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: 1266061
Sex: F
Age:
State: MI

Vax Date: 04/07/2021
Onset Date: 04/01/2021
Rec V Date: 04/28/2021
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:

Symptom List: Dysphagia, Epiglottitis

Symptoms: I can't walk around anywhere; I have allergies too; It was bad, getting hard to breathe.; she got like double the amount of symptoms that she had experienced following the first dose of Pfizer-BioNTech Covid-19 Vaccine.; she can't talk, it's closing up her throat,; she can't talk, it's closing up her throat,; taste sodium in my mouth constantly; coughing; got home and I've been sick ever since.; This is a spontaneous report from a contactable consumer (patient herself). A 62-years-old female patient received second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, solution for injection, Lot Number: EW0150; Expiration Date: 31Jul2021) via an unspecified route of administration administered on right arm on 07Apr2021 at 13:30 (at the age of 62-year-old) as SINGLE DOSE for covid-19 immunization. Medical history included ongoing Allergies with This was under control, ongoing asthma with This was under control, meniere's disease from 1989 and ongoing with This was under control, have 2 broken knees. Patient knows how to control this condition, she didn't need Prednisone prior to onset of these adverse events, Low immune system with She has an immune deficiency so her immune system very low, like 300., Respiratory illness, Genetic/chromosomal abnormalities, Endocrine abnormalities with endocrine abnormalities (including diabetes) and obesity. Family Medical History Relevant to AE reported as None. History of all previous immunization with the Pfizer vaccine considered as suspect reported as Both doses of product documented in Pfizer Suspect Vaccine and Vaccination fields. Additional Vaccines Administered on Same Date of the Pfizer Suspect reported as None. Historical vaccine included first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, Lot Number: EN6207; Expiry date: 31Jul2021) via an unspecified route of administration to the right arm on 13Mar2021 at 13:30 as single dose for COVID-19 immunization. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine other than dose 1 of 2 of the Pfizer-BioNTech Covid-19 Vaccine. Regarding concomitant products and other medical conditions patient reported none other than just her inhalers which doses of had to be increased in response to symptoms after first and second doses of Pfizer-BioNTech Covid-19 Vaccine. Concomitant medication included tiotropium bromide (SPIRIVA) taken as Dose increased to twice in the morning daily for an unspecified indication from an unspecified start date and ongoing, (Lot number: 0014678, ; Expiration Date: Jan20230); fluticasone propionate, salmeterol xinafoate (ADVAIR) 500 taken as Dose increased from once daily to twice daily an unspecified indication from an unspecified start date and ongoing; azelastine hydrochloride (Lot Number: 3N2E, Expiration Date: Feb2022), fluticasone propionate (DYMISTA) taken for an unspecified indication from an unspecified start date and ongoing (Lot number: GA00510, Expiration date: May2022); prednisone (PREDNISONE) taken for an unspecified indication with quantity of 27, Dose: 3-20mg daily for 7 days, then 2-20mg daily for 2 days, then 1-20mg daily for 3 days and Ongoing therapy. She also used a nose spray that didn't work so they switched her back to Dymista nose spray. Consumer stated that she received both doses of Pfizer's COVID vaccine and had reactions to both of them. Consumer stated that, "The second dose was even worse. They put her on Prednisone. She did not know if she should be tested again or not? She was sitting up but she could not walk around anywhere. She had 2 broken knees. She could not walk anywhere. After the second dose, they had to bring her to the hospital because she couldn't even walk to her car. She got home and she had been sick ever since. She had allergies too. She could not do anything. she had a hard time breathing. she was hesitant to get the 2nd one, but everybody said to get it. Her IgG level was down to 300 something. She was also tapering off of prednisone and she did not want to be tapering off it because it was worked well for her. She could tell by her breathing that it was helped her. She could taste sodium in her mouth constantly since she had got the vaccination." Second dose completed her prescribed therapy. Dates for Symptoms From 15Mar2021 to Ongoing Reported seriousness for Symptoms reported as Unspecified and the Symptoms was reported as worsened. Patient's doctor dropped her last week, told her she didn't know what to do with her, and that this was too stressful. Onset of symptoms following first dose of Pfizer-BioNTech Covid-19 Vaccine was on 17Mar2021. She couldn't breathe very well when she went in for the first dose of Pfizer-BioNTech Covid-19 Vaccine. She was ok the first day after the first dose of Pfizer-BioNTech Covid-19 Vaccine, seemed ok, arm didn't hurt; but then had onset of symptoms. She has been in bed the whole time since onset of symptoms, was in bed for over 2 weeks. She slept for 2 days straight, only got up for water and the bathroom. It was bad, getting hard to breathe. She had to use her emergency inhaler. The Pfizer-BioNTech Covid-19 Vaccine messed up her Meniere's disease. Doctor started patient on Prednisone for these symptoms, and Prednisone is really the only thing that clears up Meniere's disease because her ears was full and she could not get up. Prednisone helped her and I relayed in her 'rescue' inhalers (treatment) because she did 2 in the morning, two inhalers anyway when she started to feel better, she got her second one and it made her worst. She did not eat anything salty or anything, the barometric pressure was not bad. It was really funny because she had just finished everything and it was a few days before she had to go get her second dose of Pfizer-BioNTech Covid-19 Vaccine shot. She was just starting to feel normal, at least normal for her, she could get up normal and drive. They gave her the second shot of Pfizer-BioNTech and it was like a double. She clarified as she got like double the amount of symptoms that she had experienced following the first dose of Pfizer-BioNTech Covid-19 Vaccine. She is tasting sodium in her mouth from the Pfizer-BioNTech Covid-19 Vaccine. She can't have much sodium which struck up the Meniere's disease really bad the second day after the second dose of the Pfizer-BioNTech Covid-19 Vaccine; her allergies in her head went bonkers. She could not talk, it was closing up her throat, she was coughing every time she eats or dinks, and she's having a "really bad" adverse reaction to the Pfizer COVID-19 vaccine after the second dose. They had to take her out of the hospital to her car in a wheelchair "right after" getting the second shot. She could not get more than 1000 mg of sodium a day, she tastes it in her mouth constantly, she could not get rid of it and it was "going through her system". She wanted to know what to do, since her doctor told her to contact Pfizer. She wanted to know what part of the vaccine is doing that, she assures it is sodium, because sodium is in her mouth 24/7 and she could not get it out, she could not have that much sodium in her body. It was still getting really hard to breathe. She is still taking the Prednisone she was initially prescribed and started on for the symptoms that started after her first dose of Pfizer-BioNTech Covid-19 Vaccine. She is tapering off of Prednisone, and she shouldn't be tapering off, she thinks she needs to be Prednisone for some more days, maybe 3 more days, then she would be ok. It was prescribed as a 7-day burst of Prednisone. She mentioned that the only Prednisone that works on her is the Actavis manufactured Prednisone; her pharmacy orders it for her because they know that. She called the emergency room Saturday when she was really bad. They said they had a line there and it was going to be at least a 4 hour wait. With patient's low immune system, Meniere's disease and that she could hardly breathe she did not go to the emergency room because she could catch something and die while waiting. She decided she would just stay at home and rest. She has not had any Physician's office visit relative to event; she h

Other Meds: SPIRIVA; ADVAIR; DYMISTA; PREDNISONE

Current Illness: Allergy (This was under control.); Asthma (This was under control.); Meniere's disease (This was under control on prednisone)

ID: 1266062
Sex: M
Age:
State: CA

Vax Date: 02/27/2021
Onset Date:
Rec V Date: 04/28/2021
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:

Symptom List: Anxiety, Dyspnoea

Symptoms: Schizophrenia; This is a spontaneous report received from Pfizer sponsored program. A contactable consumer reported that a 26-year-old male patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Formulation: Solution for injection, Lot number and expiry date not reported), via an unspecified route of administration on 27Feb2021 as a single dose of COVID-19 immunisation. The patient medical history and concomitant medications were not reported. The reporter questions if patient can still receive the second dose as the patient is with schizophrenia and wanders off and sleeps at different locations. Outcome of the event was unknown. Information about Lot/Batch number requested.

Other Meds:

Current Illness:

ID: 1266063
Sex: U
Age:
State: NC

Vax Date:
Onset Date:
Rec V Date: 04/28/2021
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:

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

Symptoms: My elbow is bigger than the golf ball on my left arm; That vaccine is poisonous; Sometimes it runs a temperature over 100 degrees over one spot, the rest of my body is cool; This is a spontaneous report from a contactable consumer (patient). A patient of unspecified age and gender received bnt162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE), first dose via an unspecified route of administration on an unspecified date, single dose for covid-19 immunisation. The patient's medical history and concomitant medications were not reported. Patient experienced that patient's elbow is bigger than the golf ball on left arm. Patient thinks that vaccine is poison. Sometimes patient runs a temperature over 100 degrees over one spot, the rest of the body is cool. Patient thinks that the vaccine is poisonous. The outcome of the events was unknown. Information on the Lot/Batch number has been requested.

Other Meds:

Current Illness:

ID: 1266065
Sex: M
Age:
State: CT

Vax Date: 02/24/2021
Onset Date: 02/24/2021
Rec V Date: 04/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: miss the second dose on 17Mar2021; he fractured his ankle; This is a spontaneous report from a contactable consumer (Patient) via Pfizer sponsored program. A 79-year-old male patient received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, Solution for injection, Batch/Lot number: unknown) via an unspecified route of administration on 24Feb2021 (at the age of 79-years) as single dose for COVID-19 immunisation. The patient medical history and concomitant medications were not reported. On 24Feb2021 (same day of vaccination), the patient fell down a flight of stairs and broke his ankle. The patient was scheduled to get the second dose on 17Mar2021 but unfortunately, he fractured his ankle which required him to undergo surgery and miss the second dose. Patient would like to know when to get the second dose of the vaccine and asks if he would need to restart the vaccination series due to the incident and if not, how long would he have in between the doses to receive the second vaccine. The outcome of the events was unknown. No follow-up attempts are possible; information about lot/batch number cannot be obtained.

Other Meds:

Current Illness:

ID: 1266066
Sex: F
Age:
State: FL

Vax Date: 03/10/2021
Onset Date:
Rec V Date: 04/28/2021
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: headache; shortness of breath; body pain; This is a spontaneous report from a contactable nurse (patient). A 59-year-old female patient received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number: EN6199) via unspecified route on left arm single dose for COVID-19 immunization on 10Mar2021, 02:00 PM, at 58-year-old. Medical history included: high blood pressure, asthma, diabetes; allergies: ranitidine, metformin. Concomitant medication was not reported. The patient had headache, shortness of breath, body pain; doctor or other healthcare professional office/clinic visited and was reported as life threatening illness (immediate risk of death from the event). Treatment received as: betamethasone 6mg/ml 3ml, prednisone 40 mg x 4. Outcome of the event was resolving.; Sender's Comments: Based on the information currently available, a possible contributory role of the suspect vaccine BNT162B2 in triggering the onset of the events headache, shortness of breath, body pain cannot be excluded. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate. ,Linked Report(s) : US-PFIZER INC-2021445163 Same patient, different shot/event

Other Meds:

Current Illness:

ID: 1266067
Sex: F
Age:
State: FL

Vax Date: 03/28/2021
Onset Date: 04/05/2021
Rec V Date: 04/28/2021
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: strong headache; a lot of shortness of breath; lungs full of fluids; stomach sickness; lost of smell; This is a spontaneous report from a contactable Nurse (patient). A 59-years-old female patient received bnt162b2 (BNT162B2), dose 2 via an unspecified route of administration, administered in Arm Left on 28Mar2021 14:00 (Batch/Lot Number: EN6208) as SINGLE DOSE for covid-19 immunisation. Medical history included high blood pressure, asthma, diabetes. Known allergies: ranitidine/metformin. No pregnant. The patient's concomitant medications were not reported. No covid prior vaccination.No other vaccine in four weeks. Historical Vaccine included first dose bnt162b2 at 58 year old for covid-19 immunisation, first dose lot number=EN6199, administration date=10Mar2021, administration time=02:00 PM, vaccine location=Left arm and experienced headache, shortness of breath and body pain. The patient experienced strong headache, a lot of shortness of breath, lungs full of fluids, stomach sickness, lost of smell on 05Apr2021 with outcome of recovering. The event was serious due to life threatening. AE resulted in: Doctor or other healthcare professional office/clinic visit. AE treatment: Betamethasone 6mg/ml=3ml/ predinisone 40mg x 4. No covid tested post vaccination.; Sender's Comments: Based on the current available information and the plausible drug-event temporal association, a possible contributory role of the suspect product BNT162B2 to the development of reported events cannot be excluded. The case will be reassessed if additional information becomes available. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.,Linked Report(s) : US-PFIZER INC-2021444473 Same patient, different shot/event

Other Meds:

Current Illness:

ID: 1266068
Sex: F
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 04/28/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Transverse Myelitis worsened; Transverse Myelitis worsened; I could not walk; trouble breathing; This is a spontaneous report from a contactable consumer (patient). A 39-year-old female patient received second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE) on an unspecified date at single dose for COVID-19 immunisation. Medical history was not provided. Patient was not pregnant, was not pregnant at time of vaccination. Concomitant medications included other medications in two weeks. No other vaccine in four weeks. Patient previously received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number: EN6207) at the age of 39-years, via an unspecified route of administration in right arm on 19Mar2021 14:00 at single dose for COVID-19 immunisation and experienced transverse myelitis; received zaleplon (SONATA) and experienced allergies. Less than 24 hours after receiving the second vaccination, the transverse myelitis worsened and patient could not walk and was beginning to have trouble breathing. Patient went to emergency room and was admitted and treated there for the following week for the condition transverse myelitis. Events resulted in Doctor or other healthcare professional office/clinic visit, Emergency room/department or urgent care, Hospitalization, Life threatening illness (immediate risk of death from the event). Days hospitalisation: 7. Patient received treatment for the events included among other meds, 5 day course of IV steroids . No covid prior vaccination, patient underwent covid test (Nasal Swab) post vaccination on 10Apr2021, covid test result was Negative. Outcome of the events was not recovered. Information about lot/batch number has been requested.

Other Meds:

Current Illness:

ID: 1266069
Sex: F
Age:
State: NY

Vax Date: 03/06/2021
Onset Date: 03/01/2021
Rec V Date: 04/28/2021
Hospital: Y

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

Lab Data:

Allergies:

Symptom List: Pharyngeal swelling

Symptoms: heart attack; This is a spontaneous report from a contactable consumer (patient herself). This 60-year-old female patient (not pregnant) received the first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unknown route of administration in the right arm, on 06Mar2021 at 15:30 (Lot number EN6203) as single dose and the second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unknown route of administration in the left arm, on 27Mar2021 at 15:30 (Lot number EP7534) as single dose, for COVID-19 immunisation. Relevant medical history included allergy to nickel and latex). Past drug history included allergy to penicillin. Relevant concomitant medications included ezetimibe, chondroitin sulfate, glucosamine, biotin and vitamin (unspecified). No other vaccine was received in four weeks. The patient had a mild heart attack approximately two weeks after her first dose of the vaccine (untreated) in Mar2021 and a major heart attack 2 weeks to the day after her second dose (11Apr2021, at 02:00). The patient visited the emergency room and she was hospitalized for 5 days. The event was also considered serious as life-threatening. Therapeutic measures taken as result of the event includes angioplasty. The patient was recovering from the event.

Other Meds: EZETIMIBE; GLUCOSAMINE CHONDROITIN [CHONDROITIN SULFATE;GLUCOSAMINE]; BIOTIN

Current Illness:

ID: 1266070
Sex: M
Age:
State: CA

Vax Date: 04/11/2021
Onset Date: 04/17/2021
Rec V Date: 04/28/2021
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: Appendicitis. Perforated appendix that started 6 days after vaccination; This is a spontaneous report from a contactable consumer. A 38-year-old male consumer (patient) reported that he received BNT162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Lot number unknown) via an unspecified route of administration in left arm on 11Apr2021 10:00AM (at the age of 38-year-old) for COVID-19 immunisation. Relevant medical history and concomitant medications were not reported. The patient had not COVID prior vaccination. On 17Apr2021, the patient had perforated appendix that started 6 days after vaccination. The event resulted in doctor or other healthcare professional office/clinic visit, emergency room/department or urgent care, hospitalization, life threatening illness (immediate risk of death from the event). The patient was hospitalized for 6 days. Treatment included antibiotic and potential surgery upcoming. The patient was tested for COVID post vaccination (no results). The event was not resolved. Information on the lot/batch number has been requested.

Other Meds:

Current Illness:

ID: 1266071
Sex: F
Age:
State: PA

Vax Date: 04/20/2021
Onset Date: 04/20/2021
Rec V Date: 04/28/2021
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: post-cardiac arrest; collapsed; initial rhythm was PEA; unresponsive; This is a spontaneous report received from a contactable pharmacist. A 74-year-old female patient received second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, lot number unknown), on 20Apr2021 (at the age of 74-year-old) at single dose for COVID-19 immunisation. It was reported that patient was not pregnant. Facility type vaccine was reported as unknown. The patient's medical history included acute respiratory failure with hypoxia, cardiac arrest, transaminitis, and diabetes. It was unknown if patient had COVID prior vaccination. The patient's concomitant medications were not reported. It was unknown if patient received other medications in two weeks and if she received any other vaccine in four weeks. The patient previously received first dose of BNT162B2 on unspecified date at single dose for COVID-19 immunisation, lisinopril and hydrochlorothiazide/triamterene (DYAZIDE) both reported as known allergies. It was reported that patient was brought in by emergency medical services (EMS) status post-cardiac arrest. Per EMS she was driving to urgent care (unclear why). She just got her second Pfizer vaccine. At urgent care she collapsed and cardiopulmonary resuscitation (CPR) was initiated immediately. EMS arrived and her initial rhythm was pulseless electrical activity (PEA). They placed a gel and administered 3 rounds of CPR with 3 onset epinephrine. No shockable rhythm. Patient arrived at hospital intubated and unresponsive on 20Apr2021. Duration of hospitalization was reported as two days. The events were reported as serious with criteria hospitalization and life-threatening illness (immediate risk of death from the event). The events resulted in doctor or other healthcare professional office/clinic visit and emergency room/department or urgent care. It was unknown if patient was tested for COVID post-vaccination. The outcome of the events was resolving Information on lot number/batch number has been requested.; Sender's Comments: The reported events would seem unlikely related to suspect vaccine BNT162B2, but more likely due to underlying cardiovascular morbidities. The impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.

Other Meds:

Current Illness:

ID: 1266072
Sex: M
Age:
State: NV

Vax Date: 02/09/2021
Onset Date: 03/31/2021
Rec V Date: 04/28/2021
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:

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

Symptoms: Major PE detected on CT Scan at an ER; This is a spontaneous report from a contactable consumer (patient). A 74-year-old male patient received second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE; lot number: EM9810 ) on 09Feb2021 at 11:00 (at 74 years) at single dose in left arm for covid-19 immunisation. The patient medical history and concomitant medications were not reported. Patient took the first dose of the vaccine (lot EL3247) in Jan2021 at 11:00 am (at 74 years) in left arm for covid-19 immunisation. No COVID prior vaccination. On 31Mar2021 at 12:00 the patient experienced major pulmonary embolism (PE) detected on computerised tomogram (CT) Scan at an emergency room (ER). The event required doctor or other healthcare professional office/clinic visit and emergency room/department or urgent care. Event was serious duet to hospitalization and life threatening illness.Patient was hospitalized in 2021 for 4 days. Patient was treated with Heparin and Eliquis. Patient was tested post vaccination: Nasal Swab was done on 31Mar2021 and was negative. The outcome of the event was recovering.

Other Meds:

Current Illness:

ID: 1266073
Sex: F
Age:
State: MD

Vax Date: 03/12/2021
Onset Date: 03/01/2021
Rec V Date: 04/28/2021
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: had Hepatitis D 3 days after First Pfizer Vaccine; This is a spontaneous report from a Pfizer sponsored program COVAX support. This is a spontaneous report from a contactable consumer. A female patient of an unspecified age received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Solution for injection, Lot number was not reported) 1st dose via an unspecified route of administration on 12Mar2021 as SINGLE DOSE for COVID-19 immunization and hydrocortisone, neomycin sulfate, polymyxin b sulfate (CORTISPORIN). The patient medical history and concomitant medications were not reported. On Mar2021 the patient had hepatitis D 3 days after first Pfizer vaccine. It was reported that, second covid dose was given 03Apr2021. Caller was never asked about other injections at the time of the vaccine and was not supposed to get them so close together. The outcome of event was unknown. No follow-up attempts are needed; information about lot/batch number cannot be obtained.

Other Meds:

Current Illness:

Date Died: 04/19/2021

ID: 1266074
Sex: M
Age:
State:

Vax Date: 04/12/2021
Onset Date: 04/16/2021
Rec V Date: 04/28/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: fever; feeling weak; unable to walk independently; no appetite; This is a spontaneous report from a contactable consumer via social media. A 73-year-old male patient received the second dose of (lot number: EW2243), via an unspecified route of administration on 12Apr2021 09:45 (at the age of 73-years-old) as a single dose for covid-19 immunisation. The patient's medical history and concomitant medications were not reported. The other medications that the patient received within 2 weeks of vaccination were insulin and for blood pressure. Prior to vaccination, the patient was not diagnosed with Covid-19. The patient previously received the first dose of bnt162b2 (lot number: ER4812), via an unspecified route of administration on 16Mar2021 (at the age of 73-years-old) as a single dose for covid-19 immunisation. The patient's concomitant medications were not reported. On 16Apr2021, the patient experienced fever, feeling weak, unable to walk independently and had no appetite. The adverse events resulted in doctor or other healthcare professional office/clinic visit. There was no treatment received for the events. The outcome of the events was fatal. The patient died on 19Apr2021. Cause of death were fever, feeling weak, unable to walk independently and had no appetite. An autopsy was not performed. Since the vaccination, the patient hasn't been tested for covid-19.; Reported Cause(s) of Death: fever; feeling weak; unable to walk independently; no appetite

Other Meds:

Current Illness:

ID: 1266075
Sex: M
Age:
State: NY

Vax Date: 04/12/2021
Onset Date: 04/16/2021
Rec V Date: 04/28/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: Multiple blood clots in the left leg had to be submitted to the Emergency Room at the hospital for immediate treatment; This is a spontaneous report from a non-contactable consumer. A 40-years-old male patient received 1 dose of bnt162b2 ((PFIZER-BIONTECH COVID-19 VACCINE) lot number: ER2613 via an unspecified route of administration, in arm left on 12Apr2021 at the age of 40 years as SINGLE DOSE for covid-19 immunization. The patient medical history was not reported. There were no concomitant medications. The patient experienced multiple blood clots in the left leg and he had to be submitted to the emergency room at the hospital for immediate treatment on 16Apr2021 12:00 with outcome of recovering. The patient was hospitalized for 2 days and was treated with unspecified treatment. Covid test post vaccination: Nasal Swab on 20Apr2021 result Negative No follow-up attempts are possible. No further information is expected.

Other Meds:

Current Illness:

ID: 1266076
Sex: M
Age:
State: TN

Vax Date: 03/19/2021
Onset Date: 04/14/2021
Rec V Date: 04/28/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: his legs were extremely weak; has to hold onto something to go through the house; rash is across his upper back, chest, and down both arms; Patient had a dry cough; running a fever; the next morning and it was even worse; flu-like symptoms after both doses; Sore all Over/Achy all over; This is a spontaneous report based on information received by Pfizer from Biontech [manufacturer control number: 40968], license party for Comirnaty. A contactable consumer reported that a 74-year-old male patient received second dose BNT162b2(COMIRNATY, Formulation: Solution for injection, Lot number: EN6207, Expiration: 31Jul2021), via an unspecified route of administration in arm left on 19Mar2021 at single dose for COVID-19 immunization. The patient medical history includes Arthritis (arthritis is in his right foot only and his big toe, diagnosed in 2017 or 2018) and Concomitant medication were not reported. Historical vaccine included BNT162b2 (COMIRNATY) on 26Feb2021 for Covid-19 immunisation and Unspecified steroid shot. Stated reaction was three to four days. First shot got caller and patient down for a week. Second shot got caller down for three days. At first, patient's reaction was running like hers. Patient had a dry cough on an unspecified date in 2021. Was going for a COVID test today. Last week patient started running a fever on an unspecified date in 2021 and his legs were extremely weak on 14Apr2021. Has to hold onto something to go through the house on 14Apr2021. He was moving a little better, but not much. Patient had to go to doctor for his foot. Has terrible arthritis in the big toe on his right foot. Gets steroid shot every three months. Three weeks and four days after second COVID shot everything seemed to have worn off. The PA put the shot in his foot and it bruised the patient. Patient still has bruises on an unspecified date in 2021. Got the steroid shot in his big toe and two days later the weakness hit a second time. It really wiped him out. Caller cannot help patient get up and down. Patient was struggling with his legs and was aching. Wants to know if a steroid shot on top of the COVID shot and that close after would cause another reaction? The PA said it was ok to get a steroid shot three weeks after. Patient started having these reactions and doesn't know if it was the COVID shot. Has had steroid shots every 3 months for 4 years. Has never had this kind of reaction. Patient didn't think about getting the steroid shot because he seemed to be feeling fine. Reaction started the next morning and it was even worse on an unspecified date in 2021. By the third day after the shot he was down and caller couldn't help patient get up. It scared the caller. Patient also broke out in a rash across his shoulders and down both arms. States her husband has had both shots and he has been having issues since the second one n 19MAR2021. Reporter states 3 weeks and 4 days after the second vaccine, her husband had to have a steroid shot in his foot because he has terrible arthritis in his right foot. Reporter states the patient has had a flare up since then with weakness in his legs and a rash on his chest. States the only difference this time is that he had just had the second Covid vaccine 3 weeks prior. States he has not had steroid reactions in the past, and she feels like this reaction was because of the Covid vaccine. Clarifies the shot in his foot was on 13Apr2021 and she does not know what steroid was injected. States it was 3weeks and 4 days between the steroid injection and the vaccine. States maybe they should war people not to get a steroid shot for a longer time after the vaccine. States after the first vaccine for about 5 days they were just laid out. States they ate soup and whatever they could warm up in the microwave. States his ear doctor said if they reacted to the first shot they must have had Covid at sometimes. States she doesn't know, they never got tested before but they didn't have any symptoms. States her husband's test yesterday was negative. Weakness in the Legs AE: States for the last 2 days, he could not even get up on his own and she can't lift him because he was bigger than she was. Rash was states it was not itching or anything, just a rash. States it was odd because she has had hives, and this was just broken out. Clarifies the rash was across his upper back, chest, and down both arms on 14Apr2021. States it was kind of like speckled on his body like the measles on an unspecified date in 2021. States the patient was 74 years old and he had measles when he was a kid just like she did, so it is not the measles. States the patient had a Covid 19 test done yesterday and it came back negative, so he doesn't have Covid. She doesn't know what it was. Treatment: states he was taking Motrin for the Aching. States she does not know if the reaction was because the PA did the injection, it had always been the doctor that had given the injection. Caller states she thinks it was getting the steroid injection on top of receiving the Covid shot. States the both received their vaccines because they couldn't get a shot because they weren't giving shots at her age, so when offered them the vaccine, they jumped on it. Yes, last Monday to his Nurse Practitioner, did not address the weakness in his legs because did not know what to do for that. She did not even say what she thought it was, said he needed to see someone about that but does not know who to see, does not know whether to go to the ER or who to go to. Not that emergent but when doctor does not know what to treat with worrisome. She was calling about to finish the report and to speak with the Medical department regarding if this has been reported before or if any information on the Covid vaccine and steroid injections. He received the 1st dose on 26Feb2021 and the 2nd dose on 19Mar2021. She mentioned that both of them experienced achiness, sore all over after the 1st dose and flu-like symptoms on an unspecified date in 2021 after both doses. Her husband however, had muscle weakness on his legs after the 2nd dose. On 13Apr2021, about 3 weeks and 4 days after the 2nd dose, her husband received a steroid shot on his right foot. They noticed that the weakness on his legs became extreme, to which he had trouble standing up and has to hold on to something to stand up as he cannot support himself. He also had a rash on his trunk, back, and down his arms. She mentioned that the rash was not itchy but was speckled like measles. They were wondering if this has been reported and if it was possibly an interaction between the vaccine and steroid. They mentioned that they already consulted with their HCP but said that they really cannot tell. Outcome of his legs were extremely weak, has to hold onto something to go through the house was not recovered while with other event rash is across his upper back, chest, and down both arms, Achy all over was recovered on 22Mar2021 and flu-like symptoms after both doses and Sore all Over was recovered on an unspecified date in 2021, while with other events was unknown. Follow up attempts were needed. Further information is expected.

Other Meds:

Current Illness:

Date Died:

ID: 1266077
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 04/28/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Had both vaccines and died from COVID-19 afterwards; Had both vaccines and died from COVID-19 afterwards; This is a spontaneous report from a contactable nurse. A 42-year-old patient of an unspecified gender received BNT162B2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE), dose 1 and dose 2; both via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as SINGLE DOSE for COVID-19 immunization. The patient's medical history and concomitant medications were not reported. The patient had both vaccines and died from COVID-19 afterwards on an unspecified date. The patient did not have any known underlying health conditions or issues. The patient died on an unspecified date. It was not reported if an autopsy was performed. No follow-up attempts are possible; information about lot/batch number cannot be obtained.; Sender's Comments: The information currently provided is too limited to make a meaningful medical assessment hence, the events are conservatively assessed as related to the suspect drug BNT162B2 until further information becomes available. This impact of this report on the benefit/risk profile of the Pfizer product is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly to regulatory authorities, Ethics Committees, and Investigators, as appropriate.; Reported Cause(s) of Death: Had both vaccines and died from COVID-19 afterwards; Had both vaccines and died from COVID-19 afterwards

Other Meds:

Current Illness:

Date Died:

ID: 1266078
Sex: F
Age:
State: AR

Vax Date:
Onset Date:
Rec V Date: 04/28/2021
Hospital:

Vax Type: DTAPHEPBIP
Manufacturer: GLAXOSMITHKLINE BIOLOGICALS
Vax Name: DTAP + HEPB + IPV (PEDIARIX)
Lot:
Dose Series: UNK
Vax Route:
Vax Site: LG

Lab Data:

Allergies:

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

Symptoms: pulmonary embolism; short of breath; This is a spontaneous report from a non-contactable consumer via Pfizer sales representative. A 63-years-old female patient received BNT162B2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE), dose 2 via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as single dose for covid-19 immunisation. The patient medical history and concomitant medications were not reported. The patient died of pulmonary embolism 2 days after 2nd vaccine dose. She had been short of breath the day after the shot, called the pharmacy where she'd received it, and they told her to go to ER. The reporter thought that she did not go to the ER, and then later died at home. It was unknown if an autopsy was performed. Outcome of the event short of breath at the time of death was unknown. No follow-up attempts are possible; Information about lot/batch number cannot be obtained.; Reported Cause(s) of Death: pulmonary embolism

Other Meds:

Current Illness:

ID: 1266090
Sex: F
Age: 43
State: CA

Vax Date: 04/12/2021
Onset Date: 04/22/2021
Rec V Date: 04/28/2021
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: Night sweats, cramping and menstration longer and heavy

Other Meds: None

Current Illness: None

ID: 1266091
Sex: F
Age: 33
State: TX

Vax Date: 04/06/2021
Onset Date: 04/25/2021
Rec V Date: 04/28/2021
Hospital:

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

Lab Data:

Allergies: Ortho Evra - hives

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient received COVID J&J vaccine on 4/6, Presented to ED on 4/27/21 with complaint of 3 days of increasing leg pain and SOB

Other Meds: Vitamin B12, levonorgestrel-ethinyl estradiol 0.1-20 mg, ketoconazole shampoo, doxycycline, diclofenac 1% gel, esomeprazole 40 mg, fluoxetine 10 mg, valacyclovir 1 g daily, metronidazole 1% gel

Current Illness:

ID: 1266092
Sex: M
Age: 43
State: TX

Vax Date: 03/13/2021
Onset Date: 03/30/2021
Rec V Date: 04/28/2021
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: Pulsatile tinnitus. I hear my heartbeat on my right ear. It is a vascular problem in the head.

Other Meds: None

Current Illness: None

ID: 1266093
Sex: F
Age: 45
State: HI

Vax Date: 04/21/2021
Onset Date: 04/22/2021
Rec V Date: 04/28/2021
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: I had a reaction to a blood pressure medication

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

Symptoms: I started to get muscle twitching in my left arm, it moved to my breast bone and around to the upper portion of my rib cage. I also experienced quite a bit of deep muscle pain around the injection site and extreme tiredness. I spoke to my doctor and he prescribed cyclobenzaprine for the twitching

Other Meds: Sertraline, Bupropion, Portia, Metformin

Current Illness: Infection from a cat bite.

ID: 1266095
Sex: F
Age: 41
State: FL

Vax Date: 04/10/2021
Onset Date: 04/10/2021
Rec V Date: 04/28/2021
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: Depakote

Symptom List: Unevaluable event

Symptoms: As soon as I took the vaccine shot I had an immediate headache, after taking the vaccine I took Tylenol and slept in the rest of the day. The next day I woke up and my arm was red and swollen. I was running fever, still had the headache and now blurry vision. My entire body was hurting. My left side of my body felt numb and tingling. The next two days the pain became worse. I did not really have an appetite. When I did eat I could barely hold my food down. On Wednesday morning I could barely get out of bed, I also felt extreme pain in my lower legs, stabbing pain in stomach and right lower side. I also had ringing in my ears, more in the right ear. I then notice a bruise on my left leg, that it was not originally there, and was also tender to touch. I went to the emergency room on the same day and I was admitted. I was in there for 4 days, they tested my leg and stated it was not a blood clot, although it look and felt like one. They discharge me and advise me that it was a migraine that was causing all my pain. This was on Sunday, I had a follow up with my PCP on the Friday, however to being in so much pain and shortness of breath, and arm pain I was advise to go to the ER on the Thursday and was admitted again. I was told in the ER I had a blood clot in my right arm and it was most likely from the IV from the previous visit. My blood pressure and heart rate was so high that they put me on medication. No matter the pain medication they gave me, it would not completely take the pain away. They discharge me again on Monday and after me begging them to get run any and all test, they said they found nothing. I'm still in the same amount of pain and same symptoms, still having trouble keeping my food down. The only thing that changed is my left arm is not as sore, however I still have a huge knot and its still warm to touch. I don't know what else to do that is why im contacting the CDC for help. I'm in a extreme amount of pain and pounding headaches. Please help

Other Meds: Whelchol, Symbicort, Vitamin C, blackseed Oil

Current Illness: Asthma, IBS

ID: 1266096
Sex: M
Age: 46
State: CO

Vax Date: 04/24/2021
Onset Date: 04/25/2021
Rec V Date: 04/28/2021
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: had a bad reaction to leviquine

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

Symptoms: EXTREME chills and fever. Alternated 4 or 5 cycles. Woke up with having thrown off my blankets and had to get ice packs and open windows to cool down enough to sleep, a few hours later woke up SHIVERING like I never have before. I thought I was convulsing until I realized I could control it with my breathing. I was shivering so hard that I bit my tongue several times. I didn't have much energy so it took several minutes before I could grab blankets and even longer before I could close the window. I was wrapped in several layers of blankets and was still shivering until I fell asleep. I woke up again and my blankets were soaked in my sweat. This cycle got more and more intense until the next day. *I've been hospitalized with pneumonia and this felt 100 times worse. The next day, I had the worst diarrheic that I've ever had, sudden urge.. barely made it to toilet and INSTANTLY discharged what felt like a gallon of brown liquid (it was probably less but felt pretty nasty).

Other Meds: Lamotrogine

Current Illness: nipe

ID: 1266097
Sex: F
Age: 47
State: AZ

Vax Date: 04/14/2021
Onset Date: 04/24/2021
Rec V Date: 04/28/2021
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: amoxicillin

Symptom List: Injection site pain, Pain

Symptoms: Sore arm for a few days with fatigue, resolved after a week. On the morning of 4/23 the bottom of my shot (left) arm felt bruised, tender. By the night of 4/23 my left armpit was also sore, tender. Late night 4/23 my left breast was extremely sore and I noticed lumps, very swollen ducts? As of now, late night on 4/28, or very early morn 4/29, the lumps are large, extremely painful and don?t seem to be going away . I?m anxious about my second shot.

Other Meds: n/a

Current Illness: slight seasonal allergies - pollen

ID: 1266098
Sex: F
Age: 38
State: MA

Vax Date: 04/24/2021
Onset Date: 04/24/2021
Rec V Date: 04/28/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Injection site pain, Menorrhagia

Symptoms: Body aches and 101 fever 12 hrs after shot. Chills and headache after. Next day arm soreness and a rash around the vaccination site, lasting 4 days and still going. On day 4 after vaccine, dizziness, weakness and vertigo. Brain fog. Still ongoing

Other Meds: None

Current Illness: None

ID: 1266099
Sex: F
Age: 36
State: DC

Vax Date: 03/14/2021
Onset Date: 03/14/2021
Rec V Date: 04/28/2021
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: Fever. Chills. Nausea. Fatigue. Dizziness. Pain in arm. Hives. Hot skin. Stronger menstrual cramps. Irregular period.

Other Meds:

Current Illness:

ID: 1266100
Sex: F
Age: 45
State: MO

Vax Date: 04/12/2021
Onset Date: 04/12/2021
Rec V Date: 04/28/2021
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: Tinnitus, bi lateral

Other Meds: None

Current Illness: None

ID: 1266101
Sex: M
Age: 56
State: IL

Vax Date: 04/05/2021
Onset Date: 04/18/2021
Rec V Date: 04/28/2021
Hospital: Y

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

Lab Data:

Allergies: none

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Vaccine- Induced Thrombotic Thrombocytopenia Portal and hepatic vein thromboses Diabetic Ketoacidosis

Other Meds: metoprolol amlodipine spironolactone metformin empagliflozin l

Current Illness: no acute illness

ID: 1266102
Sex: F
Age: 48
State: ME

Vax Date: 04/02/2021
Onset Date: 04/15/2021
Rec V Date: 04/28/2021
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: NKFDA

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

Symptoms: Extremely heavy menstrual bleeding started thirteen days post vaccine and has not stopped (going on two weeks). This bleeding includes huge clots, some so large that they have to be ?pushed? out...some clots are the size of a small fist. The bleeding is consistent and has several episodes of gushing causing blood to overtake feminine hygiene products and spill all over clothing/furniture. During this bleeding clots can be felt passing as well even when seated. The clots have subsided somewhat compared to when this first started and bleeding appears to be slowing somewhat in the past day.

Other Meds: None

Current Illness: None

ID: 1266103
Sex: M
Age: 37
State: FL

Vax Date: 04/27/2021
Onset Date: 04/28/2021
Rec V Date: 04/28/2021
Hospital:

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

Lab Data:

Allergies: Lactose intolerant

Symptom List: Nausea

Symptoms: Flu symptoms

Other Meds: None

Current Illness: None

ID: 1266104
Sex: F
Age: 66
State: AZ

Vax Date: 03/29/2021
Onset Date: 03/31/2021
Rec V Date: 04/28/2021
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: Fairly loud tinnitus all the time. Descdribed by constant tinny sound, not whooshing, high pitched

Other Meds: Lorazepam .5 mg Pure Thyro 100 mg Vit D 2000 IU Adrenal Cortex 50 mg

Current Illness: None

ID: 1266105
Sex: M
Age: 53
State:

Vax Date: 04/20/2021
Onset Date: 04/21/2021
Rec V Date: 04/28/2021
Hospital:

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

Lab Data:

Allergies: n/a

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

Symptoms: Fever around 40 degrees Celsius for 24 hours, chills, headache, strong sweating, general weakness of the body. After a day, lower-grade fever (38 degrees Celsius for the next day and 37 degrees later on) and general body weakness for the next 5 days.

Other Meds: n/a

Current Illness: n/a

ID: 1266106
Sex: F
Age: 40
State: OH

Vax Date: 04/26/2021
Onset Date: 04/27/2021
Rec V Date: 04/28/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: 4/26: pain at injection site, containing to strengthen as day progressed. 8pm: swollen lump nodes in neck, fatigue. 4/27: 4am; fever, chills, body aches, fatigue. Pain at injection site and swollen lump nodes in neck and left arm pit. Continues throughout the day, off and on fever every couple of hours. 6pm; fever gone, chills gone, extreme fatigue gone. 4/28: 4am; swollen lymph nodes, neck and left armpit. Painful injection site and left armpit lymph node. Minor body aches.

Other Meds: Tylenol

Current Illness:

ID: 1266107
Sex: M
Age: 59
State: NY

Vax Date: 04/24/2021
Onset Date: 04/25/2021
Rec V Date: 04/28/2021
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: Headache/Sweating/Insomnia- 2:30AM 4/25/21 Body Aches/Fatigue- 10AM 4/25/21 All Symptoms Self-Resolved- 4PM 4/26/21

Other Meds: Prilosec, Vitamin D

Current Illness: None

ID: 1266108
Sex: F
Age: 38
State: HI

Vax Date: 04/26/2021
Onset Date: 04/27/2021
Rec V Date: 04/28/2021
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: Antibiotic, penicillin and sulfa drugs

Symptom List: Erythema, Pruritus

Symptoms: Fever, intense chills and then sweat/chills throughout 1st night. Super bad headache at 3:00am and then lip swelling started - by 9:00am they were enormous.

Other Meds: Spirolachon

Current Illness:

ID: 1266109
Sex: F
Age: 37
State: VA

Vax Date: 04/14/2021
Onset Date: 04/15/2021
Rec V Date: 04/28/2021
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: NKDA

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

Symptoms: Inability to move L arm due to pain. Experiencing SOB - pt reports this is due to pain. Vaccine administered through public health event at vaccination site. Seen in office on 4/27 - no edema, erythema, warmth at vaccine site. EDC mid June

Other Meds: prenatal

Current Illness: none

ID: 1266110
Sex: F
Age: 48
State: PA

Vax Date: 04/24/2021
Onset Date: 04/25/2021
Rec V Date: 04/28/2021
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, Novocaine

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

Symptoms: Menstrual cycle changed day after receiving vaccine. Approximately 2 weeks early.

Other Meds: Turmeric

Current Illness: Lymphedema

ID: 1266111
Sex: F
Age: 55
State:

Vax Date: 04/22/2021
Onset Date: 04/28/2021
Rec V Date: 04/28/2021
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, Sulfa

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Red hot rash around area of injection.

Other Meds: Fish Oil, Estropause, Vit D, Acidophilus

Current Illness:

ID: 1266112
Sex: F
Age: 33
State: TX

Vax Date: 04/27/2021
Onset Date: 04/28/2021
Rec V Date: 04/28/2021
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: Headache, nausea, vomiting, dizziness. Patient fell unconscious at least once and began vomiting.

Other Meds: Patenol, Zyrtec

Current Illness:

ID: 1266113
Sex: F
Age: 49
State: MA

Vax Date: 04/20/2021
Onset Date: 04/28/2021
Rec V Date: 04/28/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Small - dime-sized - raised welt at injection site. Area is warm to touch and mildly itchy. Only other side effect was arm soreness for 3 days after injection.

Other Meds: Bupropion, Adderall, Duloxetine, Flonase, Azelastine

Current Illness: None

ID: 1266114
Sex: F
Age: 43
State: NJ

Vax Date: 04/07/2021
Onset Date: 04/14/2021
Rec V Date: 04/28/2021
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: On 4/14, one week after my second Moderna shot, I experience swelling of the lymph nodes under my left arm/armpit area. It was painful and a bit freaky until I did some research that said that this is a side effect of the Moderna vaccine. It is still painful and swollen today, 4/28/21, although definitely not as much as two weeks ago. I do believe it will be back to normal by next week, judging by how the swelling and pain have decreased. I did get the same milder symptoms under my right arm/armpit but those are gone now.

Other Meds: Wellness Formula

Current Illness: None

ID: 1266115
Sex: F
Age: 31
State: MN

Vax Date: 04/27/2021
Onset Date: 04/28/2021
Rec V Date: 04/28/2021
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: Fever, chills, headache, nausea, fatigue, HSV1 and HSV2 outbreaks

Other Meds: Adderall, Zoloft, Buspar, Valtrex

Current Illness:

ID: 1266116
Sex: F
Age: 24
State: PA

Vax Date: 04/17/2021
Onset Date: 04/28/2021
Rec V Date: 04/28/2021
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: Enlarged, sore thyroid gland

Other Meds: Calcium supplements, fish oil, B 12

Current Illness: None

ID: 1266117
Sex: M
Age: 33
State:

Vax Date: 11/30/2017
Onset Date: 01/18/2019
Rec V Date: 04/28/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: On 30-Nov-2017, the patient received the first dose of Rabipure (Inactivated Rabies Virus Vaccine, Batch number 641011E) and the first dose of co-suspect vaccine Ixiaro (Batch number JEV16D22B), both administered at an unknown dosage regimen, unknown route of administration and for an unknown indication. On 13-Dec-2017 (13 days after the first dose- inappropriate schedule of vaccine administered), the patient received the second dose of Rabipur (Inactivated Rabies Virus Vaccine, Batch number 64111E) and first dose of Nimenrix at an unknown dosage regimen, unknown route of administration and for unknown indication. On 12-Jan-2018, (43 days after the first dose- inappropriate schedule of vaccine administered), the patient received the third dose of Rabipur (Inactivated Rabies Virus Vaccine, Batch number 641011E) at an unknown dosage regimen, unknown route of administration and for an unknown indication. On 19-Jan-2018, the patient received the second dose of co-suspect Ixiaro vaccine (Batch number JEV16F288) at an unknown dosage regimen, unknown route of administration and for unknown indication. On an unknown date during Christmas Days in 2018, approximately 347 days after receiving the last dose of Rabipur and 340 days after the last dose of Ixiaro vaccinations, the patient developed cold problems with flu-like symptoms, limb pain, resting tremor of the hands *(explicitly coded as 'Tremor of hands)*, angiofibroma in the facial area *(explicitly coded as 'Angiofibroma')*, sleep disorders and migraines. Initially, a suspected diagnosis of an autoimmune reaction after vaccinations was revealed. On 18-Jan-2019, approximately 1 year after receiving the last dose of Rabipur, the patient was diagnosed with chronic fatigue syndrome and myalgic encephalomyelitis, which made the patient incapacitated and is now suing for vaccination damage. The reporter did not provide outcome for the events of chronic fatigue syndrome, myalgic encephalomyelitis, *resting tremor of the hands and angiofibroma in the facial area*.

Other Meds:

Current Illness:

ID: 1266119
Sex: F
Age: 58
State: MD

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

Symptom List: Vomiting

Symptoms: Vaccination given in right gluteoid area. Rash later diagnosed as Sweet Syndrome began in right thigh on April 13, 2021 and then spread to both legs, upper arms, and shoulders. Though Sweet syndrome is usually accompanied by fever, in this case there was no fever. Began prednisone on April

Other Meds: osimertinib 80 mg tab, famotidine 40mg tablet, iron-150 oral, calcium carb/D3/Magnesium/Zinc, Century Silver multivitamin

Current Illness: Stage 4 lung cancer, adenocarcinoma, never smoker

ID: 1266126
Sex: F
Age: 22
State: CA

Vax Date: 04/23/2021
Onset Date: 04/24/2021
Rec V Date: 04/28/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Fainted; Thirsty; Shaking; Look pale; Hypotension; Arm soreness; Nausea; CHILLS; Fever; This spontaneous case was reported by a consumer and describes the occurrence of SYNCOPE (Fainted) in a 22-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 008C21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concurrent medical conditions included Pollen allergy (environmental allergy) and Dust allergy (environmental allergy). Concomitant products included CETIRIZINE HYDROCHLORIDE (ZYRTEC [CETIRIZINE HYDROCHLORIDE]), FEXOFENADINE HYDROCHLORIDE (ALLEGRA) and CLARITHROMYCIN (CLARITIN [CLARITHROMYCIN]) for Allergy, MONTELUKAST for Asthma, COLECALCIFEROL (VITAMIN D [COLECALCIFEROL]) for Supplementation therapy. On 23-Apr-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) at an unspecified dose. On 24-Apr-2021, the patient experienced SYNCOPE (Fainted) (seriousness criterion medically significant), THIRST (Thirsty), TREMOR (Shaking), PALLOR (Look pale), HYPOTENSION (Hypotension), MYALGIA (Arm soreness), NAUSEA (Nausea), CHILLS (CHILLS) and PYREXIA (Fever). On 24-Apr-2021, SYNCOPE (Fainted), TREMOR (Shaking), PALLOR (Look pale) and HYPOTENSION (Hypotension) had resolved. At the time of the report, THIRST (Thirsty), MYALGIA (Arm soreness), NAUSEA (Nausea), CHILLS (CHILLS) and PYREXIA (Fever) outcome was unknown. The action taken with mRNA-1273 in response to the event was not applicable. The treatment medications included Tylenol (paracetamol) and Advil (Ibuprofen). Company comment: Based on the information provided which includes a temporal association between the use of mRNA-1273 vaccine and onset of the reported events, a causal relationship cannot be excluded. Headache, nausea, myalgia, pyrexia and chills are consistent with the product safety profile.; Sender's Comments: Based on the information provided which includes a temporal association between the use of mRNA-1273 vaccine and onset of the reported events, a causal relationship cannot be excluded. Headache, nausea, myalgia, pyrexia and chills are consistent with the product safety profile

Other Meds: ZYRTEC [CETIRIZINE HYDROCHLORIDE]; ALLEGRA; CLARITIN [CLARITHROMYCIN]; MONTELUKAST; VITAMIN D [COLECALCIFEROL]

Current Illness: Dust allergy (environmental allergy); Pollen allergy (environmental allergy)

ID: 1266127
Sex: F
Age: 28
State: CO

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 04/28/2021
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: Fatigue; Brain fog; Sweating a lot; Was ghost white; severe chills,freezing; Very very high fever; Nausea; Had a seizure; Blue lips; Fainted; Was out for like 30 minutes; Something white on the patient's mouth; Little lightheaded; This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of SEIZURE (Had a seizure), CYANOSIS (Blue lips), SYNCOPE (Fainted) and LOSS OF CONSCIOUSNESS (Was out for like 30 minutes) in a 28-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No medical history was provided by the reporter. Concomitant products included VITAMINS NOS for an unknown indication. On 06-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 06-Apr-2021, the patient experienced SEIZURE (Had a seizure) (seriousness criteria medically significant and life threatening), CYANOSIS (Blue lips) (seriousness criterion life threatening), SYNCOPE (Fainted) (seriousness criterion medically significant), LOSS OF CONSCIOUSNESS (Was out for like 30 minutes) (seriousness criterion medically significant), ORAL DISCHARGE (Something white on the patient's mouth), DIZZINESS (Little lightheaded), HYPERHIDROSIS (Sweating a lot), PALLOR (Was ghost white), CHILLS (severe chills,freezing), PYREXIA (Very very high fever) and NAUSEA (Nausea). On an unknown date, the patient experienced FEELING ABNORMAL (Brain fog) and FATIGUE (Fatigue). On 06-Apr-2021, SEIZURE (Had a seizure), CYANOSIS (Blue lips), SYNCOPE (Fainted), LOSS OF CONSCIOUSNESS (Was out for like 30 minutes), ORAL DISCHARGE (Something white on the patient's mouth), HYPERHIDROSIS (Sweating a lot), PALLOR (Was ghost white), CHILLS (severe chills,freezing) and PYREXIA (Very very high fever) had resolved. At the time of the report, DIZZINESS (Little lightheaded), FEELING ABNORMAL (Brain fog), FATIGUE (Fatigue) and NAUSEA (Nausea) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. The patient's concomitant medication included Adderol used for an unknown indication. The patient had received 1st dose of Modena vaccine and was monitored for 30 minutes at the facility where she got the vaccine , the patient went to her house and had little light headed and nausea, that evening she went to sleep and around 9 or 10 Hours after she had received the 1st dose of the Moderna vaccine she? fainted and had a seizure. She was out for like 30 minutes, she had blue lips, had something white on her mouth. The HCP told, that she should go to the hospital but it was really busy so they stabilized her at her house. The patient had never had seizures, it is a life threatening event. The patient is being seen by a neurologist and her primary care, and ?they have just started with the CT scans and the studies(caller did not specify)? with pending results, so once the caller has all the test results she wouldlike to call back and give the most updated details on the patient?s case. The patient had fatigue and brain fogs, but she did not have another seizure, Caller reported that ?for now, we are dealing with the symptoms she had on the 06-Apr-2021. The patient had cancelled her 2nd dose appointment. The patient treatment medication included Advil on 06-Apr-2021. Company comment: Based on the information provided which includes a temporal association between the use of mRNA-1273 vaccine and onset of the reported events, a causal relationship cannot be excluded. chills, nausea, pyrexia and fatigue are consistent with the product safety profile.; Sender's Comments: Based on the information provided which includes a temporal association between the use of mRNA-1273 vaccine and onset of the reported events, a causal relationship cannot be excluded. chills, nausea, pyrexia and fatigue are consistent with the product safety profile.

Other Meds: VITAMINS NOS

Current Illness:

ID: 1266128
Sex: F
Age: 30
State: LA

Vax Date: 04/01/2021
Onset Date: 04/22/2021
Rec V Date: 04/28/2021
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: Extreme fatigue, moderate body aches , delayed menstrual cycle - no treatment

Other Meds: None

Current Illness: None

ID: 1266129
Sex: M
Age: 46
State: FL

Vax Date: 04/22/2021
Onset Date: 04/22/2021
Rec V Date: 04/28/2021
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: Chills, Diarrhoea, Fatigue, Feeling abnormal, Headache

Symptoms: Headache 4/10 left side. Pt. stated that he still had a headache. pt. informed that if symptoms persist or worsen to call 911. Pt. told to follow up with primary care provider. Pt. verbalized understanding. Pt. A+Ox3.

Other Meds:

Current Illness:

ID: 1266130
Sex: M
Age: 28
State: FL

Vax Date: 04/26/2021
Onset Date: 04/27/2021
Rec V Date: 04/28/2021
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: Pain on left lower side of stomach around at random times, this is the second day in a row. Feeling exhausted and sore the second day after the vaccine. Feeling hot and flushed and then cold at times Headache

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm