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: 1351312
Sex: F
Age: 79
State: NJ

Vax Date: 05/22/2021
Onset Date: 05/24/2021
Rec V Date: 05/26/2021
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: Rash approx. three inches below injection. Pink in color and is about three inches wide going from center of right arm below injection site to the left. Some raised swelling and discomfort or slight pain. Tylenol does help and make it more comfortable.

Other Meds:

Current Illness:

ID: 1351313
Sex: M
Age: 73
State: MI

Vax Date: 04/19/2021
Onset Date: 04/22/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: amlodipine, atorvastatin, lotensin, prevastatin, simvastatin

Symptom List: Anxiety, Dyspnoea

Symptoms: Bells Palsey

Other Meds: Cozaar, Levothyroxine, metformin, metoprolol

Current Illness:

ID: 1351315
Sex: F
Age: 16
State: CA

Vax Date: 05/25/2021
Onset Date: 05/25/2021
Rec V Date: 05/26/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: EL1284
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: No

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

Symptoms: No adverse events. Minor patient received 1st dose of Moderna erroneously at an alternate site on 2/22/21 and received her 2nd dose at our location on 5/25/21.

Other Meds: Oral contraceptive

Current Illness: No

ID: 1351316
Sex: F
Age: 30
State: WI

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: NONE

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: NONE - REPORTING ERROR: PATIENT RECEIVED A 0.3ML DOSE OF PFIZER VACCINE THAT WAS MIXED WITH 0.8ML OF SALINE RATHER THAN 1.8ML OF SALINE, HUMAN ERROR ON PHARMACY PART OF PERSONNEL RECONSTITUTING VACCINE; PATIENT INFORMED ON 05/26/21 2:17PM OF VACCINE ERROR AND INSTRUCTED TO WATCH FOR ABNORMAL OR GREATER THAN NORMAL SIDE EFFECTS.

Other Meds: N/A

Current Illness: N/A

ID: 1351317
Sex: F
Age: 52
State: NY

Vax Date: 01/22/2021
Onset Date: 02/04/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: I woke up with nausea and an headache. I get headaches anyway, so it was hard to say if it was because of the shot. I also had diarrhea. It kept me out of work. I did not have a fever. I was very fatigued and stayed in bed or slept most of the day. I out was out of work for a week. I would try to go to work and would come home sick. Overall, my symptoms lasted about a week to two weeks. I did not receive any treatment. My doctor thought it was viral. She recommended a bland diet, and if it didn't improve she was going to put me on an antibiotic. All of this happened about a week to two weeks after my vaccine. I was going to give a stool sample if the diarrhea didn't quit, but I slowly started feeling better so nothing was ever done. I have an ongoing issue so I don't believe that my symptoms are related to the covid vaccine.

Other Meds: Gabapentin - 1xday/2 600mg tablets bupropion - 1xday/150mg estradiol - 1xday/2mg progesterone - 1xday/100mg sertraline - 1xday/100mg montelukast - 1xday/10mg emgality - 1xmonth/injection/120mg inhaler - as needed zyrtec - 1xday/10mg vitamin

Current Illness: GI problems

ID: 1351318
Sex: F
Age: 70
State: MI

Vax Date: 02/23/2021
Onset Date: 02/24/2021
Rec V Date: 05/26/2021
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: I received 2nd shot on 2-23-2021. Went to bed but was woken up by severe migraine. Migraine went on for 4 days with my trying to combat it with the Tizanidine. Nothing stopped the pain. I have had severe and medium pa8n in my head, in my back right side 0f my head and right neck muscle since then. Nothing is stopping the pain and Ive been home bound in bed since then. I have Cervical Dystonia which causes severe migraines and I take the Tizanidine for that. It has handled my condition fine till 2-24-2021 at 2am. I finally got into the dr last week and she has ordered Diazapam to help sleep but it has no effect. Im now scheduled for 2 MRI's June 3rd 2021. Its also possible I should be Botox shots to my muscle to stop it from spasming and causing the migraines. Whatever was in the 2nd Moderna shot, has caused my neck muscle to spasm non stop and is effected my whole right side of my head, the top and front area.

Other Meds: Tizanidine, Duloxetine, Celecoxib, Tramodol

Current Illness: Cervical Dystonia,

ID: 1351319
Sex: M
Age: 24
State: MD

Vax Date: 05/08/2021
Onset Date: 05/25/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: MYOCARDITIS. I experienced extreme chest pain, tightness, shortness of breath, painful heart beats, I could feel each beat. I hunched over in my bed groom grabbing my abdomen and fell onto my bed and almost passed out from whack I?d assume is lack of oxygen. I could barely breathe for about five minutes and felt relatively severe pain particularly in the right side of my chest. I could feel every muscle, tendon, and artery inflamed, enlarged, and hurting. My chest felt like it filled up with a balloon. Heart rate went up too. I have NEVER EVER felt ANYTHING like this in my LIFE. Not even close. It was a brand new sensation to me first time I?ve ever felt anything like this at all, and very intense and frustrating. Keeping in mind I am in perfect health. I am a body builder with a perfect physique. I work at a high end restaurant and have an extremely good diet. I have a normal sleep and sexual routine, I don?t use any medications whatsoever even Tylenol or ibuprofen. I have no pre existing conditions. I have no history of heart or cardio problems. My family has a history of low blood pressure. I have next to no stress or anxiety in my life. I am 24 years old I work out and run miles, five to six days a week. I don?t use nicotine, tobacco, and I haven?t had a drink of alcohol in ten years (14yrs old). I smoke marijuana on a daily basis. After about ten minutes the incident went down and I was able to breathe a little better but still had pain and tightness in my chest. I have had shortness of breath ever since. This is being written the day after the event about 26 hours later. I ran a mile last night and went to the gym it seemed to help both my breathing and the pain and tightness but it has not fully gone away. I feel my heart straining somehow as I am typing this. One thing to note is I did not want to get vaccinated but was pressured to do so, and before getting it I was very nervous and honestly upset. The woman administering it was not helpful at all and actually mocked my unsureness and was very rude and unprofessional. She didn?t answer any technical questions I had. During my interaction with her between my nerves and her behavior I?m absolutely certain my heart rate was elevated at the time of getting the shot. I have only had one shot. The episode of myocarditis occurred two weeks after my first shot. Two days after my scheduled second shot, which I missed because of work and was going to reschedule before this occurred. I am not going to be getting the second shot. Will be following up with my primary care doctor as soon as possible. Haven?t had time.

Other Meds: Smoke marijuana

Current Illness: None

ID: 1351320
Sex: M
Age: 29
State: NY

Vax Date: 04/29/2021
Onset Date: 04/29/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: amoxicillin

Symptom List: Pharyngeal swelling

Symptoms: Severe headache, rigors, high fever (subjective), tachycardia, severe nausea. Drenching sweats, "strange thoughts". Rigors and drenching sweats throughout the night. "Crazy shaking fits." Presyncope. Got to point where patient considered calling ambulance. Lasted 12 hours then fully resolved.

Other Meds: none

Current Illness: none

ID: 1351321
Sex: M
Age: 25
State: TX

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Student went to emergency department with compliant of wisdom tooth pain, chills, numbness and nausea on 5/19/21, the day after his second dose of vaccine.

Other Meds: None

Current Illness: None

ID: 1351322
Sex: M
Age: 19
State: MI

Vax Date: 05/05/2021
Onset Date: 05/12/2021
Rec V Date: 05/26/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011J201A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: unknown

Symptom List: Diarrhoea, Nasal congestion

Symptoms: patient stated suspected myocarditis (sharp pain in chest, worse on inhale), started 1 week after 1st dose of COVID-19 Pfizer vaccine. Took ibuprofen over-the-counter and symptoms subsided

Other Meds: unknown

Current Illness: unknown

ID: 1351323
Sex: F
Age: 41
State:

Vax Date: 05/24/2021
Onset Date: 05/25/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: dizziness

Other Meds:

Current Illness:

ID: 1351324
Sex: M
Age: 62
State:

Vax Date: 03/24/2021
Onset Date: 04/04/2021
Rec V Date: 05/26/2021
Hospital: Y

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: Patient presented to the ED on 4/4/21 and was admitted to another facility for intestinal obstruction. Patient presented to the ED on 5/6/21 and was admitted for hypotension due to hypovolemia.

Other Meds:

Current Illness:

ID: 1351325
Sex: F
Age: 53
State: NJ

Vax Date: 03/19/2021
Onset Date: 04/07/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: bees, Benadryl

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

Symptoms: Patient started to develop chest pain, shortness of breath, cough approximately 3 days to 1 week following second covid vaccination. This continued to get progressively worse prompting visit to PCP on 4/7/21. Initially conservative treatment with medication for allergies and asthma didn't help. Symptoms worsened and led to a second visit with PCP on 5/17/21 where patient was sent over to the ER for additional evaluation. CT of the chest revealed bilateral pleural effusions, evidence of air trapping and bronchial wall thickening. Patient diagnosed with pleurisy, pleural effusions. She is still undergoing treatment with pulmonary and is started on furosemide, prednisone, inhalers. She continues to be short of breath and may be required to be out of work for as long as 4 months as per the pulmonologist.

Other Meds: Singulair, frova prn, artane, minocycline

Current Illness: none

ID: 1351326
Sex: F
Age: 48
State: TX

Vax Date: 01/06/2021
Onset Date: 01/07/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Starting the evening after the 2nd dose of the vaccine, participant got chills, nausea and fever 102.9 F and 2 episodes of vomiting. Symptoms continued throughout most of the next day and low grade fever, body aches and nausea. Participant took Tylenol and called a colleague for advice, who advise to take Tylenol, plenty of fluids and rest. The next several days the symptoms continued to improved and completely resolved within a week.

Other Meds: none

Current Illness: none

ID: 1351327
Sex: F
Age: 36
State: NJ

Vax Date: 05/25/2021
Onset Date: 05/25/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: Blueberries, eucalyptus

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

Symptoms: Soreness on both arms simultaneously since ~10 pm- Took 2 Motrin- no effect Soreness and swelling on left arm increased ~12 am- took 2 Motrin- pain and swelling decreased a little but still can't lift arm without surge of pain Chills and hot flashes since 4 am interchangeably, Headache on and off since ~12:30 pm - took 2 Excedrin- no effect; took 2 more 4 hours later - no effect Nausea with stomach cramps at ~1:30pm- ate toast and drank herbal tea- symptoms decreased by a little Dizziness around the same time as nausea- sat down in a chair and put head down with eye closed Extreme fatigue- all-day- lots of sleep and water

Other Meds: Wixela Inhub, ChlorTrimeton, Rhinocort, Azelastine Hydrochloride

Current Illness: None

ID: 1351328
Sex: F
Age: 16
State: VT

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Patient experienced seizure activity after receiving 2nd dose of pfizer vaccine. Sx started approximately 5 mins after receiving injection. fell and hit head. B/L upper extremity contractures noted that did not resolve and was associated with extreme pain and muscle rigidity.

Other Meds: none

Current Illness: none

ID: 1351329
Sex: F
Age: 13
State: WI

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: NONE

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

Symptoms: NONE - REPORTING ERROR: PATIENT RECEIVED A 0.3ML DOSE OF PFIZER VACCINE THAT WAS MIXED WITH 0.8ML OF SALINE RATHER THAN 1.8ML OF SALINE, HUMAN ERROR ON PHARMACY PART OF PERSONNEL RECONSTITUTING VACCINE; PATIENT INFORMED ON 05/26/21 2:35PM OF VACCINE ERROR AND INSTRUCTED TO WATCH FOR ABNORMAL OR GREATER THAN NORMAL SIDE EFFECTS.

Other Meds: N/A

Current Illness: N/A

ID: 1351330
Sex: M
Age: 34
State: IL

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 05/26/2021
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: Patient was given the vaccine and a min or so after the vaccine was given called for help and then blacked out. Patient was having troubled breathing and turned pale. Patient was given and injection of Epinephrine 0.3 mg to the right leg and 911 was called. After being checked out by EMS the patient declined going to the hospital for further treatment

Other Meds: None

Current Illness: None

ID: 1351331
Sex: M
Age: 12
State: WI

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: SOME FOOD ALLERGIES

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: NONE - REPORTING ERROR: PATIENT RECEIVED A 0.3ML DOSE OF PFIZER VACCINE THAT WAS MIXED WITH 0.8ML OF SALINE RATHER THAN 1.8ML OF SALINE, HUMAN ERROR ON PHARMACY PART OF PERSONNEL RECONSTITUTING VACCINE; PATIENT INFORMED ON 05/26/21 2:35PM OF VACCINE ERROR AND INSTRUCTED TO WATCH FOR ABNORMAL OR GREATER THAN NORMAL SIDE EFFECTS.

Other Meds: N/A

Current Illness: N/A

ID: 1351332
Sex: F
Age: 66
State: VA

Vax Date: 05/25/2021
Onset Date: 05/25/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: Magnesium citrate

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

Symptoms: Developed shakes, chills, alternating hot and cold flashes, fatigue, muscular aches starting at 11:45 pm. Has let up some - shakes have stopped. and am generally feeling better (4:00 pm).

Other Meds: Daily multivitamin, calcium

Current Illness: Seasonal allergy

ID: 1351333
Sex: F
Age: 33
State: UT

Vax Date: 03/24/2021
Onset Date: 03/24/2021
Rec V Date: 05/26/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Lactose intolerant

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

Symptoms: Fatigue, upset stomach, a slow moving wave of pain that eventually became full body by the following morning. Followed by more stomach pain, abdominal cramping, rage, and confusion into the following days. Side effects lasted a week.

Other Meds:

Current Illness:

ID: 1351334
Sex: F
Age: 42
State:

Vax Date: 04/28/2021
Onset Date: 04/28/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Unevaluable event

Symptoms: patient experienced extreme tachycardia and loss of consciousness

Other Meds:

Current Illness:

ID: 1351335
Sex: M
Age: 54
State: FL

Vax Date: 04/22/2021
Onset Date: 04/23/2021
Rec V Date: 05/26/2021
Hospital: Y

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 known/reported

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

Symptoms: Patient experienced HA on way home from receiviong vaccine. HA persisted on 4-23-21 throughout morning and into early afternoon. Patient became catatonic at home, family called 911 and pateint was rushed to hospital via ambulance in hypertensive crisis and seizure activity. Patient diagnosed with brain bleeds in two sepearte areas of brain. Original commentary by neurosurgeon was this was unrelated to Moderna vaccine, current neurologist thinks it could have been related. Patient was in hospital for several days then released on 4-28-21. Patient is healing, going to therapy and compliant with all neurology follow ups. Patient still not released to return to work or to driving as of 5-26-21.

Other Meds: None known

Current Illness: None known/reported

ID: 1351336
Sex: F
Age: 51
State: MD

Vax Date: 05/13/2021
Onset Date: 05/17/2021
Rec V Date: 05/26/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 011L20A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies: Shellfish

Symptom List: Injection site pain, Pain

Symptoms: Severe pain in feet on May 17, 2021. Severe cramping in feet after both shots. Severe blood circulation issues. I believe these issues stem from the vaccine as I didn't have these issues prior to the shots being given.

Other Meds: Metoprolol Succinate ER 50 mg Potassium Cit 10MEQ Multivitamins Omega - 3

Current Illness: none

ID: 1351337
Sex: M
Age: 22
State: CA

Vax Date: 04/13/2021
Onset Date: 04/13/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: PCN

Symptom List: Injection site pain, Menorrhagia

Symptoms: Vomiting and severe stomach pain. 1st episode 4/14-25 hospital stay 2nd episode 5/20-present Vomiting and severe stomach pain

Other Meds: Cloidine, respiradone, lithum

Current Illness: none

ID: 1351338
Sex: M
Age: 17
State: NC

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Patient is 17 years old, received dose of Moderna vaccine inadvertently. Pt monitored for 15min post administration, no signs or symptoms of adverse reaction.

Other Meds: None

Current Illness: None

ID: 1351339
Sex: F
Age: 66
State: IN

Vax Date: 04/03/2021
Onset Date: 05/03/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Had COVID the month of December- no hospitalization. Had first moderna April 3, 2021. Second moderna shot May 4. I have had low platelets for a few years but not any lower than 43,000. Went for blood work on May 3 2021 for Dr. for check up and my platelets were 17,000. She prescribed me a steroid and brought them back up to 156,000 by May 10. She told me it was from COVID . My vaccine was very close to my appointment.

Other Meds: Simvistatin, omega 3, probiotic.

Current Illness: None

ID: 1351340
Sex: F
Age: 29
State: CA

Vax Date: 04/10/2021
Onset Date: 04/10/2021
Rec V Date: 05/26/2021
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: Allergic to Zpack, amoxicillin, Zithromax, mushrooms, alcohol consumption

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: ER- TWO VISITS- 4/10/2021 4/12/2021. I've seen a couple doctors to get follow ups and get stronger allergy medications, I can't recall how many I have seen. I had a rash, difficulty breathing, dizziness, chills, shaking, fast heart rate, throat swelling, extremely fatigue. Still having breathing problems, still getting hives, started allegra and I take it daily, I also have to use my inhaler almost daily, I have never had asthmatic symptoms before this.

Other Meds: None

Current Illness: None

ID: 1351341
Sex: F
Age: 14
State: WI

Vax Date: 05/21/2021
Onset Date: 05/21/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: unknown

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

Symptoms: Initial complaint at 1353: Lightheaded, hot, cold, headache on right side, diaphoretic to the touch 1406 BP 110/70 HR 64 Denies SOB, tingling throat. Ate at 12 noon fruit and chips 1410 BP 122/72 HR 66 Worsening of headache on right side of head, room spinning. Hot/Cold flashes have passed. 1413 Spinning has stopped. Everything is bright. Clamminess has subsided 1417 R side of face numb. symmetrical grimace/smile 1419 Sitting up. Reports dizziness. Feeling melting down right side face. ***Documentation provided stops here.

Other Meds: Fluoxetine

Current Illness: denied

ID: 1351342
Sex: M
Age: 15
State: NC

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Nausea

Symptoms: After receiving patients first Pfizer Covid shot patient passed out twice. EMS was contacted at this time. Patient regained consciousness each time. He then passed out a third time after EMS arrived at the seen. Due to this he was transported to nearest hospital ER for further testing

Other Meds: Fluoxetine

Current Illness: none

ID: 1351343
Sex: M
Age: 56
State:

Vax Date: 04/10/2021
Onset Date: 05/21/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Injection site pain

Symptoms: Tested positive for covid 19 on 05/25/21

Other Meds: Na

Current Illness: Na

ID: 1351344
Sex: M
Age: 54
State: NH

Vax Date: 04/10/2021
Onset Date: 04/11/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: Penicillin

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

Symptoms: Experienced severe headache, leg pain, shortness of breath. Was admitted to Hospital on 4/11/2021. Discharged 4/12/2021. Follow up w Primary doctor

Other Meds: omeprazole 20 mg delayed release

Current Illness: none

ID: 1351345
Sex: F
Age: 15
State: IN

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: None known, NKDA

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

Symptoms: Event: About 2-3 minutes after the vaccine was administered, the patient had an erythematous warm rash, initially to the left deltoid and left antecubital fossa area (vaccine was administered in the same arm). The rash was flat and blotchy, some areas were slightly raised. After about 5-7 minutes, the rash had spread to the patient's upper chest/ torso, clavicle areas, and upper back. Patient stated the rash was not pruritic, just that the areas felt hot. No respiratory distress or wheezing, patient did not seem anxious. She denied previous similar reactions to medications, food, vaccines, or blood draws in the past. Treatment: an ice pack was applied to the vaccine site on the left deltoid and left arm area. Since patient did not have any rash to the face/ lips, and no respiratory distress, it was determined that she was not in need of IM Benadryl or Epi. We do not currently have PO Benadryl pills on site. Patient was instructed that she could take 50mg of Benadryl when she gets home. Education was provided to the patient that if she feels any throat closing, difficulty swallowing, tongue or lip swelling, or difficulty breathing at home, she should call 911 immediately. I also discussed with the patient that she could consider taking 50mg Benadryl prior to her second COVID-19 vaccine appointment if she prefers. I discussed with her that if the rash was persistent tomorrow, she should consult her family/ primary care physician. Patient's mother speaks another language, and patient translated this information to her mother, and patient and mother had no additional questions or concerns. Patient's mother was present with the patient in-person during the vaccine visit, as patient is a minor. Outcome: patient was observed in the observation area for 30 minutes to monitor for worsening of rash, and to monitor for any new developing symptoms. Rash was largely resolved after 30 minutes with the ice pack, just a faint area of flat erythema to the left upper arm area around the biceps.

Other Meds: None

Current Illness: None

ID: 1351346
Sex: U
Age: 34
State: OH

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Tremor

Symptoms: Patient received vaccine and was fine then transitioned to another chair, after a couple of minutes he passed out in the chair, his wife was able to shake him and he came back after a minute. The patient stated that he usually passes out after all vaccines due to a severe fear of needles. After he came to it he stated he felt fine. We provided the patient with water and an ice pack to place on the back of this neck. He stayed at pharmacy for additional 15 minutes and when he left he felt fine and his wife was going to be with him for the rest of the day.

Other Meds:

Current Illness:

ID: 1351347
Sex: M
Age: 44
State: ID

Vax Date: 01/08/2021
Onset Date: 01/15/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Erythema, Pruritus

Symptoms: Developed a rash at approximately the date listed. I did not pursue treatment for another week when I went to my physician and was diagnosed with Shingles.

Other Meds: None

Current Illness: None

ID: 1351348
Sex: F
Age: 53
State: IN

Vax Date: 04/21/2021
Onset Date: 04/21/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: Sulfa drugs

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

Symptoms: At 10:00 p.m. on the same day as I got the vaccine!! I had Cold Chills that lasted all night and had a slight fever. And had stomach upset. Felt Nauseated into the next day which was the day after the Covid -19 vaccine shot. I felt weak that whole day. But my symptoms only lasted for one full day! And then I was okay after that!!

Other Meds: Celocoxib-100mg Capsule, Cephalexin-250mg Capsule, Tolterodine Tartrate- 2mg tablet Culurelle Probiotics Extra Strength Tylenol-500mg caplets

Current Illness: No

ID: 1351349
Sex: F
Age: 61
State: NC

Vax Date: 05/06/2021
Onset Date: 05/07/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: None Known

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

Symptoms: Woke up at 5am on 5/7/21 with severe lower abdomen/back pain & severe cramping; took Ibuprophin & used heat pad. Pain subsided by noon but still slightly sore when, got up & moved around that day then I went to bed that night still slightly sore. Woke up again at 6am with severe pain like morning before; took Ibuprohin and heat pad. Tried to get up around 8am but had to return to bed by 10am. Pain got worse to point where I could not breath with SEVERE cramping in lower back/abdomen. Called for EMT to transport to ER. Was given muscle relaxer OTW ER. After about 1 hr in ER was given another muscle relaxer and pain med (Morphine). (NOTE: this form will not allow use of Continuation Pg)

Other Meds: Omeprazole/Lisinopril/Simvastatin/Prozac/Bupropion/Allegra

Current Illness: None

ID: 1351350
Sex: M
Age: 4
State: MD

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Pt received expired Pentacel. Expiration date was 5/14/2021.

Other Meds: None

Current Illness: No illness

ID: 1351351
Sex: F
Age: 31
State: IL

Vax Date: 04/12/2021
Onset Date: 04/12/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: Maxalt

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

Symptoms: Within 15 minutes of the shot, I became extremely weak in my muscles. In the middle of the night I had a fever of 103 and couldn't stop shaking, it was so painful. That was the weirdest thing I ever experienced in my life. I had three blankets and a robe on and couldn't stop trembling. There was pain all over my body, I had to wear a dress to the hospital because I couldn't put on pants because of the pain. At the ER, I was given an injection of Toradol and the pain was gone within 20 minutes.

Other Meds: Metformin ER 500mg, Fish Oil, Prenatal Vitamins, Zinc, Vitamin B6, Vitamin D3, Vitamin C

Current Illness: None

ID: 1351352
Sex: M
Age: 12
State: IA

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Patient given Moderna vaccine at age 12

Other Meds:

Current Illness:

ID: 1351353
Sex: F
Age: 64
State: WA

Vax Date: 05/08/2021
Onset Date: 05/12/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: aspirin red & yellow dyes bees

Symptom List: Pain in extremity

Symptoms: fever of 102 high heart rate(140-170) low o2 stats (79-84)am on oxygen 3 liters could not stay awake hard time for family to wake me and exhaustion. temp lasted 4 days the other symptoms about 6 days

Other Meds: flecanide, amlodapine, eliquis, sybicort, spiriva, hydrochlorazide,carvadadal

Current Illness: none

ID: 1351354
Sex: F
Age: 50
State: CT

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: seldane, aspirin

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

Symptoms: triggered seizures, headache, muscle pain

Other Meds: excedrin 1500 mg twice daily

Current Illness: none

ID: 1351355
Sex: M
Age: 46
State: NJ

Vax Date: 05/25/2021
Onset Date: 05/25/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: Tramafol. Pennecillin

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

Symptoms: Fever, chills, generalized severe body aches, severe headache

Other Meds: Montelukast sodium, Alprazolam, Viibryd, Zolpidem Tartrate, Eletriptane Hbr, daily multivitamin, magnesium/Zinc/Calcium supplement, Alleve OTC

Current Illness:

ID: 1351356
Sex: F
Age: 44
State: VA

Vax Date: 05/22/2021
Onset Date: 05/22/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: 5/22/21 day of shot customer reports she came home and took nap after got home from shot appointment woke up around 8:00pm with headache. Took BC pill to relieve headache. Headache resolved 24 hours later. 5/24/21 developed lightheadness and dizziness along with right side arm tingling all way down entire into hand. Right side of arm is tingling and continues today 5/26/2021 day of report. Lightheadness and dizziness went away 5/25/21 sometime, tingling with "cannot lay down on my right side of body" reported . Also same day 5/26/2021 customer reports under armpit above right breast a dull throbbing pain "feels like a boil inside under my arm "

Other Meds: none. BC pills for occasional migraine; took BC upon awakening from nap at 8:00 due to headache

Current Illness: none

ID: 1351357
Sex: F
Age: 29
State: FL

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 05/26/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 026LZOA
Dose Series: 1
Vax Route: IM
Vax Site: RA

Lab Data:

Allergies: None reported

Symptom List: Vomiting

Symptoms: Documentation completed at the site of the event on 05/26/2021 by MA. 0854: Pt stated that she felt "dizzy" and "clammy". Pt closely monitored and given ice packs. BP 150/70, P 62, O2 sat 100%. 0950: BP 110/60, P 58; O2 sat 100%. No syncope. Pt still feeling dizzy. Pt sts her wife will pick her up, supervisor advised. Pt laid down, feet elevated for 10 minutes. Pt states that after laying down she is feeling better. Color has returned to face, vitals were WNL. 1030: Pt went home, wife picked her up, she did not drive. notifed APRN of the event on 05/26/2021 at 1015. APRN- telephone call on 05/26/2021 @ 1211: Called pt at her home. Pt sts she was laying down, still feeling tired/weak but denies syncope or other neurologic signs/symptoms. PLAN: Encouraged pt to push PO fluids with electrolytes and explained rationale. To go to ER if syncope or any other neurologic changes. Pt understood and agrees. APRN- telephone call on 05/26/2021 @ 1526. Pt states she is feeling much better, weakness has subsided. Pt has been drinking a lot of fluids. Reports tenderness to injection site. PLAN: Continue to push PO fluids. May use compresses to arm PRN pain. May take tylenol/advil PRN arm pain. Told pt incident will be reported to VAERS. To call the office if any questions. Pt understood and agrees.

Other Meds: None reported

Current Illness: None reported

ID: 1351358
Sex: F
Age: 45
State: CA

Vax Date: 05/22/2021
Onset Date: 05/22/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: Cats, Pollen

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: While in observation period following 1st dose Pfizer COVID vaccine, patient flagged the EMT to state she was feeling a sensation of rapid heart beat and dizziness. Client stated the symptoms began immediately after vaccine dose. EMT noted that client was alert and oriented x 4. Client was moved to a wheelchair and transported to the zero gravity chair for further evaluation. At 1426 baseline vitals taken while sitting: Blood Pressure (BP): 130/86, Respiratory Rate (RR): 14, Heart rate (HR): 84, Pupils equal, round, reacting to light (PEARL), Skins were warm, dry and normal color for ethnicity. Client stated rapid heart rate subsided, and dizziness was subsiding. Client claims symptoms lasted less than 5 minutes. Client denied history of reactions to other vaccines. Stated positive for allergy to cats, pollen, medical history of Asthma with inhaler use. Client was offered a bottle of water. At 1437 second set of vitals taken while sitting: BP 136/80, RR 12, HR 83, PEARL, skins warm, dry and normal color for ethnicity. Client stated symptom of dizziness was improving. Client advised to stay additional 30 minutes for observation. At 1453 final set of vitals obtained with client standing: BP 136/88, HR: 88, RR: 12, PEARL skins warm and dry, negative for orthostatic pressures. Client stated symptoms completely resolved and denied dizziness and rapid HR. Client waited an additional 5 minutes for husband to finish his observation time. Husband stated he would drive client home. At 1458 they both walked away from the observation site with a steady gait.

Other Meds: Albuterol Inhaler

Current Illness: Asthma

ID: 1351359
Sex: F
Age: 53
State: TX

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: Benzodiazepines

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

Symptoms: The patient was nervous about getting the vaccine. As soon as I injected the vaccine, she stated it felt like fire in her arm. Within a few minutes, she stated she felt very hot and she started hyperventilating. I called 911 and tried to assist with her breathing. When the paramedics arrived, they took her blood pressure. Since her blood pressure was very elevated, they transported her to the hospital.

Other Meds: Unknown

Current Illness: Unknown

ID: 1351360
Sex: F
Age: 15
State: IA

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 05/26/2021
Hospital:

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 025j20-2A
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Moderna vaccine given at age 15

Other Meds:

Current Illness:

ID: 1351361
Sex: M
Age: 17
State: FL

Vax Date: 05/22/2021
Onset Date: 05/22/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: DAY 1: shaking jaw and body, chills, feeling cold, numb hands all came on suddenly at 10pm. Next day, headache and somache ache all day. Next day recovered except chest feeling weak and hard to breathe deeply.

Other Meds: none

Current Illness: none

ID: 1351362
Sex: F
Age: 35
State: CO

Vax Date: 05/13/2021
Onset Date: 05/16/2021
Rec V Date: 05/26/2021
Hospital:

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

Lab Data:

Allergies: None reported

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

Symptoms: Pfizer-BioNTech COVID-19 Vaccine EUA: patient presents to emergency department (ED) nauseated with intermittent chest pain and shortness of breath starting three days after vaccination. Initially experienced arms discomfort, throat tightness, chills, and numbness in face and chest that resolved. Seen at another ED three days after vaccination for chest pain and discharged. Followed-up by primary care the next day where vitals were stable and exam was not concerning. In current ED patient's vital signs within normal ranges and physical exam unremarkable. Patient diagnosed with pulmonary embolism, prescribed anticoagulants, and on follow-up with primary care provider patient reports no new symptoms and vital signs with within normal ranges.

Other Meds: levothyroxine

Current Illness: none reported

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm