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: 1258174
Sex: F
Age: 77
State: MO

Vax Date: 03/24/2021
Onset Date: 03/27/2021
Rec V Date: 04/26/2021
Hospital: Y

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 and synthetics

Symptom List: Dysphagia, Epiglottitis

Symptoms: Case noted with increasing difficulty walking and writing. Once case noted with difficulty speaking s/o transported to hospital. Hospital dx CVA. Case now resides at LTC permanently.

Other Meds: Novolog, Lantus, Multivitamin, Iron

Current Illness: n/a

ID: 1258175
Sex: F
Age: 23
State: TX

Vax Date: 04/26/2021
Onset Date: 04/26/2021
Rec V Date: 04/26/2021
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: no known allergies

Symptom List: Anxiety, Dyspnoea

Symptoms: Patient was given Pfizer vaccine that was out of the freezer for more than 5 days. Patient was informed of this and offered new vaccine. At this time, patient showed no adverse reactions.

Other Meds: no known medication

Current Illness: no known additional illnesses

ID: 1258176
Sex: F
Age: 28
State: MI

Vax Date: 04/15/2021
Onset Date: 04/24/2021
Rec V Date: 04/26/2021
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: N/A

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

Symptoms: On April 24, 9 days after my vaccination, my left arm got very hot, red and swollen at the vaccination site. There was about a 5 inch diameter circle around the injection area. It was very visibly swollen and slightly itchy. I talked to a few medical professionals and they said this could happen and it is okay. I took tylinol at 11 PM and went to bed. In the next two days, the red circle area grew larger and now covers about a 8-9 inch area of my arm. It is no longer hot, but there is a red ring and it is now painful to lift my arm. My lymph nodes under my armpit also became painful on the night of the 24th. I had a virtual visit with a doctor, and the doctor told me to ice it, take antihistamines, and observe for more growth and streaks down my arm. Because of the handwriting, I cannot tell if the lot number of this vaccination is 043B21A, 043BZ1A, O43B21A, or O43BZ1A.

Other Meds: NP Thyroid 180 mcg daily

Current Illness: N/A

ID: 1258177
Sex: M
Age: 38
State: NC

Vax Date: 04/10/2021
Onset Date: 04/10/2021
Rec V Date: 04/26/2021
Hospital:

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

Lab Data:

Allergies: none known

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: The patient received the vaccine subcutaneously rather than intramuscular. The patient had redness and inflammation in the days following the vaccination that cleared up on its own.

Other Meds: none known

Current Illness: none known

ID: 1258178
Sex: F
Age: 50
State: MN

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 04/26/2021
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: Sulfa

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

Symptoms: Chills and fever within 5 hours of vaccine. Each day after chills, fever, headache, body aches

Other Meds: Amlodipine, nortriptyline, valacyclovir

Current Illness: None

ID: 1258179
Sex: M
Age: 55
State: NJ

Vax Date: 04/10/2021
Onset Date: 04/22/2021
Rec V Date: 04/26/2021
Hospital: Y

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: Iodinated Contrast Media

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

Symptoms: I had acute appendicitis requiring an appendectomy.

Other Meds: Zyrtec (daily), Nexium (as needed), Vitamin D, Prevagen

Current Illness: None

ID: 1258181
Sex: M
Age: 72
State: GA

Vax Date: 03/26/2021
Onset Date: 04/17/2021
Rec V Date: 04/26/2021
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: Mango, Iodine media, latex contact

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: SSNHL acute

Other Meds: Rosuvastatin 10mg, Fish oil, vitamin D, 81mg aspirin

Current Illness: none

ID: 1258182
Sex: F
Age: 39
State: NC

Vax Date: 04/23/2021
Onset Date: 04/23/2021
Rec V Date: 04/26/2021
Hospital:

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

Lab Data:

Allergies: Shellfish and aspirin. Patient and husband are unsure of other allergies at time of reaction. States that they typically have a list, but did not bring it to the vaccine clinic on 04-23-2021. States that there are "a few more". Patient carries epi pen due to shellfish allergy.

Symptom List: Pharyngeal swelling

Symptoms: At approximately 8:30 AM patient received 2nd dose of Pfizer vaccine in the right arm at the Public Health Center's drive through vaccine clinic. She was accompanied by her husband who was driving her vehicle. At 8:34 AM she notified staff in observation parking area that she felt dizzy, chest pain, and reported wheezing. Two RN's responded at 8:34 AM to observation parking area with emergency kit. Upon arrival, patient verbalized again that she felt dizzy, chest pain and tightness now, no audible wheezing heard, patient's skin was pale, and her respiratory rate was high. Advised patient to take slow deep breaths and to try to relax and remain calm. No improvement. At 8:36 AM called 911 for the patient to be evaluated. While one RN was on the phone with 911 operator, patient reports to the second RN throat pain/ tingling, difficulty swallowing, a feeling of a "lump in her throat", continued chest pain and tightness, and states that she feels she cannot breathe in or out well. Per standing order Epinephrine 0.3 mg administered in the right thigh IM. Both RN's remained on scene. No improvement, and patient continued to state it was getting harder to breathe, and that her throat was tingling and she could hardly swallow. At 8:44 AM 0.3 mg Epinephrine administered in the left thigh IM per standing order. At 8:50 AM EMS arrived. Patient had improvement. Vital signs stable upon arrival per EMS. Breathing difficulty improved upon EMS arrival. No further difficulty swallowing reported. Chest pain reported to be improved as well. 8:55 AM EMS transported patient to local hospital. Attempted to contact the patient on 04-26-2021 to determine outcome of event. Phone went to voicemail. Voice message left.

Other Meds: Unknown

Current Illness: None reported

ID: 1258183
Sex: F
Age: 29
State: TN

Vax Date: 04/08/2021
Onset Date: 04/09/2021
Rec V Date: 04/26/2021
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:

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: My water broke the next morning (April 9) after having the second dose of moderna on April 8th. I was at 36 weeks and 1 day in my pregnancy. I had just scheduled a c-section for April 30th on the day I got the injection. So my water breaking the next morning was quite a shock. We were able to do a c-section. He weighed 6 pounds and 3 ounces. He had hypoglycemia and we ended up having to do a glucose pump.

Other Meds:

Current Illness:

ID: 1258184
Sex: F
Age: 37
State: IL

Vax Date: 04/24/2021
Onset Date: 04/24/2021
Rec V Date: 04/26/2021
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

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Sore arm, headache, fever, muscle aches, joint pain, nerve pain, brain fog, mild nausea beginning late evening/overnight on day of injection (Saturday) and continuing until early morning 2 days later (Monday). Sore arm continuing but beginning to reduce in severity. Treated with Tylenol every 4-6 hours. After dose 1, I experienced a sore arm, as well as a rash at the injection site appearing 8 days after injection and resolving 1 week later.

Other Meds: Escitalopram 10 mg, vitamin D, vitamin B-12, Liletta IUD

Current Illness: None

ID: 1258185
Sex: F
Age: 48
State: TX

Vax Date: 04/17/2021
Onset Date: 04/17/2021
Rec V Date: 04/26/2021
Hospital:

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

Lab Data:

Allergies: N/A

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

Symptoms: Before I start, I've really tried documenting this to you earlier and it kept timing out on me. Hopefully the third time is a charm! On Saturday, April 17th at approximately 11:55 am, (45 mins after my shot) I started experiencing partial paralysis to the left side of my face. My cheek bone started to go numb, within the hour, after a weird tingling sensation, it went from my cheek bone down towards my jaw (all becoming numb). This lasted all weekend. I used cold compresses for a little bit at a time just to make the heat coming off of that side feel a little better as my face was flushed. On Monday, April 19th, my lower cheek started to not be so numb. The tingling sensation would come and go from my eye brawl, then the side of my mouth/lip area. I developed a headache that Monday evening. Tuesday morning, my headache was gone. This tingling sensation and partial numbing would last through Wednesday, April 21st. That day, I called my doctor's office and told them about my reaction and to see if they could do some blood work or something. They said that I needed to go to the ER at a hospital for help and to get it documented. Out of all weeks for me to have a side effect, this busy mom had too much going on to schedule an ER visit. My daughter is going into high school and she had auditions and clinics where I had made the choice to figure out I will try to go there on another day. By Thursday, April 22nd, my cheek bone started to become un-numb. The affected side started to feel like the other side of my face. During this entire time, I didn't take any medicine. By Friday, April 23rd, I felt much better. I have more control of my face muscles and I feel like this might be something that was just temporary, but I told myself that if it comes back in any way, I will go to the ER regardless of what is going on in my life. It was a scary thing and now as I look at my card, it reads that the second shot is May 8th at 11:15. I am really scared to get that because who knows what will come from it and I wouldn't want to get anything permanent. I know with traveling, some countries are making it mandatory to be vaccinated. So does this mean that I will not be able to travel if I don't get that second shot. I have no idea what to do with this appointment. Any advice would be great! As of today, April 26th, I feel 95% better on my left side of my face but if I sleep on it for too long, it tends to feel heated at my cheek bone. Aside from that I'm much better. Now onto the second side effect, my left arm muscle was in excruciating pain and I could not lift my arm for two days. It effected my elbow to my shoulder. After Monday, April 19th, my arm started to get better every day. This was the arm that I got my shot in. Today, April 26th, is the first day it seems back to normal. I know you can have a sore arm with this shot, but this was much more than a sore arm. My left side of my face, my left arm, and a headache were the only abnormal events that took place after my first Covid shot. I am thankful to be feeling much better, but will continue to monitor the situation of my face as that is what is most concerning about this vaccination.

Other Meds: N/A

Current Illness: N/A

ID: 1258186
Sex: F
Age: 51
State: MA

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 04/26/2021
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: bacitracin

Symptom List: Rash, Urticaria

Symptoms: throat numbness, lip and tongue swelling

Other Meds: levonorgestrel (MIRENA) 20 mcg/24 hr (5 years) intrauterine device

Current Illness: Dysplastic nevus of skin Postpartum thyroiditis Elevated cholesterol

ID: 1258187
Sex: M
Age: 48
State: NJ

Vax Date: 04/24/2021
Onset Date: 04/24/2021
Rec V Date: 04/26/2021
Hospital:

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

Lab Data:

Allergies: Latex bandges

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

Symptoms: I felt extremely dizzy about 2 hours after my 2nd vaccination of Moderna so I tried to take it easy and stayed in bed most of the day and night . The day after I did try to walk outside and suddenly became extremely dizzy while carrying an item and fell in my driveway without even having the ability to put my hands out front. My face is now swollen, cut and bruised and I also have pain in my neck.I have pictures of my face after my fall and had to call out of work today Monday 4/26/2021 as a result.

Other Meds: Generic Zoloft 150 MG daily Amitriptyline HCL 10 MG at night

Current Illness: TBI and post concussion syndrome. Attending VestibularTherapy twice weekly for balance and gait issues.

ID: 1258188
Sex: M
Age: 78
State: ID

Vax Date: 03/31/2021
Onset Date: 04/04/2021
Rec V Date: 04/26/2021
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: Unknown

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

Symptoms: Patient states that 4 days after getting the vaccine he had vertigo and light headed-ness. He saw his PCP for follow-up. On Friday, 4/23/21, patient states he woke up with a nose bleed and has had two-three nose bleeds since then.

Other Meds: Aspirin

Current Illness: None

ID: 1258189
Sex: F
Age: 37
State: GA

Vax Date: 04/19/2021
Onset Date: 04/22/2021
Rec V Date: 04/26/2021
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: Heart rate decreased, Heart rate increased, Hypertension, Injection site pain, Musculoskeletal chest pain

Symptoms: On 4/22/21 in the evening I noticed that an area above my knee on my left leg was sensitive/ painful any touch. Through out the night the issue persisted. Even my sheets touching my the area on my left thigh caused mild pain (2-3 on pain scale). Area on the back was really tender to touch. No signs of bruising or swelling was present . The next day I called a nurse at work to ask what I should do and she suggested I come in to be evaluated. I was then sent to the ER to rule out a blood clot. An ultrasound was done on the left leg and no clot was found. The area remained sensitive to touch and tender for about 36 hours and then resolved.

Other Meds: Aviane, Montelukast, levocetirizine, trulance, evening primrose oil, omega 3 fatty acids, fiber chewable

Current Illness:

ID: 1258190
Sex: F
Age: 39
State: CA

Vax Date: 04/21/2021
Onset Date: 04/21/2021
Rec V Date: 04/26/2021
Hospital: Y

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

Lab Data:

Allergies: Iodine, Remicade, Inflectra, Cphalexin, Compazine, Contrast dye, Fish, Penicillin, Humira

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

Symptoms: Inj at 0825. At 0830 pt with swelling of throat, hoarseness within 5 mins of injection; increasing stridor and tongue swelling. Epi Pen given X1 with good results. Team alert team arrived to transport patient to ED where care continued (epi, Prednisone, albuterol, ) and 2 days in hospital.

Other Meds: Atorvastatin

Current Illness: ANKYLOSING SPONDYLITIS OF UNSPECIFIED REGION OF SPINE

ID: 1258191
Sex: F
Age: 25
State: IL

Vax Date: 04/08/2021
Onset Date: 04/08/2021
Rec V Date: 04/26/2021
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: Penicillins, seafood,

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

Symptoms: 4/8 1:35 pm -immediately following shot: dizziness, Extreme nausea, scratchy throat, feeling as though the throat was closing up. 2pm violently vomiting, pounding headache, went to sleep at 2:30 PM woke up around noon Friday4/9 4/9 vomiting, nausea, headache, weakness, unable to eat or drink food, Profusely sweating even though I was cold. Symptoms continued, I was admitted into er on 4/18. 4/26 near black out twice, lower abdomen hurting worse then the rest of the stomach.

Other Meds: Women?s multi vitamin, zofran, dicylomine,

Current Illness: Chrons,

ID: 1258192
Sex: M
Age: 63
State: LA

Vax Date: 03/17/2021
Onset Date: 04/13/2021
Rec V Date: 04/26/2021
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: none

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Acute pericarditis, severe chest pain, colchicine 0.6 mg tablet 2 times per day for 10 days, asprin 81 mg

Other Meds: propranolol 10 mg,, multi vitamin, omeprazole , claritin

Current Illness: none

ID: 1258193
Sex: F
Age: 60
State: PA

Vax Date: 04/25/2021
Onset Date: 04/25/2021
Rec V Date: 04/26/2021
Hospital:

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

Lab Data:

Allergies: shellfish

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Pfizer-BioNTech COVOD-19 Vaccine EUA: At 30 minutes after injection of vaccine, I experienced numbness of my lips and tongue. This lasted approximately 5 hours.

Other Meds: none

Current Illness: none

ID: 1258194
Sex: F
Age: 32
State: NY

Vax Date: 03/24/2021
Onset Date: 04/03/2021
Rec V Date: 04/26/2021
Hospital:

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

Lab Data:

Allergies: Cefaclor (medication)

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

Symptoms: Shingles on right side of forehead. Pain began about a week after first COVID-19 shot but rash didn't appear until around midday on April 3.

Other Meds: Zyrtec, Nexplanon (birth control implant); Supplements/Vitamins: Vitamin D, B complex, Iron, Zinc, Magnesium, Collagen, probiotic

Current Illness: N/A

ID: 1258195
Sex: F
Age: 48
State: PA

Vax Date: 04/16/2021
Onset Date: 04/23/2021
Rec V Date: 04/26/2021
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: Pseudoephedrine causes skin reaction of boils phenylephrine causes skin reaction of boils Diphenhydramine states "can not tolerate" no specific reaction provided Tree Nuts cause shortness of breath

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

Symptoms: One week after vaccination she woke with very enlarged, tender lymph node in the axilla of the same arm she received the vaccine. she also developed fatigue at the same time the lymph node was noticed. There was not fever or local redness or warmth. Size and tenderness of nodes has gradually improved although fatigue is unchanged. She was examined it was 4 days after the onset of symptoms. At that time there were 3 enlarged lymph nodes in anterior aspect of right axilla ranging 1/2 - 1 cm in size. Firm but not fixed. Mildly tender w/o warmth or redness. No pectoral, epitrochlear or supraclavicular adenopathy. No rashes or wounds on chest or upper extremity, No fever. Breast exam normal.

Other Meds: None reported

Current Illness: Approximately 2 weeks prior to vaccination had contusion to sternal area. She states she took diclofenac, ibuprofen, cyclobenzaprine and omeprazole for a few days but was not taking them at the time of her vaccination.

ID: 1258196
Sex: F
Age: 33
State: VA

Vax Date: 04/01/2021
Onset Date: 04/17/2021
Rec V Date: 04/26/2021
Hospital: Y

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

Lab Data:

Allergies: None

Symptom List: Unevaluable event

Symptoms: Patient developed blurry vision and headaches 16 days after her vaccine. went to the ER a week later and was diagnosed with Optic Neuritis via CT imaging

Other Meds: None

Current Illness: None

ID: 1258197
Sex: F
Age: 32
State: GA

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 04/26/2021
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: Shellfish, gluten intolerance

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

Symptoms: Swollen red circle on skin at injection site, over 1" in diameter, extremely painful to touch (shirt sleeve or bedsheet laying against it caused extreme pain). Redness felt hot to the touch. Pain started to lessen by the 23rd, swelling and heat started going down by the 24th, then became itchy. Still slightly red and skin feels slightly rough as of the 26th.

Other Meds: Citalopram, alprazolam, buspirone

Current Illness: N/A

ID: 1258198
Sex: M
Age: 32
State: OH

Vax Date: 04/20/2021
Onset Date: 04/21/2021
Rec V Date: 04/26/2021
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: Hydrocodone

Symptom List: Injection site pain, Pain

Symptoms: Fever (101.5) for 18 hours. Light fever (99) until 36 hours after first symptom. Shakes and chills. Achey joints. Flu symptoms and weakness. Sluggish 24 hours. Cutaneous hyperesthesia for 48 hours. Chest pain and odd feeling when taking deep breaths until 04/23. Persistent headache until 04/24 evening. Headache persisted over front left eye and back of head.

Other Meds: No

Current Illness: No

ID: 1258199
Sex: M
Age: 17
State: PA

Vax Date: 04/08/2021
Onset Date: 04/10/2021
Rec V Date: 04/26/2021
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: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Fever, dysequilibrium

Other Meds: Vit D, MVI

Current Illness: None

ID: 1258200
Sex: F
Age: 33
State: IL

Vax Date: 04/22/2021
Onset Date: 04/23/2021
Rec V Date: 04/26/2021
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: Latex

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

Symptoms: Arm was sore

Other Meds: None

Current Illness: None

ID: 1258201
Sex: F
Age: 31
State: FL

Vax Date: 12/29/2020
Onset Date: 12/29/2020
Rec V Date: 04/26/2021
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: Shellfish

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Broke out in an itchy rash that produced hives across the chest and travelling up the throat externally. Administered oral benadryl 50mg as one dose.

Other Meds: No

Current Illness: None

ID: 1258202
Sex: M
Age: 31
State: CA

Vax Date: 04/21/2021
Onset Date: 04/21/2021
Rec V Date: 04/26/2021
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: Pt called and stated he was having sob, and chest discomfort tightness, stated started at 7:00am and has not improved or changed nothing that he dose changes this discomfort stated 6/10 scale I told him I felted that he should be seen by the ED, he also had bone pain and Diff breathing

Other Meds:

Current Illness:

ID: 1258203
Sex: F
Age: 41
State: MN

Vax Date: 04/21/2021
Onset Date: 04/22/2021
Rec V Date: 04/26/2021
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 known

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

Symptoms: I previously had COVID-19 early last August. I had all the symptoms and had a fever around 99-100 for many days in a row. I also got the coughing towards the end of Covid and then had Covid pneomonia and was hospitalized for 4 days as my body just needed oxygen. I was hoping to take the vaccine so I wouldn't get the full Covid illness again. I took my first dose of the vaccine Wednesday morning, 4/21. I only felt tired Thursday morning, 4/22 however by middle of the afternoon I began to have shivers and was very cold. As the night went I was feeling terrible and had first seen a 104 temp but thought I took it wrong. Later took my temp again and was 102.5. After taking some ibuprofen my temp went down to 99.8. I had terrible leg pain and restless legs and couldn't get comfortable the entire evening, full body was in pain. It was worse then having actual Covid, I've never had my body feel that bad before but very glad it was for a shorter time period. Very sore and stiff, almost as if I couldn't get up to use the restroom. I was sleeping in and out (trying atleast) and woke up with night sweats around 11pm. I do think my fever had finally broke around then. I was in communication that night with my friend who is a nurse and we both hoped I would be better by the next morning. Thankfully I did sleep the rest of the night and only felt very tired and exhausted Friday & Saturday. Friday, it was still hard to get out of bed, alot of soreness but glad the fever was done. Saturday was better just tired and started to feel almost back to normal again on Sunday (5 days post my 1st vaccine dose) just still tired even today on Monday, 4/26.

Other Meds: Womens Daily Vitamin, Vitamin D supplement, Hair Skin & Nails supplement with Biotin, Vitamin C gummy

Current Illness: None

ID: 1258204
Sex: F
Age: 68
State: NH

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 04/26/2021
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: Incorrectly documented dose 2 of Pfizer in this patient's account. This patient did not actually receive this dose of Pfizer - recorded the correct dose under the correct patient's account. Please disregard the Pfizer vaccine documented in this patient's account.

Other Meds:

Current Illness:

ID: 1258205
Sex: F
Age: 52
State: GA

Vax Date: 04/23/2021
Onset Date: 04/24/2021
Rec V Date: 04/26/2021
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

Symptom List: Injection site pain

Symptoms: Rash on patients neck and chest area. Lasting from early Saturday (April 24) until Monday (April 26). Rash is still visible, but greatly improved. Low grade fever of 99 degrees or less. Symptoms were manageable by anti-histamine and Tylenol.

Other Meds: None

Current Illness: None

ID: 1258206
Sex: F
Age: 72
State: FL

Vax Date: 03/12/2021
Onset Date: 03/13/2021
Rec V Date: 04/26/2021
Hospital:

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

Lab Data:

Allergies: Eggs chicken Codeine penicillin Actifed

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

Symptoms: Fever throwing up and sick weakness for three days

Other Meds: Calcium and D

Current Illness: None The second moderna shot made me extremely ill. High fever and throwing up. I was weak for a week

ID: 1258207
Sex: F
Age: 54
State: VA

Vax Date: 04/22/2021
Onset Date: 04/23/2021
Rec V Date: 04/26/2021
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: penicillian

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

Symptoms: Severe muscle aches all over body for 24 hours, nothing helped. Now I have swollen lymph nodes in the neck and arm pit.

Other Meds: none

Current Illness: none

ID: 1258208
Sex: F
Age: 47
State: AZ

Vax Date: 04/22/2021
Onset Date: 04/23/2021
Rec V Date: 04/26/2021
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: Sulfa, Eggs

Symptom List: Tremor

Symptoms: Fever for 12 hours with migraine. Once recovered had problems with controlling blood sugars where the medication was not as effective and causing problems with blood sugar that was being controlled having problems with controlling the levels and increased dosages only providing mild help.

Other Meds: Humalog, Lantus, Metformin, Redds,

Current Illness: Diabetes, & eye degeneration

ID: 1258209
Sex: F
Age: 65
State: CA

Vax Date: 02/16/2021
Onset Date: 04/01/2021
Rec V Date: 04/26/2021
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: Erythema, Pruritus

Symptoms: Was fine after vaccine no arm pain. Two months later severe arm pain unable to lay on arm and move arm back or raise up high

Other Meds: Effexor,dyazide,Celebrex, Vitamin D, Protonix, synthroid

Current Illness: None

ID: 1258211
Sex: F
Age: 18
State:

Vax Date: 04/10/2021
Onset Date: 04/10/2021
Rec V Date: 04/26/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: During obs, member became pale, felt faint, appeared to be hyperventilating and was obviously very anxious. Adult emergency called. Moved to holding room. BP 80s/40s O2 sats 60%, patient hyperventilating, c/o numbness in her hands and fingers. Alert and oriented, talking the whole time and very anxious. Member improved with O2 sats 100% BP 120/56. Observed x1 hr.

Other Meds:

Current Illness:

ID: 1258212
Sex: F
Age: 55
State: FL

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 04/26/2021
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: Gluten Sulfur (got hives once while taking an antibiotic)

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

Symptoms: Moderna Vaccine April 14th - Recieved first shot at around 9:30 am. Stayed in waiting room 15 minutes. Was about to leave but started to feel dizzy, nauseous and a little faint. The nurse checked on me and I stayed in waiting room an extra 15 minutes till I felt a little better and went home. My left shoulder where I received the shot swelled up and was hot and bright red. My arm hurt so bad I couldn?t use it and need help to get undressed and get in bed. I took one Ibprofen. April 15th - I didn?t sleep well because my arm hurt very bad, but I got up and went about my day. Around 5pm I started feeling chills and it continued to get worse. I was shaking in bed and was covered with all the blankets I could find. I had terrible pain all over my body. I took 3 Ibprofen and after an hour the shakes stopped and I had a 101 temperture. I stayed in bed and took a clonazapam to help me sleep. April 16th - I felt weak and ache and stayed in bed all day. April 17th - I felt a little better and got up and went about my day. That evening I had 1/4 glass of red wine with my steak dinner and I also took an acylclovir (a medication I normally take but stop taking after the vaccine) and went to sleep at 11pm. Around 1:30am I woke up out of a terrible nightmare and was seeing weird patterns when I closed my eyes. My body felt very strange, an anxious terrified feeling... my spine felt tingling and my body was writhing... I took a clonazapam and an Ibprofen, tried to watch something calming on TV, felt a bit better an hour later and went back to sleep. April 18th - I felt weak and ache and stayed in bed all day. April 19th - I felt a little better, 70% energy, did my work out April 20th - Woke up at 3 am with hot flashes and headache. Feeling 50% energy, but did my workout, naped for 3-4 hours in the afternoon. April 21st - Woke up at 3 am with hot flashes and headache. Feeling 50% energy, but did my workout, naped for 3-4 hours in the afternoon. April 22nd - Woke up at 3 am with hot flashes and headache. Feeling 50% energy, but did my workout. Decided not to nap hoping not to wake up at 3am...cleaned house but felt very tired. April 23rd - Woke up at 3 am with hot flashes and headache. Feeling 50% energy, but did my workout and stayed in bed all day afterwards. Took CBD oil before bed. April 24th - Slept a little better, did my workout in the morning... felt 50% energy. Took a 2 hour afternoon nap. Rested most of the day. Took CBD oil before bed. April 25th - Slept in till 7:30 am and didn?t workout. I felt a little better. Went for a walk and a swim in the afternoon. April 26th - Woke up at 5 am with hot flashes. Still not 100%, but did my workout

Other Meds: I stopped taking my prescription medication (Acyclovir) except for one night I took one 400 mg. I took a half a dose of Zolmitriptan a few times for headaches. I took Ibuprofen a few times for fever and aches. I took CBD oil and Clonazepam

Current Illness: None

ID: 1258213
Sex: F
Age: 68
State: MD

Vax Date: 03/30/2021
Onset Date: 04/05/2021
Rec V Date: 04/26/2021
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: Iodine contrast dye

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Soreness, slight swelling, and rash at and around injection. Extreme fatigue, muscle aches and cramping, sinus drainage, occasional headache, decreased ability to attend and concentrate. At this date, the symptoms in my left upper extremity have resolved. The other symptoms are still present mildly and occasionally.

Other Meds: Multiple vitamin supplements, omega 3s, collagen, lutein supplement.

Current Illness: ?sinus infection--had to call off work. Tested negative for covid 19.

ID: 1258214
Sex: F
Age: 33
State: IL

Vax Date: 04/22/2021
Onset Date: 04/22/2021
Rec V Date: 04/26/2021
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: None

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

Symptoms: Approx. 60 seconds after my vaccine injection: - Highly accelerated heartrate - Difficulty breathing (due to accelerated heart rate) - Dizziness - Feeling faint - Headache - Fever These symptoms lasted 10 min; however the dizziness, headache and fever lasted 45 minutes. No pain in the arm at all.

Other Meds: Cabergoline 0.5mg tablets; Spironolactone 50mg tablets; Nortrel 1/35 tablets 28; Women's One-A-Day vitamins; Hairfinity vitamins; Vitamin D3 5,000 IU; Vitamine B12

Current Illness: IVF egg retrieval

ID: 1258215
Sex: M
Age: 51
State: WI

Vax Date: 03/18/2021
Onset Date: 03/19/2021
Rec V Date: 04/26/2021
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: Fish

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

Symptoms: Extreme joint pain tiredness fingers felt cold and ached to touch anything sore neck in lymphnode area then the headaches started a few days later like 5 days i felt very tired weak not sick to stomach but felt like blood was dirty hard to explain right kidney hurt then weeks of headaches felt like head was bleeding it hurt so bad chest felt like just got over a chest cold or bronchitis or ran out in cold weather and also very cramped feet some of this still happening but most has subsided . The scariest part was the feeling of my headache terrible .i never went to a er or doctor but almost did.

Other Meds: Omeprazole

Current Illness: Posative results potassium gate channel test uncontrolled muscle spasms general aches pain memory issues ,lumps in me all over i assume some sort of immune over active issue inflamation as well

ID: 1258216
Sex: M
Age: 35
State: IA

Vax Date: 04/25/2021
Onset Date: 04/25/2021
Rec V Date: 04/26/2021
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: Pain in extremity

Symptoms: When mixed, vial was only mixed with 1mL of diluent and 1 dose was given to patient. No other doses were given from vial. Patient was made aware. Patient was followed up with on 4/25 at 4:30pm and no issues reported at the time. Also called patient on 4/26 at 10am and patient stated he was having a low-grade fever and sore arm.

Other Meds: None

Current Illness: None

ID: 1258217
Sex: M
Age: 23
State: IN

Vax Date: 04/24/2021
Onset Date: 04/25/2021
Rec V Date: 04/26/2021
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: >100 degree fever, chills, body aches (particularly in the legs and joints), and fatigue

Other Meds: Guanfacine Wellbutrin Acetametaphine

Current Illness:

ID: 1258218
Sex: F
Age: 70
State: FL

Vax Date: 02/26/2021
Onset Date: 03/01/2021
Rec V Date: 04/26/2021
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: After receiving my second dose of the Moderna Covid 19 vaccine on 2/26/2021 I woke up around 2 am on 3/1/2021 with very loud ringing in my ears. This ringing has been constant since then. I have gone to my primary physician on 3 occasions as well as an ENT on 2 occasions. I have been treated with Hydroxyzine, Sudafed and Flonasemist.

Other Meds: Amlodipine Besylate 2.5 Mg LosartanPotassium and Hydrochlorothiazide 50/12.5 Mg

Current Illness: None

ID: 1258219
Sex: M
Age: 53
State: TX

Vax Date: 04/13/2021
Onset Date: 04/16/2021
Rec V Date: 04/26/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: reports symptoms of right eye tearing and tongue paresthesia with inabity to drink out of right side of mouth and or grasp straw. reported drooling with right side facial drooping noted on ER visit. Reports that symptoms started approx. on the 16 of Apr and was evaluated on the 23 of Apr for concerns of TIA which was ruled out. Pt was then treated for suspected Bells Palsy with Acyclovir and Prednisone

Other Meds: diltiazem and allopurinol

Current Illness: none

ID: 1258220
Sex: F
Age: 24
State: AZ

Vax Date: 04/21/2021
Onset Date: 04/21/2021
Rec V Date: 04/26/2021
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:

Symptom List: Vomiting

Symptoms: Second dose given before 24 days

Other Meds:

Current Illness:

ID: 1258221
Sex: F
Age: 18
State: IN

Vax Date: 04/24/2021
Onset Date: 04/24/2021
Rec V Date: 04/26/2021
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: I vomited multiple times over the course of a couple days and I had a fever of 101 with lots of sore muscles

Other Meds: none

Current Illness: none

ID: 1258222
Sex: F
Age: 33
State: MA

Vax Date: 04/17/2021
Onset Date: 04/26/2021
Rec V Date: 04/26/2021
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:

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

Symptoms: My arm feels like there is a bad bruise and the muscle feels sore when I move around. It appears red blotchy and visibly swollen. It is also warm to the touch. Read online people who experience this use antihistamines to treat so I applied topical Benedryl. No difference yet.

Other Meds: I take generic Claritin for my allergies most days and ibuprophen most days.

Current Illness:

ID: 1258223
Sex: F
Age: 57
State: IL

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 04/26/2021
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: Ampicillin, Ancef, Cortison cremes

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Hives on left jaw line area. Hive on both ulna bone area. Took 1 Benadryl tablet after one hour. Hives disapeared after one hour of taking Benadryl. Lethargic for two weeks following vaccine. Arm soreness on and off for two weeks.

Other Meds: Daily: Progesterone 600 mg, Vitamin C, Zinc Complex, DIM 200 mg, D3, B12, Calcium Citrate Magnesium and Zinc, Super B Complex, Fish Oil

Current Illness: None

ID: 1258224
Sex: M
Age: 41
State: MD

Vax Date: 03/25/2021
Onset Date: 03/25/2021
Rec V Date: 04/26/2021
Hospital:

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

Lab Data:

Allergies: Penicillins Kiwi

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

Symptoms: Patient developed itching 10 mins post-vaccination. Itching moved from upper body to head and inside mouth. Felt slight soreness in throat 45 mins in. Took diphenhydramine 25mg. Symptoms slowly dissipated. Stayed under observation a total of 1.5 hours. No feeling of obstruction in throat, no shortness of breath or wheezing, no rash or swelling. VS normal, physical exam normal. Slight increase in heart rtate which may have been due to Adderall.

Other Meds: Duloxetine, Wellbutrin, Adderall

Current Illness: None

ID: 1258225
Sex: F
Age: 57
State: IN

Vax Date: 04/16/2021
Onset Date: 04/17/2021
Rec V Date: 04/26/2021
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: Weakness, achiness, chills

Other Meds: Mobic, oxybutin, atorvistatin, omeprazol, linsinopril

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm