Meds:

Current Illness:

ID: 1233585
Sex: F
Age: 45
State: GA

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: 011J20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: LATEX, PENICILLIN, ROCEPHIN, CIPROFLOXIN, TROVAN

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: PATIENT EXPERIENCE A RASH STARTING TO DEVELOP ON HER RIGHT ARM AND HER BACK HAD STARTED TO ITCH APPOXIMATELY 10 MINUTES AFTER HER SECOND DOSE OF MODERNA. PATIENT WAS ANTICIPATING THIS REACTION BECAUSE SHE ALSO EXPERIENCED A MILD FULL BODY RASH AFTER HER FIRST DOSE THAT LASTED FOR 24 HOURS. PATIENT REQUESTED BENADRYL. SHE RECIEVED 25MG/10ML ORAL DOSE OF BENADRYL 12.5MG/5ML CHILDREN SYRUP. PATIENT HUSBAND WAS WITH PATIENT TO DRIVE HER HOME. PATIENT IS ALSO A PART OF A TRIAL STUDY FOR AUTOIMMUNE RHEUMATOID ARTHRITIS TO SEE HOW THEY MOUNT ANTIBODIES TO THE VACCINE. PATIENT SAID SHE RECEIVED PERMISSION TO CONTINUE MODERNA SECOND DOSE.

Other Meds: N/A

Current Illness: RHUEMATOID ARTHRITIS

ID: 1233586
Sex: M
Age: 35
State: CA

Vax Date: 04/09/2021
Onset Date: 04/12/2021
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: Lactose intolerant and dairy allergy.

Symptom List: Pharyngeal swelling

Symptoms: Small growth between testicles and butt. Slightly painful to touch. No treatment attempted yet.

Other Meds: None

Current Illness: Did give blood on the same arm 2 days prior.

Date Died: 04/14/2021

ID: 1233587
Sex: F
Age: 87
State: VA

Vax Date: 01/21/2021
Onset Date: 02/20/2021
Rec V Date: 04/20/2021
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: NKDA

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Patient received two dose Moderna series of vaccinations for COVID 19 (1/21/2021 and 2/18/2021). Patient reported to ED feeling weak on 2/20/2021, but was not tested for COVID at that time. Reportedly, patients family were all tested for COVID and were positive on or about 2/21/2021. The patient was later admitted to the hospital on 4/13 with COVID. She subsequently expired on 4/14.

Other Meds:

Current Illness: PMHx: CVA

ID: 1233588
Sex: F
Age: 35
State: CO

Vax Date: 04/08/2021
Onset Date: 04/20/2021
Rec V Date: 04/20/2021
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: amoxycillen

Symptom List: Diarrhoea, Nasal congestion

Symptoms: On Day 12 (April 20), I woke up with soreness, redness/rash, raised bump and hot to touch.

Other Meds: NA

Current Illness: NA

ID: 1233589
Sex: F
Age: 59
State: CT

Vax Date: 04/09/2021
Onset Date: 04/11/2021
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: Latex

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

Symptoms: I had no reaction to shot #1 other than a slightly sore arm. After 36 hours and 12 minutes, I was awakened with a migraine, which I have now had for 10 days. I tried treating with OTC, guafesin, and netti pot and it has only minimally improved my headache. I visited the doctor today and he said there is inflammation in my sinuses and behind my ear drum. He prescribed a 5 day-dose of Prednisone (reducing by 1 each day) to see if that will alleviate the inflammation and my headache. Outsome unknonwn at this time.

Other Meds: Synthroid, 112 mcg, 1x/day, ibuprofen

Current Illness: none

ID: 1233590
Sex: F
Age: 63
State: CT

Vax Date: 04/17/2021
Onset Date: 04/18/2021
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: None

Symptom List: Rash, Urticaria

Symptoms: About a day after getting my second Pfizer COVID vaccine, I started hearing a ringing in my ears -- high in pitch. It is fairly constant during my waking hours and slightly louder or more dominant in my right ear. There is no external sound making this noise. Moreover, I do not have hearing loss.

Other Meds: Liothyronine 5mcg Levothyroxine 88 mcg Bupropion 300 MG XL Rosuvastatin 5 MG occasional Advil as needed 1x or so per week

Current Illness: None

ID: 1233591
Sex: F
Age: 24
State: FL

Vax Date: 04/15/2021
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: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Symptoms: Bad rashes over Backside, Stomach, Hands and neck

Other Meds: None

Current Illness: None

ID: 1233592
Sex: F
Age: 21
State: NY

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: 025J20-2A
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: nione

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

Symptoms: Patient came in forher first dose of the Moderan vaccine. Patient is an overnight associate. We processed her paperwork, I asked her if she felt ok (answered the questions she had fiklled out) and then I proceeded to have her sit in the booth. When I went into the booth, I explained to her when her second dose was and to bring back her vaccine card. She stated she did not really want to get the shot, but was being pressured by her mom. I asked her if she was sure she wanted the shot, and she said yes because her dad has a heart condition. I then proceeded to administer the shot at 8:12 am. She did very well with the shot- no bleeding in the bandaid. I asked her to sit for about 10 minutes. I proceeded to walk back into the pharmacy, and I dispoded of the gloves. I then walked over to my computer, then I heard the loud thump at 8:14 am. I immedietly ran out to the booth and she had fallen over. We called a code white and called 911. Pt was awake, hit her head and mouth. I asked her if she had eaten and she said she could not remember, She said the shot was fine and she was on her phone and that is all she remembers. I rubber her back and chatted with her until the fire department arrived. She was able to call her cousin from her phone, but I did not move her until the fire department came. EMS came and she went with them. EMS stated that she had not slept in 24 hours and that could be the cause. The time from the shot to the thump was no more than 1 minute.

Other Meds: none

Current Illness: none

ID: 1233593
Sex: F
Age: 62
State: IN

Vax Date: 04/14/2021
Onset Date: 04/15/2021
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: Seasonal allergies to outdoors

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

Symptoms: I didn't think I had an adverse reaction until just now I read that herpes is one in several people. The day I had the vaccine I was sleepy and had a headache but nothing major. I did notice the next morning a rash of some sort on my right arm. Lower arm. Red raised bumps. Nothing that important I didn't think. They are still there six days later. There is sometimes like a lightning burst of pain where they are. Just come and go. I'm not that concerned about it and hope I don't have to be. But like I said after reading the headline thought I should let you know.

Other Meds: Trileptal 300 mg 2xdaily Lexapro 20 mg 1xdaily

Current Illness:

ID: 1233594
Sex: M
Age: 25
State: KS

Vax Date: 04/13/2021
Onset Date: 04/14/2021
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: none

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

Symptoms: Constant tinnitus ever since the second dose of vaccine. High pitch ringing sound in both ears that will not go away. While it isn't too loud, I always hear it in silence and it is very difficult to go to sleep. It hasn't gone away for a week straight and is starting to worry me that it won't go away.

Other Meds: none

Current Illness: none

ID: 1233595
Sex: F
Age: 47
State: VA

Vax Date: 04/06/2021
Onset Date: 04/07/2021
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: None

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

Symptoms: After receiving my 1st dose of Pfizer I unexpectedly got my period 2 days later. It was about 10 days early, and I?m normally very regular. At the time I chalked it up to pre menapausal symptoms . But it was definitely out of the norm. If I go back to 30 days normal cycle I?ll be more convinced it was due to vaccine.

Other Meds: Vitamin D Zyrtec

Current Illness: None

ID: 1233596
Sex: F
Age: 27
State: MN

Vax Date: 01/15/2021
Onset Date: 04/16/2021
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: Flagyl (rash)

Symptom List: Ear pain, Hypoaesthesia

Symptoms: First dose 1/13/21 second dose 2/1/21 Covid positive 4/19/21 symptoms stuffy nose/lose of taste and smell

Other Meds: Prenatal Vitamin D

Current Illness: None

ID: 1233597
Sex: F
Age: 25
State:

Vax Date: 04/20/2021
Onset Date: 04/20/2021
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:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: lightheaded, nausea, vomiting x2. Evaluated by EMS-Refusal to transport.

Other Meds:

Current Illness:

ID: 1233598
Sex: M
Age: 38
State: VA

Vax Date: 03/30/2021
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: Minor allergy to milk (protein), high allergy to grass / pollen

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

Symptoms: Painful 'dead-arm' effect within 1-2hours, lasting 2 days. Approximately 7-8 days after injection, developed slightly raised red welts/chill-blains on hands (fingers, palm and back of hand) and feet (ties and heels). Welts were 'hot' and intensely itchy for 2 days and then painful on the 3rd day before fading. Treated with hydrocortisone cream.

Other Meds: Men's Multivitamin - every other days

Current Illness: Nil

ID: 1233599
Sex: M
Age: 83
State: SC

Vax Date: 01/30/2021
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: NONE KNOWN

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

Symptoms: RESIDENT STATES THAT HIS RIGHT ARM ITCHES FROM VACCINE SITE TO FOREARM AREA. AREA HAS RED DISCOLORATION. DENIES ANY PAIN AT THIS TIME.

Other Meds: 1. ATIVAN 0.5MG 2. COMBIVENT 3. FLONASE 4. GUAIFENESIN 5. IPRATROPIUM 6. LASIX 7. LOPERAMIDE 8. PEPCID 9. POTASSIUM CHLORIDE 10. PROAIR 11. PULMICORT 12. SYMBICORT 13. TYLENOL 14. ZANAFLEX 15. ZYRTEC 16. IMODIUM 17. LISINOPRI

Current Illness: NONE ACUTE

ID: 1233600
Sex: F
Age: 41
State: PA

Vax Date: 04/13/2021
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: Allergic to shellfish (shrimp. lobster, crab). Allergic to Levaquin

Symptom List: Unevaluable event

Symptoms: After showering on 4/14/21 I immediately developed a full body rash with very itchy hives and severe swelling (body and facial). I immediately took 2 benadryl (50mg total) this took about an hour to kick in and helped somewhat with the itching. The swelling persisted. I visited my PCP on Thursday (4/15) and he prescribed zyrtec 2x daily and 2 benadryl at bedtime. He also prescribed a prednisolone pack in case it worsened but I did not take because I didn't want to negate the effects of the vaccine. I was also seeing improvement so I didn't feel I needed the steroid. I followed the 2 zyretc /benadryl for 2 full days and then reduced dosage to 1 zyrtec/1 benadryl at bedtime starting 4/18 and continue to do so. As of today 4/20 my body rash is greatly reduced as is the facial swelling. I have very minimal of both as of today.

Other Meds: Multi vitamin 1x daily (PM), Probiotic 1x daily (AM) Sometimes I take CBD oil in the am but did not take any for at least a week prior to vaccination

Current Illness: None

ID: 1233601
Sex: F
Age: 49
State: PA

Vax Date: 04/10/2021
Onset Date: 04/11/2021
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: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: Right arm still is painful and has a lump, dizziness, headaches

Other Meds: Humira

Current Illness: Auto immune- ulcerative colitis

ID: 1233602
Sex: F
Age: 46
State: AZ

Vax Date: 03/05/2021
Onset Date: 03/06/2021
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, topical alcohol, food allergies, bee sting

Symptom List: Injection site pain, Pain

Symptoms: overall body fatigue with angina-like symptoms, bone aches, fever, head ache for next 36-48 hours. Head ache (frontal lobe with right eye visibility impairments at times for the next 6 days). For the next 2 weeks approx 50% lower strength/fitness during gym workouts.

Other Meds: bio-identical HRT

Current Illness: none

ID: 1233603
Sex: F
Age: 63
State: TN

Vax Date: 03/31/2021
Onset Date: 04/01/2021
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: Doxycycline, Sulfacetamide

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient daughter reported that the patient broke out in a body rash a day or so after she received her second dose of Pfizer COVID-19 vaccine.

Other Meds: Fluoxetine, Carvedilol, Clonidine, Omeprazole

Current Illness: None that we are aware of.

Date Died: 04/14/2021

ID: 1233604
Sex: F
Age: 104
State: WI

Vax Date: 02/26/2021
Onset Date: 04/14/2021
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:

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

Symptoms: Patient was in ED x 2 and died within 60 days of receiving a COVID vaccine series

Other Meds:

Current Illness:

ID: 1233605
Sex: F
Age: 59
State: TX

Vax Date: 04/05/2021
Onset Date: 04/05/2021
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: sulfur

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Pain started at injection site - next day moved to my mid arm like I was hit..next day moved to my elbow and has not left after 2 weeks. It is sometimes hard to pick things up with my arm - the muscles and elbow hurt

Other Meds: none

Current Illness: none

Date Died: 04/09/2021

ID: 1233606
Sex: M
Age: 52
State: MA

Vax Date: 04/08/2021
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: UNK
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: NKDA

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: 52 m active alcoholic with lab abnormalities c/w heavy etoh including pancytopenia (anemia to 7s, throbocytopenia to 70s, mild leukopenia-since 12/20); 2 recent admissions (feb march 2021) with likely etoh-induced pre-renal AKI; DM; who received 2nd dose of moderna 4/8/21. After not being in contact with his family for several days, family sought him at his residence where he was found pulsless and apneic on the floor with some scant blood near his face. CPR-- >transported to hospital where upon attempting to intubate profuse bleeding into larynx/pharynx noted. Despite ongoing cpr and mechanical ventilation team in ER was unable to re-establish pulse. He was pronounced dead at about 8 PM 4/9/21.

Other Meds: folate, thiamine, magnesium, ustekinumab, glipizide, hctz/lisi, glargine

Current Illness: Alcoholism, pancytopenia, thrombocytopenia, acute kidney injur

ID: 1233607
Sex: F
Age: 60
State: KS

Vax Date: 04/08/2021
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:
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: penicillin

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

Symptoms: cold painful toes and numb and tingly finger tips and forearm.

Other Meds: calcium,vitamin D, probiotic and levothyroxin

Current Illness: none

ID: 1233608
Sex: F
Age: 45
State: CA

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:

Symptom List: Nausea

Symptoms: Coughing, SOB

Other Meds:

Current Illness:

ID: 1233609
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: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot:
Dose Series: UNK
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: anaphylaxis to bee pollen, Augmentin, cefpodoxime

Symptom List: Injection site pain

Symptoms: Patient is a 30 y.o. female Patient received Covid vaccine at immunization site. During 15 minutes post-monitoring period: Please see additional note below regarding counseling points, monitoring, and interventions done. COVID-19 Vaccine Adverse Reaction Reaction due to: First dose of vaccine Symptoms: Difficulty swallowing, Throat tightness, Dizziness/Lightheadedness, Shortness of breath, Lip and/or tongue swelling How long after administration did the symptoms start?: Immediately (within 15 minutes) Interventions: Additional monitoring, Education provided regarding symptoms and home care, Other (comment) (pt used her own epi pen with improvement, given 50mg oral diphenhydramine) If reassessed, patient's condition: Improved (improved with epi pen) Disposition: Education and follow-up phone number (given follow-up precautions) Pt experienced throat and tongue swelling 10-12 minutes after Pfizer COVID19 vaccine that improved with the use of her own epinephrine pen. Symptoms rapidly improved. Pt was given 50mg oral diphenhydramine. BP 136/86 hr 93, SaO2 100%. Was counseled on when to seek emergency medical attention. I advised pt to be evaluated by allergy specialist prior to her second dose and pt says she already has one via facility. Has her fiance to drive her home. 30 min observation with periodic vitals. 11:40a BP 120/76 11:45a BP 126/70 HR 86, SaO2 99%

Other Meds: adapalene 0.1% gel, epinephrine 0.3mg IM, duo-neb 0.5mg-0.3mg nebulizer every 6 hours PRN, Junel FE 1/20 tablet daily, tretinoin 0.25% topical cream

Current Illness:

ID: 1233610
Sex: F
Age: 54
State: OH

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: Sulfa, iodine as internal medium

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

Symptoms: Sore injection site following shot. After going to bed at normal time around 10pm I woke up around 11pm with immense body wide pain including headache and could not sleep. After trying to move this morning I had onset of freezing chills and still unable to find comfort to sleep. Trying hot bath soaks, hot herbal tea, electric heating pad.

Other Meds: Omeprazol, nasacort otc, lexapro

Current Illness: Working on managing some menopause issues

ID: 1233611
Sex: M
Age: 20
State: NC

Vax Date: 04/19/2021
Onset Date: 04/20/2021
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: possible nut allergies, shellfish (lobster), seasonal allergies

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

Symptoms: Patient had bowel movement after waking up and going to bathroom. He fainted, calling for help to his parents on his way down to the floor. Parents found him on floor cognitively responsives but not moving body (He does not remember anything after coming to kneel on floor). Parents found him clammy. Mother called 911 and was instructed to keep him lying on floor. He complained of being cold but was sweaty. Blanket placed over him on floor and kept there until EMS arrived. Patient c/o nausea. They got him into rolling chair and was going to leave when he had another episode of dizziness, clammy and nausea. EMS transported him to hospital. Blood work was done with no abnomalities noted. Upon discharge he complained of headache. Nausea dissipated upon eating and some ginger ale. Patient had previous had "covid arm" with first injection but no other complaints.

Other Meds: He takes Vitamin D and C , Quercetin, and Zinc

Current Illness: none noted

ID: 1233612
Sex: F
Age: 57
State: CA

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: none

Symptom List: Tremor

Symptoms: 103 fever, body aches, chills, nausea, headache, dizziness, weakness

Other Meds: none

Current Illness: none

ID: 1233613
Sex: F
Age: 54
State: KY

Vax Date: 04/11/2021
Onset Date: 04/12/2021
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: EURYTHROMYCIN, DOXYCYCLINE

Symptom List: Erythema, Pruritus

Symptoms: SEVERE JOINT PAIN THE DAY AFTER INJECTION, MIGRAINE BEGINNING THE DAY AFTER INJECTION LASTING 4 DAYS, JOINT PAIN CONTINUED FOR 7 DAYS FOLLOWING INJECTIONCONTINUES TO HAVE INTERMITTENT HEADACHE

Other Meds: HUMIRA, IMURAN, BIOTIN, FOLIC ACID, TYLENOL

Current Illness: NO ACUTE ILLNESSES AT TIME OF VACCINATION AND UP TO ONE MONTH PRIOR

ID: 1233614
Sex: M
Age: 28
State: GA

Vax Date: 04/19/2021
Onset Date: 04/19/2021
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: Augmentin

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

Symptoms: Soreness in the left arm from 3 hours after shot. Headache and elevated temperature in the late afternoon and evening. Fever and chills in the evening. Headache continued in the morning of April 20th. Took 200 mg ibuprofen, 50mg zinc and 2 tbsp elderberry.

Other Meds:

Current Illness:

ID: 1233615
Sex: F
Age: 38
State: NM

Vax Date: 02/17/2021
Onset Date: 02/17/2021
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: None

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

Symptoms: After receiving the vaccine I had the normal reaction the sore arm, felling tired and headache. However my left arm continues to hurt to this day where the injection was done, it has effect my mobility and there is constant pain in my leg arm.

Other Meds: None

Current Illness: None

ID: 1233616
Sex: F
Age: 20
State:

Vax Date: 04/14/2021
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: IM
Vax Site: LA

Lab Data:

Allergies: mustard, chlorhexidine

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient received dose 2 of the Pfizer COVID vaccine (lot EW0161, exp 7/2021) at 1315. At 1322, patient raised her hand to signal she felt unwell. EMT and PHN approached. Vital signs: pulse 107, O2 99%, respirations 20, blood pressure 114/82. Patient reported feeling hot and dizzy. Patient stated she ate breakfast and had been drinking fluids. Allergies to mustard, chlorhexidine. Medical conditions include asthma, anxiety, and vocal cord disfunction. Medications include albuterol, Zyrtec. At 1325, patient reported an improvement in symptoms. PHN offered Benadryl but patient declined. At 1330, vital signs: O2 98%, pulse 107, respirations 18, blood pressure 112/78. Patient reported continued improvement as her dizziness had resolved but she still felt hot and wanted to go oputside. PHN encouraged patient to stay for 30min since start of symptoms but patient stated she wanted to leave to get some fresh air. EMT noted that the corner of the room where patient was seated felt warm. At 1340, PHN and EMT monitored patient as she stood up. Patient reported no dizziness. Patient left walking with steady gait at 1345.

Other Meds: albuterol, Zyrtec

Current Illness:

Date Died: 03/29/2021

ID: 1233617
Sex: M
Age: 69
State: MI

Vax Date: 03/24/2021
Onset Date: 03/29/2021
Rec V Date: 04/20/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: 5:30 pm 3/29/21 received phone call from aunt that ems had taken dad to hospital because he was feeling unwell. he vomited prior before and just didn't feel right. ems showed up and observed him, glucose was 139..not out of range...vitals stable..2nd moderna vaccine 5 days prior...ems said that is was probably side effects...asked if he really wanted to go in...said yes, took him to hospital...5:45 daughter called hospital to get status check....she is poa for medical...er doc said he was intubated and on vent.....er doc said he was very sick...6:50 pm daughter got to er and room he was on vent and knocked out...he had antibiotics, sleeping meds..meds to rise bp in iv.....er doc came in daughter asked why he was on vent...asked about o2 doc said he was fine just unresponsive...labs were being done at time...had him on dextrose, propofol, dexmedtominine,..asked to have him transferred to own hospital..8:10 dr. comes in with lab results...kidneys and livers were showing multi organ failure...triponin was high as well..red flags were: creatine 9.93, gsr-5, hemoglobin-7, liver lft-500, triponin 14, covid test was negative, white count was in range, daughter mentioned vaccine again and doc said nothing nor did she mention heart being in trouble, no answers regarding what the cause of this was...for the record he only had kidney issues due to type 2 diabetes, was not at dialysis level...9:30 ems shows up to take dad to another hospital were not ready from him yet...9:41 dad heart started to drop on monitor withing 15 secodes iit flatlined in front of daughter......med staff did cpr...brought in epi pens and manual cpr for heart...a little after 10 heart was started it ran for 4 minutes then crashed again..10:05 continued cpr until 10:28, dr showed that walls i heart not squeezing very damaged, brought in echo during process, 10:28 time of death

Other Meds: insulin

Current Illness:

ID: 1233619
Sex: M
Age: 1
State: NY

Vax Date: 04/15/2021
Onset Date: 04/18/2021
Rec V Date: 04/20/2021
Hospital: Y

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: Patient was brought into the ER on Sunday and reported that since vaccinations had been febrile, lethargic, and irritable. Patient was anorexic as well. Pushing fluids and discharged home. The next day patient was brought back to the ER, temp of 103, 2 wet diapers in a 48 hour period, 1 bout of diarrhea, poor PO intake both food and liquids. Patient was admitted to the hospital and given IV fluids, dextrose before patient started to feel better

Other Meds: Tylenol PRN

Current Illness: None that we are aware of

ID: 1233620
Sex: F
Age: 39
State: IN

Vax Date: 04/14/2021
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: Allergic to sulfa drugs and latex products. Allergic asthma response to most scented products, trees, and flowers.

Symptom List: Pain in extremity

Symptoms: Headache lasting 4 days solid. It is now intermittent. When headache was constant, I also got a Migraine headache that started on day 2 and ended midway through day 4. The Migraine may or may not be related. I sometimes still get them during my period even though I take Topiramate as a preventative. I am also experiencing an increase in fatigue and slept excessively the first 4 days. The pain from my fibromyalgia spiked hard on day 2 and three. I am still in a flare.

Other Meds: Acetaminophen Acetazolamide Lansoprazole Sertraline Bupropion Famotidine Montelukast Meloxicam Cephalexin Buspirone Topiramate Cyclobenzaprine Lamotrigine Solifenacin B-complex Folic acid Vitamin c Calcium Magnesium Zinc

Current Illness:

ID: 1233621
Sex: F
Age: 53
State: IN

Vax Date: 04/15/2021
Onset Date: 04/16/2021
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: Left arm could not touch between shoulder and elbow without severe pain and the 5th day uncotraollable runs, fatigue and weakness

Other Meds: levothythroxine

Current Illness: none

ID: 1233622
Sex: F
Age: 45
State: IN

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: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: None

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

Symptoms: Red swollen hot to touch itchy on first shot the red spot wasn't as large as the second shot. It hurts to touch it. It's very red and swollen. It itches as well.

Other Meds: Insulin

Current Illness: None

ID: 1233623
Sex: F
Age: 24
State: NY

Vax Date: 04/16/2021
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: Gluten allergy

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

Symptoms: Immediate and intense pain at injection site. Patient lost consciousness. Has had sever nerve pain through entire body since injection. Triggered Anxiety.

Other Meds: N/A

Current Illness: N/A

ID: 1233624
Sex: M
Age: 26
State: AR

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: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: Amoxicillin

Symptom List: Vomiting

Symptoms: About 12 hours afterwards it feels like I caught the flu. Cold sweats, hot flashes, can't sleep, and feel nauseous.

Other Meds: Hydrocodone

Current Illness: None

ID: 1233625
Sex: M
Age: 45
State:

Vax Date: 03/18/2021
Onset Date: 03/20/2021
Rec V Date: 04/20/2021
Hospital: Y

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: Patient hospitalized within 6 weeks of receiving COVID vaccination.

Other Meds:

Current Illness:

ID: 1233626
Sex: F
Age: 20
State: PA

Vax Date: 04/20/2021
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: RA

Lab Data:

Allergies: NONE

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

Symptoms: POST VACCINE, FELT DIZZY, HOT, NAUSEA, LIKE SHE WAS GOING TO PASS OUT. BROUGHT TO OBS VIA WC. PLACED IN TRENDELENBERG ON STRETCHER, STATES RELIEF OF SYMPTOMS AFTER A FEW MINUTES, VSS THROUGHOUT OBSERVATION OF LYING TO STANDING. ESCORTED TO EXIT TO MEET FATHER WHO DROVE AT 1320 WITH NO ISSUES. 1250 INITIAL BP 109/67 HR 66 RR 16 SATS 99% RA 1255 113/65 HR 65 RR 18 SATS 100% RA 1256 SITTING BP 118/72 HR 76 RR 16 SATS 98% RA 1257 STANDING BP 117/73 HR 76 RR 16 SATS 98% RA

Other Meds: NONE

Current Illness: NONE

ID: 1233627
Sex: F
Age: 57
State: NY

Vax Date: 04/02/2021
Onset Date: 04/04/2021
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: Allergy to Singular

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Deep vein thrombosis was the diagnostic from the after effects of the second vaccination. Blood cot caused leg swelling and pain They did a cat scan & MRI Treatment was being given Eliquis (4 pills a day for 7 days) (2 pills after) It is a blood thinner and must follow up with my doctor.

Other Meds: Depakote, Metformin HCI, Omeprazole DR, Metroprolol Succinate, Lisinopril, Hydrochlorothiazide

Current Illness: Myelodysplastic syndrome (MDS)

ID: 1233628
Sex: M
Age: 3
State: CA

Vax Date: 10/27/2020
Onset Date: 12/21/2020
Rec V Date: 04/20/2021
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: None

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

Symptoms: Extreme Lethargy all day, Slurred speech, unbalanced gait, hallucinations, muscle weakness, attacks during sleep, night terrors.

Other Meds: None

Current Illness: None

ID: 1233629
Sex: F
Age: 77
State: IL

Vax Date: 03/05/2021
Onset Date: 03/07/2021
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: shellfish and penicillin

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

Symptoms: next day she had a fever the next day after taking the vax. 2 days later she had a 101 fever and she had severe pain shooting through her lower extremities. she contacted a physician that is a friend and asked to for an order to start therapy. On the 3rd day she started physical therapy. She started getting worse so she contacted her surgeon that ordered an MRI. DX is stenosis and bulging disc which she has had for years but has never been laid up because of it. She went to her PCP. They feel like she developed inflammation of the nerves for the weak parts of her body after taking the vax. The pain is in the nerve from her waist down to her ankle. She is still doing the physical therapy. She is scheduled to see an Orthopedic Doctor on 4/23/2021.

Other Meds: Cozaar, Prilosec,

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm