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: 1354612
Sex: M
Age: 61
State: CT

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 05/27/2021
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: No

Symptom List: Dysphagia, Epiglottitis

Symptoms: Within 3 minutes of vaccination, pt began to feel lightheaded and was assisted to lie down on a cot. He c/o a "scratchy throat" and a little trouble breathing; he developed a rash on his neck. VSS were stable throughout episode with SpO2 95-99%. Pt was administered Benadryl 50mg po x once w/good effect. The reaction resolved and patient left for home after an hour.

Other Meds: Citalopram; Lamotrigine

Current Illness: No

ID: 1354613
Sex: F
Age: 89
State: MN

Vax Date: 01/19/2021
Onset Date: 05/23/2021
Rec V Date: 05/27/2021
Hospital: Y

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: COVID positive after vaccine series. Patient had to go to ED and is now admitted in the hospital.

Other Meds:

Current Illness:

ID: 1354614
Sex: F
Age: 57
State: WV

Vax Date: 05/14/2021
Onset Date: 05/14/2021
Rec V Date: 05/27/2021
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: NKA

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

Symptoms: BURNING SENSATION IN ARM AFTER INJECTION THAT RADIATED TO OTHER ARM AND DOWN SPINE SORE TO TOUCH RIBS. TINGLING IN UPPER SPINE FOR 2 WEEKS FOLLOWING INJECTION. CHILL. FEVER. FATIGUE.

Other Meds: Wellbutrin Vitamin D Vitamin C Zinc

Current Illness: NONE

ID: 1354615
Sex: F
Age: 63
State: GA

Vax Date: 04/30/2021
Onset Date: 04/30/2021
Rec V Date: 05/27/2021
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: Brain fog... It continued for 3 days and I could not drive. However, it continues now to a lesser degree with light headedness and loss of balance

Other Meds: Carvedilol

Current Illness: Dystonia

Date Died: 02/09/2021

ID: 1354616
Sex: F
Age: 74
State: PR

Vax Date: 01/13/2021
Onset Date: 02/06/2021
Rec V Date: 05/27/2021
Hospital:

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

Lab Data:

Allergies: Unknown.

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

Symptoms: Difficulty breathing, coughing, congestion, dies of cardiac arrest.

Other Meds: Depakote, Seroquel, Folic Acid, Astor, Ramipril, Atorvastatin, Ferrous Sulfate, Ativan.

Current Illness: Unknown.

ID: 1354617
Sex: F
Age: 63
State: IL

Vax Date: 05/06/2021
Onset Date: 05/27/2021
Rec V Date: 05/27/2021
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: N/A

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

Symptoms: 3 weeks after the shot has vasculitis , doctor believes it was triggered from COVID shot

Other Meds: N/A

Current Illness: N/A

ID: 1354618
Sex: M
Age: 59
State: TX

Vax Date: 04/01/2021
Onset Date: 04/15/2021
Rec V Date: 05/27/2021
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: I have no allergies.

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Everything was fine, but on 04/15/2021, I started having a headache. It continued on until 05/06/2021. I am currently waiting to see a neurologist. I only had 2 days without headaches. I am not working right now because the headaches get really bad. I went on 05/25/2021 to review the finding of an MRI that was done on 05/20/2021. I also had a CAT scan performed and both tests came back negative for any problems.

Other Meds: I was taking medication for high blood pressure. It was hydrochlorothiazide and amlodipine. I was also taking thiamine and an 81mg aspirin.

Current Illness: I did not have any other illnesses.

ID: 1354619
Sex: M
Age: 62
State: VA

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

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

Lab Data:

Allergies: dust

Symptom List: Pharyngeal swelling

Symptoms: Heart beating fast and hard. More frequent get up and urinate during the night. More chest pain.

Other Meds: fish oil, flax seed oil, multivitamin, vitamin C, magnesium oxide, probiotic, nasonex

Current Illness: heart condition, sleep apnea

ID: 1354620
Sex: M
Age: 64
State: MN

Vax Date: 04/22/2021
Onset Date: 05/25/2021
Rec V Date: 05/27/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: COVID positive after full vaccination series.

Other Meds:

Current Illness:

ID: 1354621
Sex: F
Age: 76
State:

Vax Date: 03/10/2021
Onset Date: 05/21/2021
Rec V Date: 05/27/2021
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: latanoprost, PF, 0.005 % drop Blood Pressure Monitor Blood Pressure Test Kit-Medium kit Blood-Glucose Meter (ONETOUCH VERIO METER) aspirin, enteric coated (ASPIRIN, ENTERIC COATED) 81 mg EC tablet Cholecalciferol, Vitamin D3, (VITAMIN D) 25 mcg (1,000 unit) cap clopidogrel (PLAVIX) 75 mg tablet dilTIAZem CD (CARDIZEM CD, CARTIA XT) 180 mg 24 hr capsule doxazosin (CARDURA) 8 mg tablet furosemide (LASIX) 40 mg tablet gabapentin (NEURONTIN) 100 mg capsule hydrALAZINE (APRESOLINE) 100 mg tablet potassium chloride ER (K-DUR, KLOR-CON) 10 mEq tablet rosuvastatin (CRESTOR) 10 mg tablet sodium bicarbonate 650 mg tablet lancets (ONETOUCH DELICA LANCETS) 30 gauge blood sugar diagnostic (ONETOUCH VERIO TEST STRIPS) test strip acetaminophen (TYLENOL) 500 mg tablet carboxymethylcellulose (REFRESH TEARS) 0.5 % drop multiv,ca,iron,min/fa/phytoste(CENTRUM CARDIO 3 MG-200 MCG-400 MG TAB)

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient hospitalized for COVID-19 pneumonia at Hospital: CRITICAL CARE

Other Meds:

Current Illness: Transient alteration of awareness Uncontrolled hypertension

ID: 1354622
Sex: F
Age: 48
State: NY

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 05/27/2021
Hospital:

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

Lab Data:

Allergies: NKDA, NKFA, NKEA, denies any known allergies.

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

Symptoms: Patient reported feeling "flushed, hot, and a little lightheaded" with a slight headache about 10 minutes after receiving her second dose of Moderna Covid Vaccine. Pt given ice packs for face and given water to drink. Pt reported symptom improvement and resolution within a few minutes of writer evaluation. Pt denied any facial swelling, tongue swelling, throat swelling, difficulty speaking, shortness of breath, chest pain, nausea, vomiting, diarrhea, abdominal pain, fevers, chills, palpitations, dizziness, sore throat, or weakness, . Pt's vital signs were stable: BP of 122/82 mmHg, 79 bpm pulse, SPO2 97% on room air, respirations 16 breaths per minute. Pt alert and oriented x 3 and able to speak in full complete sentences. Physical exam only revealed some minor facial flushing, no wheezing on auscultation, or audible stridor - airway patent. Pt was observed by writer and staff for a total of 45 minutes from the time of receiving her second dose of Moderna. No other adverse events observed by staff or reported by the patient during that time. No medications were administered. Pt disposition was home after completion of 45 minute observation period, patient went home with family member. Additional information: Pt stated that after she got her first dose of Moderna Covid Vaccine one month prior, she experienced: "nausea, vomiting, diarrhea, fever, body pain, and rash for 7 days", she stated she went to "walk-in clinics 3 times for the body pain". She also stated the symptoms completely resolved "after 7 days". Pt denied needing to be hospitalized after her first dose of Moderna one month ago, or receiving any injections of epinephrine.

Other Meds: Denies.

Current Illness: Nausea, vomiting, diarrhea, rash, and body aches for 7 days after receiving first dose of Moderna vaccine.

ID: 1354623
Sex: M
Age: 25
State: MI

Vax Date: 05/05/2021
Onset Date: 05/08/2021
Rec V Date: 05/27/2021
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: Penicillins (Hives)

Symptom List: Rash, Urticaria

Symptoms: Three days post-vaccination #1, patient developed chest tightness and shortness of breath, has continued for past 3 weeks. Had syncopal episode on 5/26/21 and presented to Emergency Department at facility. Was found to be COVID positive with result on 5/26/21. Admitted to facility on 5/26/21, and diagnosed with pericarditis. Hospitalist suspects that pericarditis could be result of Moderna vaccine, as patient was previously young and healthy with no chronic conditions, with symptom onset 3 days post-vaccination. Patient also had expected post-vaccination symptoms, including flu-like symptoms, fever, chills.

Other Meds: Unknown

Current Illness: Unknown

ID: 1354624
Sex: M
Age: 48
State: CA

Vax Date: 05/02/2021
Onset Date: 05/05/2021
Rec V Date: 05/27/2021
Hospital: Y

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

Lab Data:

Allergies: None

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

Symptoms: Patient was admitted 5/24/21 ~2-3 weeks after his 2nd dose of pfizer vaccine. Stated that he had had shortness of breath and chest pain that started a few days after vaccine that never really got better. He was found to have pericardial effusion and pleural effusion of unclear etiology. Did not have evidence of myocarditis on EKG or imaging, but findings suspicious for pericarditis.

Other Meds: None

Current Illness: undiagnosed hypothyroidism undiagnosed sleep apnea

ID: 1354625
Sex: M
Age: 42
State: MA

Vax Date: 04/22/2021
Onset Date: 05/23/2021
Rec V Date: 05/27/2021
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: Penicillin, erythromycin

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

Symptoms: Patient developed shingles. Reporting event based on recent linkage between Covid vaccine and shingles from medical journal.

Other Meds: Daily multivitamin and oral probiotic.

Current Illness: None.

ID: 1354626
Sex: F
Age: 44
State: ME

Vax Date: 04/27/2021
Onset Date: 04/27/2021
Rec V Date: 05/27/2021
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: with this 1st of 2 shots I began getting a headache that began within 1 hour after the shot. The headache immediately became intense and stayed. Advil did not do anything for it. That same evening I began having intense abdominal pain on my right side, it became so bad I was scared my appendix was going to burst. I had my son on standby to take me to the hospital. It was so severe I could not stand. The only way that I can describe the pain would be: after natural birth and you begin nursing, the insanely intense contractions of the uterus to shed the afterbirth is how intense the pain was. I then started my menstrual cycle but was not supposed to for another week and 1/2. The pain stayed, but did dull some, it wasn't as sharp but still intense. My flow was extraordinarily heavy and I lost count of how many huge blood clots I passed. Some clots were the size of my palm. This cycle lasted a full 7 days. My normal cycle starts with a little spotting, then 1 or 2 days of medium flow, then a couple days of spotting. I also do not have my cycle every 30 days, more like 38-40. I figure its pre-menopause.

Other Meds: synthroid, celoxib, sertraline- all once daily

Current Illness: none

ID: 1354627
Sex: M
Age: 17
State: IA

Vax Date: 04/30/2021
Onset Date: 04/30/2021
Rec V Date: 05/27/2021
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: no known

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

Symptoms: no adverse reaction. Patient tolerated first vaccination shot fine, however he was 17 years old at the time it was administered which is under recommended age. Pt's mom knew and scheduled the appointment. Patient came in for second shot yesterday.

Other Meds: Escitalopram Oxalate 10mg daily

Current Illness: none

ID: 1354628
Sex: F
Age: 49
State: NE

Vax Date: 03/11/2021
Onset Date: 03/15/2021
Rec V Date: 05/27/2021
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: Shellfish

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

Symptoms: Developed a rash that would start in one area of my body extremely itchy almost unbearable. That spot would clear up then would move to another part of my body and the other one would clear up. Primarily was located on my inner thigh, upper arms, top of foot and legs, This lasted for 3 days. I now periodically have a random small rash of about 3 or 4 bumps that breaks out out of nowhere and lasts a few hours.

Other Meds:

Current Illness:

ID: 1354629
Sex: F
Age: 35
State: IN

Vax Date: 04/13/2021
Onset Date: 04/13/2021
Rec V Date: 05/27/2021
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 known allergies to food or medicine.

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Immediate burning in my arm as the vaccine was injected. Soreness in my arm there after. In the next 24 hours I had trouble concentrating and remembering anything. I felt like I had pregnancy brain. This lasted for almost 5 days. I woke up and found my ear had started bleeding at some point. Sever headache and nauseous for the next 2 days.

Other Meds: Claritan, flonase, daily vitamin

Current Illness: none

ID: 1354630
Sex: F
Age: 49
State: GA

Vax Date: 04/08/2021
Onset Date: 04/22/2021
Rec V Date: 05/27/2021
Hospital:

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

Lab Data:

Allergies: Le sina prill or anything in the Le sina Prill family of drugs

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Two-week delay, after receiving the vaccination, a flare up of allergy Asma, call out to allergy specialist told them about what was going on and the nurse gave the vaccination told wait 14 days before taking the allergy medication because it could make her immune to the Covid shot. Allergist (nurse practitonare) told her to wait was not able to take medicinal for Asma 21 day dizzy off balance fatigue and also diabetics and the steroids days. At 21 set day she went to the office to the nurse auctioneer at her Primary office, he prescribed, musnex antibodies and steroids by that Friday, stated to feel bad, dizzy, fatigue, could not taste or smell anything and blood sugar was high, loss taste and smell and had type A flu and was not able to work. Primary Dr. prescribed, put on flu medication with quarantine for three days and Covid and flu and another test. At st urgent care. ID Testing

Other Meds: No

Current Illness: No, Allery Asma

ID: 1354631
Sex: F
Age: 57
State: OR

Vax Date: 04/07/2021
Onset Date: 04/08/2021
Rec V Date: 05/27/2021
Hospital:

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

Lab Data:

Allergies: Sulph drugs only known allergy

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

Symptoms: Received vaccine on 4/7/2021. Starting next day-intense all over body itching...increased a few days. Skin flushes-arms, stomach, chest, lower back. Eye twitches. Pressure under left rib cage. Unexplained bruising-legs and arms. Inflamed veins..arms, legs, mouth. Vasculitis? Increased anxiety. Waking up in cold sweats. 2 weeks post vaccine-tongue started swelling up and develope pasty white coating, mouth lesions and blisters. Increased inflamed veins in mouth-Ongoing.

Other Meds: No presciptions. Multivitamin. Daily Iron Supplement, Vitamin C and D. Omga E supplement

Current Illness: None

ID: 1354632
Sex: M
Age: 28
State: MT

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 05/27/2021
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:

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

Symptoms: pt reports "eye twitching" that developed later that night following the vaccine, and then after a couple more days, noticed he had lost muscle tone on one side of face when he tried to drink some water and in was running out of his mouth ; he went to the ER and was diagnosed with Bell's Palsy; he began treatment with prednisone 20 mg, 3 tablets daily for 7 days

Other Meds:

Current Illness:

ID: 1354633
Sex: F
Age: 45
State: MA

Vax Date: 04/18/2021
Onset Date: 04/20/2021
Rec V Date: 05/27/2021
Hospital:

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

Lab Data:

Allergies: Steamers (vomiting) mushrooms (urticaria)

Symptom List: Unevaluable event

Symptoms: Please note, I did not report the event(s) to my HCP at this time as I did not require any treatment for the event(s). This is the reason I left HCP data blank but will provide if needed. I am on an oral contraceptive with 100% compliance daily. On 18-APR-2021, I received 2nd dose of COVID vaccine. On Tuesday, 20-APR-2021, my period started ~7 days early (sugar pill was to start on Sunday 25-APR-2021, it usually starts the following Tuesday). On this day, bilateral lower extremity pitting edema was noted in addition to knee pain/swelling. My period lasted for 26 days, stopping finally on 15-MAY-2021. It was light. The lower extremity edema also subsided around this time. The knee pain and swelling stopped 0n 28-APR-2021.

Other Meds: Lupin - oral contraceptive 1 tablet daily; Advair 1 puff BID; Albuterol 2 puffs prn

Current Illness: The event occurred after the 2nd dose of COVID vaccine. There is nowhere to record the first dose, which was received on 21-MAR-2021 at 12.00 pm.

ID: 1354634
Sex: M
Age: 32
State: NY

Vax Date: 03/31/2021
Onset Date: 05/07/2021
Rec V Date: 05/27/2021
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: PCN

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

Symptoms: 33 year old healthy man presented with seizure to Hospital ER on 5/7/2021. He required intubation. CT scan and MRI of brain showed dural venous sinus thrombosis along the anterior to mid aspects of the sagittal sinus. CBC was normal at presentation with WBC 13.9, HGB 16.1 and PLT 367k. He was admitted on unfractionated heparin. Repeat platelet count on 5/8/2021 was 153k. HIPA was negative. Patient was extubated and continued to improve. He was put on warfarin and sent home. He has some mild personality change in the immediate weeks of discharge. Hypercoagulable workup had normal Prot S & C activity, normal ATIII activity. The Factor V Leiden and Prothrombin Gene were negative. The homocysteine level was elevated at 16.3.

Other Meds: None

Current Illness: None

ID: 1354635
Sex: F
Age: 37
State: CA

Vax Date: 05/25/2021
Onset Date: 05/25/2021
Rec V Date: 05/27/2021
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: Twelve hours after injection, symptoms of chills/hot flashes started throughout the body. Muscles began to feel tight and sore throughout the body. Tingling was felt down the arms (most significantly in the left arm) and into the hands. Lightheadedness, fatigue, and general discomfort followed. Sleep was interrupted with severe pain in the left arm at injection site, increasing temperature (recorded starting at 100 deg F at 2:30 a.m. up to 101.3 24 hours after injection time). Fever and chills, headache, light nausea, and severe muscle cramping continued throughout the day. Symptoms did not cease until 48 hours after injection. 48 hours after injection, left arm at injection site is swollen, hard at the center with pain and heat to the touch, and a 3" diameter red ring/circle surrounding injection site.

Other Meds: Kelnor Tylenol Vitamin B-12 Supplement

Current Illness: None

ID: 1354636
Sex: M
Age: 40
State: TX

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 05/27/2021
Hospital:

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

Lab Data:

Allergies: n/a

Symptom List: Injection site pain, Menorrhagia

Symptoms: Pt received the Janssen covid vaccine. During the 15 minutes post-vaccination observation period, pt started not feeling well. He experienced dizziness, sweating, swelling of the lips and tongue, and shortness of breath. Pt was non-responsive. Rph administered an Epipen and staff called the ambulance. At this time, pt was becoming more responsive in response to the Epipen. EMS came and checked the pt's vitals. Vitals were within normal range. Pt was not sent to the hospital. EMS advised the family to monitor the pt and call EMS if symptoms worsen. Pt is doing okay.

Other Meds: n/a

Current Illness: n/a

ID: 1354637
Sex: F
Age: 71
State: CA

Vax Date: 02/12/2021
Onset Date: 02/13/2021
Rec V Date: 05/27/2021
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: Sulfa, Morphine, Aspirin, Macrodantin, Benzomycin, Vicodin, Tessalon Perles, Biaxin, Levaquin, Tequin

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

Symptoms: Woke up at 2:00 am with severe chills, fever, nausea and vomiting. The vomiting stopped within a few hours, but suffered with fever, headache, extreme body aches, fatigue for 2-3 days. After that body aches, fatigue, and headache continues at various times throughout the next month. I also have Fibromyalgia and an Auto-immune disease, so it is hard to discern which symptoms were from the vaccine. I felt like the vaccine kicked me into a flare of the auto-immune symptoms. As for my arm, it was swollen, red and painful starting a few hours after the shot and continued for about 2 weeks.

Other Meds: Advair, Albuterol, Fluoxetine, Armour Thyroid, Vesicare, Valtrex, Fluticasone, Raloxifene, Omprazole, Estradiol patch, Vagifem, Monteluskast, Fexofenadine, Verapamil, Meloxicam, Viatmin D, Biotin, Azo-Go-Less, Ellura

Current Illness: Bladder Infection

ID: 1354638
Sex: F
Age: 78
State: NM

Vax Date: 02/01/2021
Onset Date: 03/01/2021
Rec V Date: 05/27/2021
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: erythromycin and flagyl

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: presented for a well exam and was noted to have an irregular heart rate. She was in atrial fibrillation with rapid ventricular response. now on beta blocker, digoxin and eliquis.

Other Meds: combipatch, simvastatin, metoprolol, multivitamins, calcium

Current Illness: none

ID: 1354639
Sex: F
Age: 32
State: CO

Vax Date: 04/02/2021
Onset Date: 05/04/2021
Rec V Date: 05/27/2021
Hospital:

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

Lab Data:

Allergies: no

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: I had some pretty bad back problems and the reason I went to the doctor was because it was lasting for more than 3 days. Hip flexors were really tight and causing my back pain. I have had something similar happen before but it's always resolved itself within a week. And now I'm three weeks out and still having this back pain and hip flexor tightness. For the first two weeks - the PT said I should be laying down or standing and only sitting for 5 minutes to help those hip flexors. I'm limited now on activities that I can do. I am not suppose to lift over 20 pounds or bend over. I can't sit cross legged on the floor. PT gave me exercises to do to help.

Other Meds: no

Current Illness: no

ID: 1354640
Sex: F
Age: 48
State: MT

Vax Date: 04/23/2021
Onset Date: 05/01/2021
Rec V Date: 05/27/2021
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: penicillins, sulfonamides, cipro, topamax, prilosec, celebrex, vioxx, many Bausch & Lomb products, cafergot, cephalosporins

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

Symptoms: Not sure it's related to the shot. Three weeks after the second shot I started experiencing progressively increasing pain in the left shoulder joint. After each dose the same joint ached but the pain resided after approximately 24 hours. The area is painful to the touch but not hot or red. For 5 days to date I have treated the area with hot compresses with minimal results. For 3 days to date I receive some relief treating the area with voltaren cream (not prescribed for this). Today I began castor oil packs but have not seen any change in pain at this point.

Other Meds: Sertraline, propranolol, lamotrigine, doxycycline, pirmella 1/35, Keto BHB. Possibly alprazolam, Ritzatripran, acetaminophen, ibuprofen, pseudoephedrine

Current Illness: Allergies, migraines

ID: 1354641
Sex: F
Age: 17
State: FL

Vax Date: 04/09/2021
Onset Date: 05/27/2021
Rec V Date: 05/27/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Nausea

Symptoms: Patient was 14 days shy of being 18 years old.

Other Meds: N/A

Current Illness: N/A

ID: 1354642
Sex: M
Age: 31
State: CA

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 05/27/2021
Hospital:

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

Lab Data:

Allergies: NKA

Symptom List: Injection site pain

Symptoms: Pt at 1000 am, reported to staff that he had a history of passing out after getting shots. Pt was put on the Gurney prior to receiving the vaccine. After receiving the vaccine Pt became light headed and diaphoretic with n/v. After an hour of symptoms not improving an ambulance was called and Pt was sent to the ED.

Other Meds: None

Current Illness: Unknown

ID: 1354643
Sex: F
Age: 39
State: CA

Vax Date: 05/18/2021
Onset Date: 05/18/2021
Rec V Date: 05/27/2021
Hospital:

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

Lab Data:

Allergies: Clonazepam Eletriptan Hydrobromide Rizatriptan Sumatriptan Succinate

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

Symptoms: Immediately after receiving the second dose of Pfizer on Tues May 18, I felt prickly sensations throughout my body. After sitting for the recommended 30 minutes (due to known allergies to previous medications), I began to feel dizzy. They monitored me in the tent for several minutes and checked my vitals, which were fine. The nurse thought I may have hyperventilated. I thought I must have just had a mild panic attack. But the attacks did not stop. Rather, the first three days post vaccine, I had several panic attacks a day, even being woken from sleep because of them. It's not fear or a racing mind but a constant racing heart, weakness, feeling faint. I feel prickly sensations and sensation of heat, which are common in panic attacks. But even after three days, they were not letting up. In addition to the attacks, I felt lightheaded, weak and extremely fatigued, even at rest. There is also constant pain and tightness in my neck and jaws. Thursday evening (May 20), I had an episode where I nearly passed out. Once I got seated, my body froze. I was unable to get my words out clearly. Instead of saying the full sentence in my head, I could only get a word or two out. Instead of being able to lift my arm to eat, I couldn't move. The episode lasted about 15-20 minutes. I had several of these episodes on Saturday, two on Sunday and one on Monday. Thinking it was purely anxiety, I reached out to my psychiatrist who prescribed Klonopin to ease the symptoms. I took 0.5mg on Friday afternoon (5/21) and 0.5mg on Saturday morning (5/22). Realizing the Klonopin was likely making my symptoms worse, I have not taken any since Saturday morning (05/22). Most of the day I am breathless, weak, feel faint doing nearly nothing. I have an hour or so a couple of times of day where I'm more functional but still have to move very slowly. Otherwise, I'm either like a zombie or unable to speak clearly, stuttering when I speak, and unable to operate without feeling faint.

Other Meds: Escitalopram ?LEXAPRO? 5 mg Oral Tab ?Started 10/28/2020? Levothyroxine ?LEVOTHROID/SYNTHROID? 125 mcg Oral Tab ?Started 2/19/2021? Albuterol ?Ventolin HFA? 90 mcg/actuation Inhl HFAA ?Started 7/7/2020? Vitamin B Complex Butterbur with Fev

Current Illness: None known

ID: 1354644
Sex: F
Age: 65
State: FL

Vax Date: 05/15/2021
Onset Date: 05/16/2021
Rec V Date: 05/27/2021
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

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

Symptoms: I have had heavy vaginal bleeding for 8 days ,now spot bleeding... Also bad cramps in feet?s and pains in legs on and off,besides headaches.

Other Meds: None

Current Illness: None

ID: 1354645
Sex: F
Age: 38
State: NY

Vax Date: 05/20/2021
Onset Date: 05/26/2021
Rec V Date: 05/27/2021
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: Man little red dots on ankles, top of foot, arm, etc. I advised patient to see md for bloodwork. She has appt next week.

Other Meds:

Current Illness:

ID: 1354646
Sex: F
Age: 53
State: PA

Vax Date: 05/23/2021
Onset Date: 05/24/2021
Rec V Date: 05/27/2021
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: Ceftine

Symptom List: Erythema, Pruritus

Symptoms: First shot migraine, tired Second shot dizzy, lightheaded, vomiting, chills, headache, exhausted

Other Meds: None

Current Illness: None

ID: 1354647
Sex: F
Age: 65
State: IL

Vax Date: 02/15/2021
Onset Date: 02/15/2021
Rec V Date: 05/27/2021
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: unknown

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

Symptoms: 2 hrs after injection, bruised feeling on arm and left side of face, 4-5 hours later when chewing food was difficult on left side of mouth; Overnight into morning tongue swelled

Other Meds: none

Current Illness: none

ID: 1354648
Sex: M
Age: 17
State: CA

Vax Date: 05/21/2021
Onset Date: 05/23/2021
Rec V Date: 05/27/2021
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: NKDA

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

Symptoms: myocarditis with elevated troponins, findings on cardiac MRI. No treatment required, self-resolved. Admitted for close monitoring

Other Meds: none

Current Illness: None

ID: 1354649
Sex: F
Age: 63
State: AL

Vax Date: 05/11/2021
Onset Date: 05/12/2021
Rec V Date: 05/27/2021
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: Penacillin

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Nose bleed on left side, busted blood vessel in left eye the next day. Eye has still not cleared up fully but it is looking better.

Other Meds: Pregabalin 59mg Norco 7.5mg 3/day Folic Acid 1mg Citalopram GBR 20mg Rosuvastatin Calcium 20mg Methocarbamol 750mg 3/day as needed Low Dose Aspirin 81mg D3 Tablets 125mcg VitaFusion Women's Gummy Vitamins 2/day Nature's Bounty Hair, Skin

Current Illness: None

ID: 1354650
Sex: F
Age: 47
State:

Vax Date: 01/11/2021
Onset Date: 02/11/2021
Rec V Date: 05/27/2021
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: Sulfa

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

Symptoms: I experienced around 12 hours after the vaccine, low grade fever, chills pretty extreme body and severe joint pain. The joint pain really would not go away. It was difficult to hold a cup of coffee, had to use two hands. My hips, knees, and toes hurt real bad, had a lot of soreness sensation all over my body. I also had muscle weakness and fatigue. On two occasions I had done minor exercises, I had extreme muscles pain afterwards. The doctor dis lab work which was normal, she did not prescribed any medication. I am a doctor and I called Prednisone 20mg mediation and by the next day my symptoms were gone.

Other Meds: Cetalapram 40mg, Trazadone 50mg at bedtime

Current Illness:

ID: 1354651
Sex: F
Age: 63
State: OR

Vax Date: 04/02/2021
Onset Date: 05/13/2021
Rec V Date: 05/27/2021
Hospital: Y

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

Lab Data:

Allergies: NKDA

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

Symptoms: H&P: Patient is a 63 y.o. female who presents for chest pain found to have NSTEMI. No prior cardiac history who presents with acute onset left sided arm, and jaw pain. Associated with diaphoresis. Looked up "heart attack signs in women" and came to the ER after reading this. In the days/weeks leading up denies any chest pain or pressure, LH, dizziness or syncope. No exertional dyspnea, orthopnea, PND or LE edema. BP at home are usually 130-150s. BP in the hospital is always higher because of white coat hypertension. ER course BP 170-190s systolic, HR in the 90s, AF. EKG Q waves in the inferior lead with no significant ischemia or ST elevations. Labs notable for a troponin ~ 2000. CXR within normal limits. Given aspirin, statin, nitro and heparin. Currently feels pain free. No other acute issues or complaints/ Smoked 3 mos after a divorce, otherwise no smoking history. No significant family history of CAD. " D/C summary: "Principal Diagnosis: o Myocarditis Secondary Diagnoses: o Type II MI o Hypertension o Hypercholesterolemia o Prediabetes mellitus o Obesity Procedures/Diagnostics: 5/13/2021. Coronary angiogram. o Normal left ventricular function o Normal coronary anatomy o Right radial loop Note: A right radial loop was encountered requiring a femoral access. 5/13/2021. Echocardiogram. ? Left ventricle size is normal. Mildly increased wall thickness. Normal wall motion. Normal systolic function. LV EF is 75 % , ? Nrrmal valve function. 5/13/2021. Cardiac MRI. Evidence of myocarditis, with subepicardial late enhancement at the mid chamber and apical lateral wall with associated regional edema and mild native T1 signal elevation. Normal right and left ventricular size. Hyperdynamic LV. No significant valvular abnormality. Hospital Course: In brief, this is a 63 y.o. year old female admitted on 5/13/2021 with chest pain, troponin elevation and found to have normal coronary arteries. Preserved LV systolic function by echocardiogram. She underwent an cMRI demonstrating myocarditis. She was started on colchicine and remained pain free for the rest of the admission. Myocarditis: Presented with acute onset chest pain and troponin of ~2000. Diagnosed via MRI after normal coronary angiogram. Normal biventricular function. Etiology is likely idiopathic as she had no other obvious inciting events. Pain free prior to discharge. o Colchicine 0.6 mg twice daily. o Follow-up with Dr. on 6/8 arrival time 12:40 PM Hyertension: well controlled today. Management per PCP o Metoprolol succinate 25 mg daily o Hyzaar 100-12.5 mg daily o Amlodipine 10 mg daily Hyperlipidemia: tolerating atorvastatin 20 mg daily. "

Other Meds: none

Current Illness: none reported

ID: 1354652
Sex: F
Age: 61
State: WA

Vax Date: 05/05/2021
Onset Date: 05/25/2021
Rec V Date: 05/27/2021
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: I received my 2nd dose on May 5th. On May 25th, three weeks later, I experienced the exact same symptoms I had the day after my second shot. Chills, headache, mild temperature of 100.3. Both instances, May 5th and May 25th, lasted about 24 hours. Today, May 27th, i feel back to my normal self.

Other Meds:

Current Illness: none

ID: 1354653
Sex: M
Age: 23
State: OH

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 05/27/2021
Hospital:

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

Lab Data:

Allergies: Sulfa

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

Symptoms: Pt fainted during the 15 minute waiting period. Hit head. Recovered quickly. Was evaluated by rescue squad.

Other Meds: none known

Current Illness: none known

ID: 1354654
Sex: M
Age: 14
State: MD

Vax Date: 05/17/2021
Onset Date: 05/21/2021
Rec V Date: 05/27/2021
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: Brazil nuts

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

Symptoms: Patient presented to ER with severe unrelenting chest pain beginning abruptly 4 days after receiving first dose of Pfizer COVID19 vaccine. He was diagnosed at the ER with pericarditis and discharged with ibuprofen. Chest pain has gradually improved over past 6 days though is still intermittently present.

Other Meds: Zyrtec 10mg as needed

Current Illness: none

ID: 1354655
Sex: F
Age: 46
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 05/27/2021
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: NKDA

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

Symptoms: Client indicated she received her vaccine wihout incident at 1330. She sat in observation for 15 mins and denies having experienced any side effects. Client reported as she walked to her car, she began to experience vertigo, nausea and tingling. She sat under the tent near the observation area. MD and EMS paged. MD assessed client and recommended client remain in observation until she felt better. Client requested her adult daughter's presence as she waited. Client was observed to be crying during her assessment with MD. Client remained for continued observation. Client exited observation with her adult daughter by her side in stable condition at 1416, denied any side effects at time of departure.

Other Meds: none

Current Illness: none

ID: 1354656
Sex: M
Age: 40
State:

Vax Date: 05/27/2021
Onset Date: 05/27/2021
Rec V Date: 05/27/2021
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: mixed Covid Vaccine series: Given Moderna vaccine to patient that had Pfizer as 1st vaccine

Other Meds:

Current Illness:

ID: 1354657
Sex: F
Age: 30
State: IN

Vax Date: 05/24/2021
Onset Date: 05/25/2021
Rec V Date: 05/27/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Got injection Monday. Arm soreness starting about an hour after the shot, and worse arm pain the next day (Tuesday). Arm pain mostly gone by the 4th day after the shot (Thursday). Body aches throughout the second day after the shot (Wednesday). No fever, but felt the body aches that are usually associated with fever. Also contributed to fatigue. The body aches increased throughout the day, leading me to take one acetaminophen pill before bed. Chills were gone by the next morning (Thursday).

Other Meds: Amitriptyline (40mg per day for migraine) Tri-Lo-Marzia birth control I took one dose of acetaminophen the evening of the 25th

Current Illness: None

ID: 1354658
Sex: F
Age: 44
State:

Vax Date: 05/12/2021
Onset Date: 05/13/2021
Rec V Date: 05/27/2021
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: Metronidazole

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

Symptoms: I had slight bleeding for 4 days from my vagina after my 1st vaccine dose on 12th march 2021 and heavy bleeding and stomach cramps after my 2nx dose. I am also have palpitations which come.and go

Other Meds: Ramipril 5mg Levothyroxine 100mg

Current Illness: None

ID: 1354659
Sex: F
Age: 46
State: GA

Vax Date: 02/09/2001
Onset Date: 02/16/2001
Rec V Date: 05/27/2021
Hospital: Y

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: Bactrim

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Covid arm (rash and itching) for 1 week. Resolved on its own. Leg swelling and pain as well as shortness of breath. Had Doppler scan on leg and CTs on chest. Diagnosed?DVT left leg and PE in lungs. On blood thinner and TED hose x 6 months. On treatment now.

Other Meds: None

Current Illness: None

Date Died: 05/23/2021

ID: 1354660
Sex: M
Age: 66
State: UT

Vax Date: 05/22/2021
Onset Date: 05/22/2021
Rec V Date: 05/27/2021
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: Patient spouse reports to me the following: patient felt normal most of the day, later in the evening he felt extreme fatigue went to bed around 9pm. She found him deceased around 2am.

Other Meds: Eliquis colchicine losartan pantoprazole amlodipine

Current Illness: Tested Positive for Covid-19 in November

ID: 1354661
Sex: F
Age: 29
State: CA

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 05/27/2021
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: Patient was given dose of Janssen on 5/24 after reporting no previous vaccination. CAIR records reveal patient had also received J&J on 3/11/21. Post vaccination monitoring of client by medical personnel at facility reveals no symptoms or side effects.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm