VAERS 2021 Database www.vaers.hhs.gov

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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: 1341135
Sex: F
Age: 37
State: TX

Vax Date: 05/19/2021
Onset Date: 05/20/2021
Rec V Date: 05/22/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

Symptom List: Dysphagia, Epiglottitis

Symptoms: moderate edema and erythema to left deltoid

Other Meds: None

Current Illness: None

ID: 1341136
Sex: F
Age: 21
State: NH

Vax Date: 05/22/2021
Onset Date: 05/22/2021
Rec V Date: 05/22/2021
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: aztreonam, penicillins, cephalosporins, carbapenams

Symptom List: Anxiety, Dyspnoea

Symptoms: Within 15 minutes of administration, patient began to experience dizziness, shooting left arm pain, and felt like she was about to faint. Patient was instructed to lay down on floor. After assisting patient to the floor with legs elevated, she was observed to have blanching of lips. Check injection site to see if there was any swelling. None noted. Continued to observe patient for 5 minutes while asking questions to ensure that there was no airway constriction. After patient was able to sit up, she was offered water to drink. Patient admitted to having not eaten anything today. When patient felt well enough to walk she was escorted out by her mother. It was revealed during conversation that patient has an extreme needle anxiety.

Other Meds: sertraline, gabapentin, lamotrigine, quetiapine ER, hydroxyzine, imipramine, propranolol

Current Illness: Unknown

ID: 1341137
Sex: M
Age: 17
State: KY

Vax Date: 05/22/2021
Onset Date: 05/22/2021
Rec V Date: 05/22/2021
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: Respiridone

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

Symptoms: Shortly after receiving vaccination patient experienced blurred vision, lightheaded ness, loss of balance, headache and tiredness, profusely sweating Called 911, provided water and a safe sitting position

Other Meds: Bipolar and anxiety medication

Current Illness:

ID: 1341138
Sex: F
Age: 40
State:

Vax Date: 05/12/2021
Onset Date: 05/14/2021
Rec V Date: 05/22/2021
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: Patient contacted the pharmacy today reporting a perceived ADR following her first dose of the Moderna Covid19 vaccine which she received on 5/12/21. The patient said that she is now experiencing an irregular menstrual cycle. She began bleeding within days of the vaccine, which is 2 weeks earlier than her expected menstrual cycle, which is typically very regular. She sates that she is still bleeding today lightly. I suggested that she contact her physician or OBGYN and would report perceived ADR.

Other Meds:

Current Illness:

ID: 1341139
Sex: M
Age: 15
State: SC

Vax Date: 05/22/2021
Onset Date: 05/22/2021
Rec V Date: 05/22/2021
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: dizziness, lightheaded, black out, cold/clammy skin, profuse sweating, ringing in the ears 911 was called and responded to by both fire and medical paramedics vitals were taken and patient was observed for an additional 20 minutes before leaving when he had returned to a stable condition

Other Meds:

Current Illness:

ID: 1341140
Sex: F
Age: 19
State: CA

Vax Date: 05/21/2021
Onset Date: 05/21/2021
Rec V Date: 05/22/2021
Hospital:

Vax Type: FLUC4
Manufacturer: SEQIRUS, INC.
Vax Name: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT)
Lot: 276563
Dose Series: 1
Vax Route: SYR
Vax Site: LA

Lab Data:

Allergies: none

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

Symptoms: vasovagal syncope

Other Meds: no known

Current Illness: none

ID: 1341141
Sex: F
Age: 28
State: AZ

Vax Date: 05/12/2021
Onset Date: 05/12/2021
Rec V Date: 05/22/2021
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: Sulfa

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Numbness is vaginal area and buttocks. She could not feel herself pee, tiredness, achy, fever, headache.

Other Meds: None

Current Illness: None

ID: 1341142
Sex: F
Age: 37
State: TX

Vax Date: 04/30/2021
Onset Date: 05/01/2021
Rec V Date: 05/22/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Pharyngeal swelling

Symptoms: 1st, it started with headaches and hot flashes. 2nd day, body aches; sweats; fever. 3rd day, weakness. 4th day, very tired and weakness. Went to ED. I was diagnosed with pneumonia and COVID (positive). Out of work for 2 weeks. Still can't sleep on my back.

Other Meds: advair 500/50, zileuton 600 mg

Current Illness: none

ID: 1341143
Sex: F
Age: 37
State: NC

Vax Date: 05/21/2021
Onset Date: 05/21/2021
Rec V Date: 05/22/2021
Hospital:

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

Lab Data:

Allergies: Augmetin Penicillin Morphine Demoral Red dye 40

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: 1 hour post vaccine sight pain 5 hours post vaccine severe sight pain, swollen armpit lymph nodes, painful skin 6 hours post vaccine, above plus painful muscles and joints 30 hours post vaccine above not resolved and severe chest pain when a normal breath is taken

Other Meds: None

Current Illness: None

ID: 1341144
Sex: M
Age: 45
State: TN

Vax Date: 05/22/2021
Onset Date: 05/22/2021
Rec V Date: 05/22/2021
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: No known drug/food/product allergies

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient received first dose of moderna vaccine on 05/01/21 at clinic. Patient received second dose of moderna vaccine on 05/22/21 at clinic. Patient received second dose 7 days earlier than recommended 28 days after first shot. Patient waited required 15 mins after injection and did not have an adverse reaction. Called and notified CDC. Stated that patient did not need another dose. Sent email with CDC info on vaccine to clinic manager. Clinic Manager called patient's wife, apologized and informed of situation. Relayed information that CDC had stated. Sent email with CDC information to patient's wife. Patient was witness over the phone.

Other Meds: Albuterol Sulfate, Vitamin D3, Cyclobenzaprine, dexamethasone

Current Illness: No documented illnesses

ID: 1341145
Sex: M
Age: 18
State: CT

Vax Date: 05/22/2021
Onset Date: 05/22/2021
Rec V Date: 05/22/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: GAVE AN 18 YEAR OLD MALE HIS 1ST PFIZER COVID-19 VACCINE AND HAD HIM SIT DOWN FOR 15 MINUTES. ALMOST 5 MINUTES AFTER THE VACCINATION, THE PATIENT WAS SLOUCHED IN HIS CHAIR, SWEATING, LOOKING PALE, AND COMPLAINING THAT HIS BODY WAS HURTING ALL OVER. I RAN OVER TO THE PATIENT AND ASKED IF HE WAS HAVING TROUBLE BREATHING, TO WHICH HE DENIED. I BEGAN TO ASK HIM WHERE EXACTLY DOES IT HURT TO WHICH HE MENTIONED HIS LEGS AND BODY. SINCE HIS BREATHING WAS FINE, I SUSPECTED IT WAS JUST A PANIC ATTACK BUT NONETHELESS I PROVIDED HIM AN ICE PACK AND WATER. WE ALSO MOVED HIM TO A MORE PRIVATE AREA TO ELEVATE HIS LEGS. I OFFERED TO CALL 911, BUT HE DENIED. WE KEPT HIM FOR 30 MORE MINUTES WATCHING OVER HIM TO SEE HOW HE PROGRESSED. HE FELT MUCH BETTER TOWARDS THE END. THE PATIENT ADMITTED HE WAS HAVING A PANIC ATTACK. MY TECHNICIAN OFFERED TO CALL A FAMILY MEMBER TO COME GET HIM, BUT HE DENIED AND SAID HE WAS OKAY TO DRIVE HIMSELF HOME.

Other Meds:

Current Illness:

ID: 1341146
Sex: M
Age: 56
State: OH

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 05/22/2021
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: ACCORDING TO SIIS PATIENT GOT PFIZER COVID 19 VACCINATION AT SAMS CLUB ON MAY 5, 2021. PATIENT CAME TO OUR PHARMACY ON 05/19/2021 AND GOT A JANSSEN VACCINATION. PATIENT MARKED ON OUR FORM THAT HE HAD NOT HAD ANY OTHER COVID VACCINES PREVIOUSLY. WE CALLED THE SAMS CLUB AND THEY VERIFIED PATIENT DEMOGRAPHICS THAT HE GOT THE PFIZER VACCINE FROM THEM. CALLED PATIENT AND ASKED HIM AND HE STILL SAYS HE HAS NOT PREVIOUSLY GOTTEN ANY OTHER COVID VACCINATIONS AND DENIES GETTING A DOSE OF PZIFER ON 5/5/21. NO ADVERSE REACTIONS REPORTED.

Other Meds:

Current Illness:

ID: 1341147
Sex: M
Age: 60
State: PA

Vax Date: 05/21/2021
Onset Date: 05/22/2021
Rec V Date: 05/22/2021
Hospital:

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

Lab Data:

Allergies: wasps

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

Symptoms: Patient felt fine after shot, then started feeling weak, hot, lightheaded, then lost consciousness. Tapped patient, yelled his name, called 911, monitored breathing and blood pressure, provided him water, banana, oragne juice when he woke and waited for Ems. He left with ems but was feeling much better.

Other Meds: unknown

Current Illness: unknown

ID: 1341148
Sex: F
Age: 41
State: UT

Vax Date: 05/22/2021
Onset Date: 05/22/2021
Rec V Date: 05/22/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: patient received the J&J vaccine at 9 am and was monitored for 15 minutes. She is a store associate. Patient returned to work. At 1:30 patient was moving a lot of items from the pallet shipper. Patient felt dizzy and reported that she may need to faint. Patient was monitored by the pharmacist. She was counseled to drink water. We took blood pressure at 129/85 and 133/80. Patient was alert and oriented. Patient was sent home to rest. Follow up counsel on 05/26/2021

Other Meds: vitamin B injection, fish oil capsules

Current Illness:

ID: 1341149
Sex: F
Age: 31
State: MN

Vax Date: 05/19/2021
Onset Date: 05/21/2021
Rec V Date: 05/22/2021
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: No.

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

Symptoms: Period came 2 days early and has been very heavy.

Other Meds: Rainbow brand prenatal vitamin duo.

Current Illness: Bo.

ID: 1341150
Sex: M
Age: 23
State: NJ

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/22/2021
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: after receiving the vaccine pt felt sweaty and lightheaded and wanted to lay down, so the nurse directed and walked with pt to move him by the privacy area so he can lay there. while walking to the privacy area pt fell on the floor. when i examined the pt his body felt hot at touch and he stated that he was feeling dizzy. after few minutes the pt felt better and after waiting for 20 minutes pt stated he is feeling better again.

Other Meds:

Current Illness:

ID: 1341151
Sex: F
Age: 28
State: CA

Vax Date: 05/22/2021
Onset Date: 05/22/2021
Rec V Date: 05/22/2021
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: Amoxicillin

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

Symptoms: (DOB: 06/09/1992) received the 2nd COVID vaccine (Pfizer lot #EW0185, use by 05/23/2021 at 1240, expiration date 08/2021) at 1015. Client reported having a headache to EMT who immediately gave the client water, juice, and Pringles and offered to recline the anti-gravity chair back for the patient, but the patient stated, " No thank you." then notified the vaccination lead, RN, RN then assessed the patient while , EMT took the patients vitals. The patient denied experiencing shortness of breath, chest pain, difficulty swallowing, or facial flushing. Client denied having any chronic medical conditions and is allergic to amoxicillin. Reported taking an anti-depressant medication daily, name and dosage of antidepressant unknown. Vital signs taken at 1032: BP- 135/82 (Right arm, sitting upright), HR- 71, RR-16, oxygen saturation- 98%. The patient was alert and oriented to person, place, time, and situation. The patient was smiling and talking to her mother while she was sitting in the anti-gravity chair. Vital signs were taken at 1045, BP- 132/88 (Right arm, sitting upright), HR- 69, RR-16, oxygen saturation: 98%. Client reported that her headache was very mild. Patient reported having a history of intermittent headaches. Denied shortness of breath, dizziness, lightheadedness, difficulty swallowing, and chest pain. Vital Signs were taken at 1054- BP 132/84 (R arm, sitting upright), HR- 70, RR- 16, oxygen saturation at 98%. The client stated, " My headaches gone now." Client denied any vision changes, lightheadedness, chest pain, or difficulty breathing. The client was in no apparent distress. A final set of vital signs were taken at 1102, BP- 138/86 ( Right arm, sitting upright), HR- 69, RR-16, oxygen saturation at 97%. RN educated the client and her mother about V-Safe. Educated the client to follow-up with her primary care provider if symptoms returned and/or worsened, educated the client about Emergency Room precautions such as if she experienced dizziness, changes in vision, difficulty swallowing, or shortness of breath, to immediately call 911. The client verbalized understanding and left the site at 1105.

Other Meds: Antidepressant, dosage and name unknown, taken daily.

Current Illness: None

ID: 1341152
Sex: F
Age: 42
State: CA

Vax Date: 05/22/2021
Onset Date: 05/22/2021
Rec V Date: 05/22/2021
Hospital:

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

Lab Data:

Allergies: No allergies to medications or food.

Symptom List: Ear pain, Hypoaesthesia

Symptoms: At. 10:25am during observation, patient verbalized dizziness and lightheadedness. Vital signs noted: blood pressure 185/99, pulse 80, respiratory 18 02 Sat. 99%. Patient shared medical history of hypertension and migraine headaches. Patient provided information to follow up with primary care physician as soon as possible to treat hypertension. Patient stated husband would transport her to urgent care. Patient was being assisted from chair to wheelchair to exit clinic. She became weak and lethargic. Vital signs were taken again, noted at: blood pressure 204/179, pulse 136, 02 98% , respiratory 22. EMS was called and patient was transported to Medical Center.

Other Meds: None noted.

Current Illness: Patient verbalized history of hypertension and migraine headaches.

ID: 1341153
Sex: F
Age: 35
State: CA

Vax Date: 04/29/2021
Onset Date: 05/01/2021
Rec V Date: 05/22/2021
Hospital:

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

Lab Data:

Allergies: Topamax: gastro upset and hallucinations

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: I did not take very good notes because when it happened, I could not find a lot of information about my symptoms being linked to the COVID vaccine nor did I know the importance/availability of reporting. I only recently saw my symptoms as being similar to mild cases of immune thrombocytopenia and thought it important that I report my strange side effects. Within perhaps 48 hours of receiving my second COVID shot, my husband noticed a large bruise on the back of my leg. I didn't remember getting it but thought I must've forgotten a bump. I got more large bruises over the next couple days. A spot that bruised on top of my right thigh from my toddler playfully falling into me was the worst bruising I've ever had in my life, by far. It was very painful to walk and I needed ibuprofen for a couple days. The bruise was approximately 6"x2" and developed many petechiae about the size of a piece of coarse kosher salt. It lasted about a week. At two weeks post-shot, I have no bruises whatsoever, even with a rambunctious toddler. One more thing that happened during this time is that when I'd blow my nose upon waking, there would be blood/dried blood on the tissue. One morning, within a few days of my shot, I got a mild bloody nose after blowing my nose and it took about 10 minutes before I could remove the kleenex from that nostril. I am still having some trace dried blood when I blow my nose in the morning but it's improving.

Other Meds: adderall, sertraline, guanfacine, spironolactone, quetiapine

Current Illness: None.

ID: 1341154
Sex: F
Age: 34
State:

Vax Date: 05/22/2021
Onset Date: 05/22/2021
Rec V Date: 05/22/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Came to site with headache and reported anxiety Pt. stated she was feeling warm and dizzy Brought to medication screening to lie down Left at stable condition at 15:25 p.m. Recorded by RN. Evaluated

Other Meds:

Current Illness:

ID: 1341155
Sex: F
Age: 22
State: IL

Vax Date: 05/22/2021
Onset Date: 05/22/2021
Rec V Date: 05/22/2021
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: No allergies

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

Symptoms: VARS reviewed with patient to which she checked and verbally confirmed never having a severe reaction to a vaccine. 5 minutes of sitting post vaccination she felt flushed, then nauseous. She asked our technician for water. Pharmacist went out to check on her - she was alert but she said at one point everything was bright and she could not hear. She had moved herself to sitting on the floor. Called ambulance just to check her out. Pharmacist monitored her to make sure she was okay until ambulance arrived. We gave her ginger ale and crackers and cold rag and water. At this point patient confirmed she was nervous about vaccine prior and has passed out from giving blood before. Patient had only eaten half a sandwich by 3 PM in the day. Ambulance arrived and reviewed patient's vitals. She decided not to go with the ambulance. Called patient about 30 minutes after event to check on her, she stated she had gotten something to eat and felt much better. Total incident took place over 10 to 20 minutes. Pharmacist referred patient to her physician for follow up.

Other Meds: Fluoxetine

Current Illness: None

ID: 1341156
Sex: F
Age: 40
State: UT

Vax Date: 05/22/2021
Onset Date: 05/22/2021
Rec V Date: 05/22/2021
Hospital:

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

Lab Data:

Allergies: Allergy to Penicillin

Symptom List: Unevaluable event

Symptoms: Shot was administered, and patient was requested to wait the allotted 15 minutes in waiting area. Patient decided to shop during that time, and prior to returning to pharmacy, patient stated that she was beginning to worry about having side-effects from vaccine (mentioned paralysis specifically). She then became light headed and returned to pharmacy. I asked the patient to sit in our clinical services room with family and authorized her to remove her mask to ensure there wasn't any swelling occuring. Patient said she just felt dizzy and slightly nauseated. She said she had a history of anxiety and thought she may have been having a panic attack. She sat for a few minutes, we offered her a bottle of water, which she accepted, and drank some of. After approximately 10 minutes of observation, and no worsening of symptoms patient said she felt better and decided to leave the pharmacy.

Other Meds: Nothing on record.

Current Illness: Nothing on record.

ID: 1341157
Sex: M
Age: 31
State: CO

Vax Date: 05/22/2021
Onset Date: 05/22/2021
Rec V Date: 05/22/2021
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: Codeine

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

Symptoms: Patient fainted about 10 minutes after vaccine administered. Came to within a couple of minutes and vitals were stable upon examination by EMT's within about 15 minutes.

Other Meds: N/A

Current Illness:

ID: 1341158
Sex: F
Age: 23
State: PA

Vax Date: 05/21/2021
Onset Date: 05/22/2021
Rec V Date: 05/22/2021
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: None

Symptom List: Injection site pain, Pain

Symptoms: Severe headache Severe joint pain/muscle aches Fever of 101.5 degrees Fahrenheit Nausea Fatigue

Other Meds: Prozac

Current Illness: None

ID: 1341159
Sex: F
Age: 20
State: NY

Vax Date: 05/16/2021
Onset Date: 05/16/2021
Rec V Date: 05/22/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: patient said, she fainted, felt dizzy.

Other Meds:

Current Illness:

ID: 1341160
Sex: F
Age: 45
State: GA

Vax Date: 05/22/2021
Onset Date: 05/22/2021
Rec V Date: 05/22/2021
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: After 1 min of receiving Pfzier COVID Vaccine pt was dizzy. Then sweaty and calmy. Pt sat and drank water and after a few minutes cold pack on back of the neck helped the dizziness and sweatiness. Pt was in vaccination room for about 5 mins and then felt better. She sat outside for another 5 mins. She felt better and was up and shopping. Called in late afternoon to follow up, left message for patient and to take APAP for muscle soreness and any flu like symptoms

Other Meds:

Current Illness:

ID: 1341161
Sex: F
Age: 12
State: PR

Vax Date: 05/22/2021
Onset Date: 05/22/2021
Rec V Date: 05/22/2021
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: SULPHA

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Female patient with 12 years of age had a cutaneous reaction in both arms after fifteen minutes of observation. Presented itching in the punctured area.

Other Meds: N/A

Current Illness: N/A

ID: 1341162
Sex: F
Age: 60
State: PA

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 05/22/2021
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: 8:27 dizzy and nauseous - brought to stretcher, laid supine 136/75 52, 126/77 59 sitting, chest CTA, CV RRR )m/g/r 8:35 nausea 8:53 pt thought she was going to have diarrhea, escorted to restroom urinated, no BM , just flatulence/belching 8:59 no longer dizzy, nausea mild, feeling better vital 147/77, 52 9:03 stood without difficulty, ok to go home

Other Meds: sertraline, lamictal, B12, proamitine

Current Illness:

ID: 1341163
Sex: F
Age: 18
State: NY

Vax Date: 05/19/2021
Onset Date: 05/20/2021
Rec V Date: 05/22/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Patient given vaccination ID unclear if this was the LOT number. She developed a mild skin rash one day after vaccination, which spread over her face, neck and chest and arms, with lip swelling, but no other oropharyngeal edema. The rash was itchy and pruritic, raised macules that were slightly erythemaic on the face, and sparsely papular on the arms. We prescribed benadryl and prednisone, with instructions to call our service line and also see us in the office on Monday. She had unresolved blood tests, hyperglycemia, which we were trying manage with our staff however she was not adherent to follow up with us due to college coursework. My associate is her primary care attending, and had requested assistance in filling out the VAERS form.

Other Meds: None

Current Illness: Hyperglycemia

ID: 1341164
Sex: M
Age: 41
State: NY

Vax Date: 05/22/2021
Onset Date: 05/22/2021
Rec V Date: 05/22/2021
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: Patient was light-headed, pale, nauseous, and dizzy a few minutes after receiving vaccine.

Other Meds:

Current Illness:

ID: 1341165
Sex: U
Age: 15
State:

Vax Date: 05/22/2021
Onset Date: 05/22/2021
Rec V Date: 05/22/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Minutes after the vaccination patient felt dizzy and fainted and came back to consciousness shortly after. Patient felt much better just had a slight headache after regaining consciousness. Patient was given water and feet were lifted to help with circulation. Patient after additional 30 minutes of observation felt a lot better and was alert with no symptoms reported.

Other Meds:

Current Illness:

ID: 1341166
Sex: F
Age: 35
State: TX

Vax Date: 04/23/2021
Onset Date: 04/24/2021
Rec V Date: 05/22/2021
Hospital:

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

Lab Data:

Allergies: Yes: Contrast media; Analgesics

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

Symptoms: Fever. Muscular discomfort and dizziness 26 hours after vaccine and then urticaria all over body that has been going on even up to today that's 30 days going down every day. I am presenting with amenorrhea x5 days late, what we don't know is if it is due to the vaccine but it coincides. Inflammation and fluid retention some days worse than others.

Other Meds: Vitamin E; Vitamin B; Lysine; Magnesium; Biotin

Current Illness: No

ID: 1341167
Sex: M
Age: 21
State: FL

Vax Date: 05/19/2021
Onset Date: 05/20/2021
Rec V Date: 05/22/2021
Hospital: Y

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

Lab Data:

Allergies: None

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

Symptoms: The following 2 days after second dose with malaise, fatigue, myalgias, subjective fevers, third day post vaccine with chest pain consistent with myopericarditis after evaluation. Echocardiogram pending, elevated ESR, CRP, Leukocytosis, elevated CPK level, Tropnins uptrending from 8, EKG with diffuse ST segment elevation and PR interval depression, clear CXR.

Other Meds:

Current Illness: None reported by patient

ID: 1341169
Sex: M
Age: 81
State: GA

Vax Date: 05/22/2021
Onset Date: 05/22/2021
Rec V Date: 05/22/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039K20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: Reporting incorrect second dose given. Moderna administered instead of Pfizer. No adverse reaction present

Other Meds:

Current Illness:

ID: 1341170
Sex: M
Age: 17
State: TX

Vax Date: 05/22/2021
Onset Date: 05/22/2021
Rec V Date: 05/22/2021
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: Patient fainted 3 minutes after receiving the first covid vaccine.

Other Meds: None

Current Illness: None

ID: 1341171
Sex: M
Age: 66
State: SC

Vax Date: 03/05/2021
Onset Date: 05/05/2021
Rec V Date: 05/22/2021
Hospital:

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

Lab Data:

Allergies: Sulfa

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

Symptoms: Developed shingles; case is ongoing.

Other Meds: None

Current Illness: None

ID: 1341172
Sex: F
Age: 42
State: OR

Vax Date: 05/21/2021
Onset Date: 05/22/2021
Rec V Date: 05/22/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Extremely stiff and painful neck and shoulders. Head ache and very rapid resting heart rate. It's 105 and normally 61

Other Meds: Buproprian and Trazadone

Current Illness: None

ID: 1341173
Sex: F
Age: 72
State: PA

Vax Date: 02/26/2021
Onset Date: 02/28/2021
Rec V Date: 05/22/2021
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: lopressor,amplicillin, doxycycline, ct dye, zantac, prilosec, latex, high dose flu vaccine

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: pounding irregular heart beats lasting long periods of time and stronger. muscle and joint pain at intervals. lasting several weeks, not every day

Other Meds: losartan/hctz, bupropion, clonazepam, caltrate, vit.D, advil, tylenol, capzasin hp cream

Current Illness: none

ID: 1341174
Sex: M
Age: 58
State: MI

Vax Date: 04/22/2021
Onset Date: 05/02/2021
Rec V Date: 05/22/2021
Hospital: Y

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

Lab Data:

Allergies: None

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

Symptoms: Sun, 5-2-21, Petechiae appears on my lower feet, ankles, and lower legs/shins. Random bruises appearing without contact/bump. Mon, 5-3-21, Petechiae now appearing on my hands, forearms. Petechiae spots beginning to appear on my face. Nose and mouth bleeding. Went to hospital ER on 5-3-21. Rec'd IGIV (2 days), and Decadron (Steroid) 40mg daily (5 days). Discharged from Hospital after 5 days on 5-7-21, with platelet count at 58 (58,000). - Follow-up blood draw post-discharge on 5-13-21 showed platelet level back down to 1 (1,000). Directed to hospital by hematologist office, re-admitted on 5-13-21. Rec'd IGIV (3 days) and IV Solumedrol (Steroid), and Oral Steroid (2 days). Discharged again from Hospital after 2nd 5-day hospital stay.

Other Meds: 1. Tamsulosin (Flomax) - BPH 2. Occasional Osteo Bi-Flex Regular Strength - Joint Soreness

Current Illness: None

ID: 1341175
Sex: M
Age: 64
State: MI

Vax Date: 05/21/2021
Onset Date: 05/21/2021
Rec V Date: 05/22/2021
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: not known

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

Symptoms: Vaccine was administered to the patient in his left deltoid. When the needle was removed, blood started running down his arm and a large "knot" started to form at the injection site. Bandage was applied. Pharmacist told patient that we most likely hit a vein and that caused the bleeding. Told him that he would most likely end up with a nasty bruise and arm tenderness. and that he could take Tylenol or ibuprofen if needed. Also advised that a cold compress would likely help. Pharmacist called patient on 5/22 (the next morning). Patient said that he was "doing fine" and his arm "didn't bother him a bit."

Other Meds:

Current Illness: none

ID: 1341176
Sex: F
Age: 21
State: NY

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 05/22/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pain in extremity

Symptoms: Patient was light-headed, dizzy, and pale minutes after receiving the vaccine. They also reported difficulty seeing (their field of vision was all bright light.)

Other Meds:

Current Illness:

ID: 1341177
Sex: F
Age: 40
State: MN

Vax Date: 05/11/2021
Onset Date: 05/19/2021
Rec V Date: 05/22/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: I experienced my first abnormal menstural cycle where it was regular at first in terms of timing and amount of bleeding until the last day when I woke up at 2 a.m. with a lot of blood that continued into the next day so that every time I stood up blood came out and I was light headed. I went to ER because a lot of heavy bleeding soaking through pads and blood clots. I have NEVER experienced that much blood and NEVER have had large blood clots with my periods and my periods are always regular. It was scary and it was first period after getting shot. My breast also were itchy until menstural cycle and bleeding finished.

Other Meds: gabepentin, lyrica, lamotragine, wellbutrin

Current Illness: ptsd, radial nerve arm compression

ID: 1341178
Sex: F
Age: 85
State: WA

Vax Date: 05/22/2021
Onset Date: 05/22/2021
Rec V Date: 05/22/2021
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: -Had a previous allergy to Moderna vaccine dose #1 - throat got hard, difficult to swallow, got the jitters, and tingling of tongue. -Guaifenesin - patient had a red blotchy rash after taking Mucuinex chest congestion

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

Symptoms: Patient previously had a Moderna (dose #1) vaccine on 1/15/21. Patient had difficulty swallowing, tingling on tongue, and got the jitters about 10-15 mins post dose. She was recommended by her PCP to try the Johnson and Johnson vaccine because of this allergy. We had discussion with an ID specialist and pharmacy manager to go ahead and give the vaccine after weight the risks/benefits. A pharmacist was there to monitor the patient and about 15 minutes post dose, patient had difficulty swallowing and noted that this was a very similar onset to when she received the Moderna vaccine. A code blue was called, patient was sent up on stretcher to the ER. Patient received steroids (methylprednisolone) , famotidine, and Benadryl while in the ER. Currently being monitored in the ER.

Other Meds:

Current Illness:

ID: 1341179
Sex: F
Age: 40
State: CA

Vax Date: 05/01/2021
Onset Date: 05/22/2021
Rec V Date: 05/22/2021
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: Seasonal allergies.

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

Symptoms: Client reported loss of taste starting 2 hours after 1st dose and resolved without intervention the evening of the next day.

Other Meds: None.

Current Illness: Denies.

ID: 1341180
Sex: M
Age: 53
State: NJ

Vax Date: 05/21/2021
Onset Date: 05/21/2021
Rec V Date: 05/22/2021
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: Muscle pain in left forearm and hand Headache Agitation Light nausea

Other Meds:

Current Illness:

ID: 1341181
Sex: F
Age: 51
State: NJ

Vax Date: 05/21/2021
Onset Date: 05/21/2021
Rec V Date: 05/22/2021
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: Latex

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: At 3:55pm patient complained of tingling in her right arm and hand with her finger tips feeling cold. At 4 pm she complained that her right arm felt weak and heavy , she was able to push with her right arm. She denies SOB or difficulty breathing. she declined to have an ambulance called and stated she would not go the the hospital. she stated she wanted to go outside and get fresh air, she stated the she felt better and was escorted outside by this writer and a police officer. She called her husband who came to pick her up. She got into his truck on her own and denied feeling any weakness in her arm.

Other Meds: Vitamin D3 1000 IU daily, Vitamin C 500 mg daily , B12 daily , patient states she takes medication for high blood pressure but does not know the name of it.

Current Illness: scleroderma , high blood pressure,

ID: 1341182
Sex: F
Age: 49
State: ME

Vax Date: 04/19/2021
Onset Date: 04/19/2021
Rec V Date: 05/22/2021
Hospital:

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

Lab Data:

Allergies: Penicillin, codeine, feline dander

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

Symptoms: Within 5 minutes of injection I experienced: Tingling in lips and mouth, then to numb; Flushing (bright red in face and chest); rapid heart beat, shaking, disorientation for roughly 10 minutes. I was given 50mg of Benadryl and stabilized. I remained slightly flushed and had tingling in my mouth and lips for the remainder of the evening. Another 50mg of Benadryl before bed. Tues am woke up feeling fine, took 25mg of Benadryl. By 1pm was experiencing: Tingling and numbness in lips; Flushing; Light wheezing Hot and painful skin and chills. Extreme lethargy I took another 50mg of Benadryl and my symptoms abated slightly. No difficulty breathing at any point. Another 50mg of Benadryl at ~11p. Tuesday am, another 50mg of Benadryl at ~8:30a, and still exhibiting the same symptoms w/ exception of wheezing. Note: I take Benadryl on a regular basis due to my cat allergy and it does not make me sleepy. These symptoms lasted for approximately a week. For the last three weeks I have had extreme lethargy - if I try to stay up and keep working, I become nauseous. My left leg is going numb on the left side along the leg periodically. Very infrequently I get a bit of numbness and tingling in my mouth. No more wheezing.

Other Meds: Multi-vitamin, biotin, iron (Slow FE), clonazepam, lamictal, sertraline, Benadryl

Current Illness: None

ID: 1341184
Sex: F
Age: 78
State: CA

Vax Date: 02/08/2021
Onset Date: 02/09/2021
Rec V Date: 05/22/2021
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: N/A

Symptom List: Injection site swelling, Limb discomfort

Symptoms: WOKE UP NEXT DAY WITH ACHING IN MY LEFT HIP AREA, CONTINUED TO GET WORSE THAT DAY AND NEXT DAY TO THE POINT I WAS HAVING TROUBLE MOVING AND BREATHING BECAUSE OF THE PAIN. EARLY MORNING THURSDAY HAD MY HUSBAND TAKE ME TO ER AS THE PAIN HAD MOVED UP MY BACK ON THE LEFT SIDE. ER TOOK X-RAY AND SAW NOTHING, GAVE ME PAIN MEDICATION, PRESCRIBED PREDNISONE AND THE PAIN STARTED TO SUBSIDE. TOOK PREDNISONE FOR A WEEK AND THE PAIN DISAPPEARED.

Other Meds: SYNHROID, 1 A DAY VITAMIN, VITAMIN D, VITAMIN B,

Current Illness: N/A

ID: 1341185
Sex: M
Age: 14
State: CA

Vax Date: 05/22/2021
Onset Date: 05/22/2021
Rec V Date: 05/22/2021
Hospital:

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

Lab Data:

Allergies: No known allergies

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

Symptoms: Situation: 14yo male came in for first dose Pfizer vaccine. Within 5 mins after receiving vaccine, patient had a seizure for approximately 1 minute. During seizure, patient was incontinent of urine. RN was able to get to patient's side before he fell. Background: Patient did not alert vaccinator or RNs that he had a history of seizure. Mom informed staff after the event that he had a febrile seizure when he was a young child. She did not disclose what age he was at the time of the previous seizure. Assessment: RN observed patient in an active seizure for 1 minute in which his body contracted out and his eyes rolled back. She was at his side to prevent him from falling. He was placed on a gurney and moved to room 6 for closer observation for 30 mins. Pfizer vaccine administered on 5/22/21 at 12:52PM 1255 vitals ? 121/64(83), 97.3F 1257 vitals ? 122/75(90) 1311 vitals ? 116/76, HR 68, 100% O2 1318 vitals ? 112/75, HR 68, 100% O2 1325 vitals ? 111/61, HR 68, 99% O2 Recommendation: MD on call, was called and notified of the event. Her recommendation was for the patient to go to the ED for evaluation and labs. RN called the ED to notify them of the patients intended arrival. The mom agreed to take the patient to ED for further evaluation. The patient was taken out via wheelchair.

Other Meds: unknown

Current Illness: no

ID: 1341186
Sex: M
Age: 66
State: CA

Vax Date: 03/27/2021
Onset Date: 03/28/2021
Rec V Date: 05/22/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Severe muscle aches and pain beginning in the large leg muscles and migrating to hips, shoulders, arms, neck and back

Other Meds: None

Current Illness: None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm