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: 1365510
Sex: F
Age: 59
State: GA

Vax Date: 05/06/2021
Onset Date: 05/12/2021
Rec V Date: 06/01/2021
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: Phenegren, tramadol,

Symptom List: Dysphagia, Epiglottitis

Symptoms: Fever up to 101 for 3 weeks Horrible chest pain it hurt to breathe and cough felt like a broken bone it hurt so bad even on pain medication. Constant feeling of fatigue but the pain in the chest into right breast was overwhelming. Drop in blood pressure. Called pharmacy and Doctors Office non-responsive pharmacy stated to report my antibodies test was high 2.66 done at lab. I have never experienced such pain in my chest area . I thought someone would care but idk. I have no idea when this will end and Have not heard back from Doctors Office after about 7 messages.

Other Meds: Valium, bystolic, lexapro,Wellbutrin , omprezapole,oxycodone 10/325

Current Illness: None

ID: 1365511
Sex: F
Age: 81
State: GA

Vax Date: 02/13/2021
Onset Date: 02/13/2021
Rec V Date: 06/01/2021
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: Sulfa

Symptom List: Anxiety, Dyspnoea

Symptoms: Onset began the evening of the vaccination severe chills and did not feel well. On the first week had extreme fatigue. The second week I lost my sense of smell and taste. The fatigue and lost of smell and taste lasted up to five weeks. I gradually felt better, but it took about 8 weeks before I felt better.

Other Meds: Metformin 500 mg 1xday; Potassium chloride 2x day; Protonix 40 mg; Escitalopram 5 mg 1xday; Zetia 10 mg 1xday; Losartan HCL 25-100 1xday; Metformin 500 mg 1xday; Lanreotide once every 4 wks by injection; Multivitamins; B complex; Baby aspir

Current Illness: No

ID: 1365513
Sex: F
Age: 61
State: PA

Vax Date: 03/11/2021
Onset Date: 03/25/2021
Rec V Date: 06/01/2021
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: About two weeks afterwards I start having Vertigo. I had it before but it has been about 11 years since I last had it. Still having some light headiness and dizziness.

Other Meds: I have Crohns disease, Remicade, Lisinopril for high blood pressure, MP6 for Crohns, Nexium for heart burn, vitamins b-12 injection, vitamin D and calcium.

Current Illness: No

ID: 1365514
Sex: M
Age: 32
State: FL

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/01/2021
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: 32 yo WM approach staff member with c/o dizziness and light headiness ten minutes after receiving 1st dose of Pfizer vaccine. Patient stated he went to stand and felt like he was going to fall to the floor. Staff member notified EMS and NP of the complaint. PT was evaluated by on-site by EMS and NP. Patient stated he always experience some dizziness after receiving any shot. Initial VS were taken. BP 92/5967, 20. Patient was given a snack and a bottle of water as requested. PMH, Anxiety D/O. NKA. After eating snack and drinking water, patient stated he was feeling better and ask to leave. Final VS were taken. BP 110/79, 71, 20, o2 98%. Patient left facility without further incidents.

Other Meds: Fluxatine, Vitamins

Current Illness: Anxiety

ID: 1365515
Sex: M
Age: 15
State: MD

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

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

Lab Data:

Allergies: Cephalosporins, Augmentin (rash)

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

Symptoms: Mostly nonverbal pt developed temp 100-102 evening following vaccine through following day, and on day 3 had significant chest pain warranting 911 call and ED visit. Labs were significant for leukocytosis (WBC 19.8) and CXR w R hilar pneumonia. Troponin level was normal. He has improved on ABX.

Other Meds: Singulair, albuterol, Miralax, Pepcid, Albuterol prn

Current Illness: Was seen at my office for ear pain 5/25/21 and was found to have cerumen impaction.

Date Died: 05/28/2021

ID: 1365516
Sex: F
Age: 54
State: TX

Vax Date: 05/26/2021
Onset Date: 05/28/2021
Rec V Date: 06/01/2021
Hospital: Y

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

Lab Data:

Allergies: na

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

Symptoms: my friend died from this vaccine

Other Meds: na

Current Illness: RA

ID: 1365517
Sex: F
Age: 41
State: CO

Vax Date: 05/01/2021
Onset Date: 05/01/2021
Rec V Date: 06/01/2021
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: shellfish (anaphylaxis), bee sting (intense swelling)

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: At 6pm the same day as the vaccine I started feeling tired and went to bed early (8pm). The next day when I woke up I had a low fever, chills and typical flu symptoms. My skin was sensitive to the touch and I was extremely fatigued. I only got up to eat and use the bathroom. I experienced these symptoms for the next 3.4 days and took tylenol and ibuproben to reduce the effects. I felt ok for one day (Thursday). The next day (Friday) my throat felt scratchy in the morning and was worse in the evening. Saturday (one week post vaccination) when I woke up my throat hurt extremely bad and I could hardly swallow. I went to urgent care, was diagnosed with strep and started on antibiotics (Amoxicillin). I basically slept for the next few days (Sat to Tues) again only getting up to eat/use bathroom, as I was extremely tired. By the next day (Wed) my throat cleared up for the most part and I was able to return to work, although I was still feeling fatigued and was in bed early by 8:30 or 9pm. By Friday I was able to work a full day, but was extremely tired at the end of the day and going to bed early still. That weekend (2 weeks post vaccination), I started feeling tired mid day and needed short naps on Saturday and Sunday. On Monday I had to leave work early as I began feeling fatigued around noon. I came home and rested and went to bed early. On Tuesday I was extremely fatigued by 11am and came home to take a nap. This has pretty much been my life since then (now a little over 4 weeks post vaccination). I am tired all the time. I wake up around 7am most days - I have a 3 year old child and I get him ready for school. I drop him off and go to work, but by 11am I feel extremely fatigued to the extent that I cannot concentrate at all and I have to return home. Maybe it is what they call "brain fog", but it is associated with extreme fatigue. I come home and nap for between 1-3 hours, but I do not feel rested and it is generally still hard for me to concentrate. I go to bed early around 8:30pm. Sometimes i wake up during the night, but most nights I sleep without waking. Some mornings I feel ok when I wake up, but most of the time I do not feel well rested. This is really having an adverse effect on my work, and also on my mental health (because I cannot do my job effectively and I am generally too tired and grouchy to enjoy the evenings with my family). I just feel exhausted all the time even though I have been sleeping 13-16 hours per day. I visited my doctor 3 weeks post vaccination and described this situation. He ordered blood work which showed everything was within normal ranges (ie; no mononucleosis, no anemia, no diabetes, no thyroid issues, no autoimmune indicators (basic panel)) - nothing out of the ordinary.

Other Meds: none

Current Illness: 2 days exhaustion, chills from first COVID vaccination

ID: 1365518
Sex: F
Age:
State: AZ

Vax Date:
Onset Date:
Rec V Date: 06/01/2021
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: Pharyngeal swelling

Symptoms: Swelling and red bicep away from the shot. Arm is surfer painful as well.

Other Meds:

Current Illness:

ID: 1365519
Sex: M
Age: 38
State:

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

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

Lab Data:

Allergies: Sulfa drugs, bee stings, ant bites

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: 5 minutes after receiving the J&J vaccine, I went lights out. As I was sitting in the monitoring area, I was completely fine and then a wave came crushing down on me and I was out for about 5 minutes. The nurses said it looked like I was having a seizure. The EMTs called it a syncope event. I am a member of the military and and have been pumped full of vaccines. I get my annual flu shot every year. I have survived 6 rounds of Anthrax vaccines and every other vaccine the military has pumped into me. This is the First Time I have ever REACTED this way. It was CRAZY!

Other Meds: Tamsulosin (Flomax), Daily Fiber

Current Illness: Kidney Stone

ID: 1365520
Sex: F
Age: 41
State: CA

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/01/2021
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: NKA

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Patient DOB: 11/13/1979 received Janssen Lot # 1808980, expiration 6/20/2021 at 1353 in the left arm sitting in a chair. At 1354 Client stated ? I just feel a little dizzy like I?m floating.? instructed client to lie down in clinic room. Vitals taken: 1356: BP 11/79, HR 110, SpO2 97%, RR 18. Client Alert and Oriented x4. Client has no known allergies, no known prior history of vaccine reactions. History of anxiety, Migraines, and ?high heart rate? (per client). At 1401 client reported ?I feel good, I feel normal.? While still lying supine. Vitals? BP 110/90, HR 104, SpO2 97%, RR 16. Skin dry, color normal for Ethnicity, no skin color changes noted. At 1404 instructed client to sit up. Client stated ?I feel fine? in sitting position. Vitals: BP 120/88, HR 111, SpO2 98%, RR 16. At 1410 Client stood up, stated again ?I feel fine.? Alert and Oriented x4, denied dizziness or nausea. Vitals: BP 120/70, HR 110, SpO2 98%, RR 16. PHN?s educated client related to need to lay down before shots. Reviewed s/s allergic reactions, when to see PMD. At 1415 client walked off with steady gait, exited building, stated ?felt normal.?

Other Meds: not taking any medications

Current Illness: none

ID: 1365521
Sex: F
Age: 48
State: NY

Vax Date: 05/26/2021
Onset Date: 05/27/2021
Rec V Date: 06/01/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Urinary tract infection

Other Meds: None

Current Illness: None

ID: 1365522
Sex: F
Age: 12
State: NC

Vax Date: 05/18/2021
Onset Date: 05/24/2021
Rec V Date: 06/01/2021
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: Grass pollen (environmental)--anaphylactic

Symptom List: Rash, Urticaria

Symptoms: Headache, sore throat, chills, low-grade fever, malaise

Other Meds:

Current Illness: none

ID: 1365523
Sex: M
Age: 95
State: CA

Vax Date: 01/28/2021
Onset Date: 02/01/2021
Rec V Date: 06/01/2021
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: Right arm weakness, right hand numbness, leg weakness, fatigue, blurred speech, small eschemic stroke right side

Other Meds: alfuzosin, Slow FE, Multivitamin, glucosamine condroitin, omeprazole

Current Illness: arthritis, hiatus hernia, GERD

ID: 1365524
Sex: F
Age: 13
State: MN

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/01/2021
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: Prior to the vaccine patient and parent were given teaching about concerns for fainting. She was questioned if she had something to eat and drink prior to coming to the clinic and both indicated that she had. It was volunteered that patient has never had a fainting spell from receiving injections/vaccines. She was administered 0.3 ml of the Pfizer vaccine at 4:47 p.m. while seated securely in a chair. At about 4:50 p.m. she lost consciousness and assumed a prone position. She was held by both the R.N. and her mother and never fell or injured herself. She was unconscious for approximately 8-10 seconds and regained consciousness. She was alert and oriented. She was reassured and given some apple juice and a graham cracker which she consumed. Charge nurse and nurse manager appeared on the scene. EMT was summoned who brought a wheel chair and patient was transported to the observation area in the wheel chair. She was conversing and appeared oriented prior to going to the observation area.

Other Meds: None known

Current Illness: None known

ID: 1365525
Sex: M
Age: 17
State: CA

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/01/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: PT PASSED OUT. HAD HX OF PASSING OUT AT SCHOOL WHILE IN CLASS. PARAMEDIC CAME, HYDRATION OFFERED. SX RESOLVED, NO TRANSPORT.

Other Meds:

Current Illness:

ID: 1365526
Sex: F
Age: 31
State: NJ

Vax Date: 05/12/2021
Onset Date: 05/15/2021
Rec V Date: 06/01/2021
Hospital: Y

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

Lab Data:

Allergies: No

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

Symptoms: I was vaccinated on Wednesday, that day I felt fine, on Thursday I felt fatigue, fever, pain in my feet, in arm; on Friday I had severe back pain that radiated to my stomach, on Saturday morning 4:40 I was awakened by a tachycardia and afterward I had severe chest pain, I could not tolerate the pain. I went to the emergency room and they found my Troponin at 7000. They took good care of me in the hospital. They did tests on me and later on Sunday I had it again at dawn but not so strong, I am a healthy person and have not done anything out of the ordinary, the only thing different was the vaccine that I took in those days. Now I have to take medications (amlodipine, aspirin, omega, atorvastatin) I don't know for how long.

Other Meds: None

Current Illness: None

ID: 1365527
Sex: F
Age: 58
State: CA

Vax Date: 04/09/2021
Onset Date: 04/21/2021
Rec V Date: 06/01/2021
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: I am allergic to sulfa drugs.

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

Symptoms: On 04/21/2021, 12 days after I received the vaccine, I woke up with my entire left side feeling numb and I had a headache. I felt like I had pressure on my chest and I was really lightheaded. I got up for a little while and I felt like I was going to faint. I felt like I needed to eat something and I was very weak. I drank some juice and ate an orange. I was having a hard time swallowing and at times slurred my words. I realized that something serious was going on because I had pain like when I went through chemo. The base of my spine has been hurting every day since I received the vaccine and I have had headaches since as well. I was having heart palpitations and felt super weak. I didn't go to work for 2 days. That was 04/21 and 04/22. On 04/23 I had to do a zoom conference for work, for an hour, and my eyes starting hurting really bad like my eyes had been open for 24 hours. The light from the computer screen was really affecting me. At 5pm I did a tele-video appointment with the NP. She told me that she wanted me to go urgent care because it was the closest urgent care to me. After going to Urgent Care on 04/24, the doctor wanted me to go to the Hospital by ambulance. At the hospital the performed an EKG, CTA and MRA and they said that everything looked fine. They couldn't validate that my pain was from Johnson and Johnson vaccine. I was release at 10:30pm PT, I called Dr., my Oncology surgeon, and he referred me to Neurology doctor. I got an appointment with Dr., 04/27, and she ordered a CTA and an MRA. I had the scans completed on 04/28, with and without contrast. The radiologist found something. I was sent back home, but I was told that right vertebral artery was completely excluded. In January of 2020, there was a CTA performed, and I didn't have any numbness and my vertebral artery still have a steady flow even though there was a tear. It also showed that I had more stenosis in my carotid artery. I have now been referred to a new Neurosurgeon. Dr. never saw me because they couldn't view my records. The doctor told me to take Crestor and 81 mg aspirin. I did not feel that those medications helped at all. If anything, I felt worse. on 05/15, I was in the passenger seat of my grandson's car and I ended up throwing up and there was blood coming out with the vomit. He took me the Hospital. I had a video appointment on 05/11, with an NP, and she told me to up my aspirin to 325mg and continue to take Crestor. She referred me to The Stroke Neurology Group and she referred me to get a CTA. She also referred me to a GI doctor. On 05/15, against medical advice, and was taken by ambulance to another hospital. I stayed there until 3AM 05/16. They performed an MRA, a CT, Stroke Angiogram, they MRI with and without contrast, a chest x-ray and a lot of blood work. They also performed are lactate test and at first it came back as 2.5, which made them think I had an infection, but they re-tested and it came back as 1.5 which they said to be normal. The results from the hospitals. On 05/19 I went to see a Cardiologist, and she took me off of Crestor and put on pravastatin. She order an echocardiogram and a treadmill test and an EKG. I did see a GI doctor and they told me that the aspirin that I was told to take is what was making me throw up blood. I do have a neurology appointment on 06/11 and I have an appointment with the neurosurgeon on 06/16. My last heart test came back normal.

Other Meds: I was taking 75mg Synthroid, Valtrex, Zinc 50mg, D3 and 20mg generic of Prilosec.

Current Illness: I did not have any other illnesses.

ID: 1365528
Sex: M
Age: 13
State: NC

Vax Date: 05/15/2021
Onset Date: 05/23/2021
Rec V Date: 06/01/2021
Hospital:

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

Lab Data:

Allergies: n/a

Symptom List: Ear pain, Hypoaesthesia

Symptoms: 5/23-5/24, nose pain, swallow inside and under nose, fever, joint pain, muscle sore and headache 5/25-5/31, nose pain, infection area developing, fever, headache visited urgent care on 5/28, prescribed cephalexin (keflex) and mupirocin.

Other Meds: Albuterol 2 puffs as needed Advair HFA 2 puffs daily

Current Illness: n/a

ID: 1365529
Sex: F
Age: 36
State: FL

Vax Date: 04/29/2021
Onset Date: 05/19/2021
Rec V Date: 06/01/2021
Hospital:

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

Lab Data:

Allergies: sulfur

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: blurred vision, headache,

Other Meds:

Current Illness:

Date Died: 06/01/2021

ID: 1365530
Sex: F
Age: 76
State: AZ

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/01/2021
Hospital:

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

Lab Data:

Allergies: Hydrocodone-Rash, Eliquis-Rash, Penicillin- Rash

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

Symptoms: Patient passed away 3 days after receiving vaccination

Other Meds: Amlodipine 10 mg, Aspirin 81 mg, Calcitriol 0.25mg, Lisinopril 5 mg, Vitamin D 1.25 mg , PreserVision

Current Illness: Dizziness

ID: 1365531
Sex: M
Age: 45
State: IL

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 06/01/2021
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: MOTHER REPORTED HE HAD ADDITIONAL SEIZURES, VOMITING, EXTREME FATIGUE,STIFF ARM, SLURRED SPEECH, COULDN'T WALK WELL. MOSTLY AFFECTED RIGHT SIDE.

Other Meds: LAMOTRIGINE,BUSPIRONE,KEPPRA,VIMPAT

Current Illness:

ID: 1365532
Sex: F
Age: 29
State: NC

Vax Date: 05/31/2021
Onset Date: 06/01/2021
Rec V Date: 06/01/2021
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 causes rash

Symptom List: Unevaluable event

Symptoms: facial swelling, chills left leg pain, severe headache

Other Meds:

Current Illness:

ID: 1365533
Sex: M
Age: 34
State: CT

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 06/01/2021
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: NKA

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

Symptoms: Patient reported just before he was about to receive the 2nd shot that he felt numbness and tingling in his right arm and hand immediately after receiving the first shot yet he did not mention this to anyone. The numbness and tingling advanced to include his left arm and hand and he found it difficult to make a fist with either hand. Problem continues. Patient did not get the 2nd shot and was advised to contact his MD as soon as possible.

Other Meds: None

Current Illness: None known

ID: 1365534
Sex: F
Age: 60
State: GA

Vax Date: 03/12/2021
Onset Date: 04/27/2021
Rec V Date: 06/01/2021
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: n/a

Symptom List: Injection site pain, Pain

Symptoms: doing the second shoot , hot flashes the bottom parts of the body.

Other Meds: central vitamins

Current Illness: none

ID: 1365535
Sex: M
Age: 15
State: IL

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/01/2021
Hospital:

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

Lab Data:

Allergies: bee stings

Symptom List: Injection site pain, Menorrhagia

Symptoms: Patient and his Mother were in the vaccination room. appox 30 sec to 1 min following Vaccination patient stated he feels like he is going to pass out and before his mother or administering pharmacist could respond the patient fainted/ lost consciousness for approximately 30seconds

Other Meds: unknown

Current Illness: none reported

ID: 1365536
Sex: F
Age: 59
State: CA

Vax Date: 05/28/2021
Onset Date: 05/29/2021
Rec V Date: 06/01/2021
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: Gluten

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

Symptoms: Extreme debilitating body aches for over 72 hours. Extreme swelling of lymph nodes in arm pit of injected arm with extreme pain unable to use arm. Injection site does not hurt.

Other Meds: None

Current Illness: None

ID: 1365537
Sex: M
Age: 58
State: VA

Vax Date: 01/07/2021
Onset Date: 01/15/2021
Rec V Date: 06/01/2021
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: Nausea, Pain in extremity, Pyrexia

Symptoms: Had COVID Sept 27 (positive test), with ED visit on 10/4/20, and ED/Hospitalization 10/8-12--/20, with extra quarantine from 10/8 /20 to 10/18/20. Initially 6 hrs post 1st dose: Chills, fever (102.5 deg F), aches, weakness, chills, malaise, for next 30-32 hours After second dose: post 5-6 hours: Chills, fever (100.2 deg F), aches, weakness, chills, malaise, for next 22-24 hours About a week post first dose: Extremely swollen neck Lymph nodes on both sides Multiple phone calls to PCP, with a office visits on 1/19/20, and again on 2/11/21. Nodes in neck were swollen even larger on second visit.

Other Meds: Coreg Insulin ASA Atorvastatin Cozaar Cinnamon pioglitazone Glipizide Probiotic Multivitamin Metformin Trulicity Vitamin D3 Zyrtec ESOMEPRAZOLE

Current Illness: None

ID: 1365538
Sex: M
Age: 19
State: CA

Vax Date: 04/19/2021
Onset Date: 04/22/2021
Rec V Date: 06/01/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Felt fatigued with arm soreness. Two days later developed left supraclavicular lymph node swelling. Pt describes swelling as size of "ping pong ball" with tenderness. No axillary nodal swelling or tenderness. Progressive decrease in size of lymph node. Pt evaluated by clinician on 05/20/21. Non-tender palpable node measuring 2 cm X 1 cm. No axillary or cervical nodes noted. Recheck one week later, 05/27/21 - non-tender palpable node measuring 1 cm X 1 cm. CDC consultation sought 05/20 and 05/27.

Other Meds: None

Current Illness: None

ID: 1365539
Sex: F
Age: 14
State: MO

Vax Date: 05/13/2021
Onset Date: 05/16/2021
Rec V Date: 06/01/2021
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: no

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

Symptoms: She developed genital aphthous ulcers. They gave her pain medication in a form of Toradol and Gabapentin - helped with the pain. She soaked in a bathtub. They didn't give her steroids as they didn't want it to affect the vaccine.

Other Meds: Multi vitamin; Allegra; Flonase

Current Illness: no

ID: 1365540
Sex: F
Age: 46
State: PA

Vax Date: 05/21/2021
Onset Date: 05/27/2021
Rec V Date: 06/01/2021
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: Late/missed menstrual period

Other Meds: None

Current Illness: None

ID: 1365541
Sex: M
Age: 18
State: MN

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/01/2021
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 reported

Symptom List: Injection site pain

Symptoms: Patient reported feeling dizzy shortly after receiving his vaccination. Tech notified pharmacist and remained with patient. Pharmacist grabbed water and a wet towel to put on patient's neck. Patient's mom got some gatorade for the patient. Patient said his vision was "going". Got patient seated on floor and put the cool towel on his neck and told him to take some deep breaths. He started to feel better within a minute or so and had some gatorade. His color returned and was little sweaty, but reported feeling better. He remained under observation with his mom for another 30 minutes before leaving without issue. Mom stated he has felt dizzy in past, but wasn't noted on VAR.

Other Meds: unknown

Current Illness: none reported

ID: 1365542
Sex: F
Age: 17
State: CA

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/01/2021
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 induration, Injection site pruritus, Injection site swelling, Injection site warmth

Symptoms: FELT DIZZY AND HAD A WITNESSED SYNCOPAL EPISODE, TRANSPORTED TO COT, APPEARED DIAPHORETIC AND PALE. PARAMEDIC CAME, BP 86/51, HR 49, OFFERED HYDRATION, SX RESOLVED, NO TRANSPORT, AMA SIGNED.

Other Meds:

Current Illness:

ID: 1365543
Sex: M
Age: 17
State: WA

Vax Date: 05/29/2021
Onset Date: 06/01/2021
Rec V Date: 06/01/2021
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: myopericariditis

Other Meds: vyvanse

Current Illness: none

ID: 1365544
Sex: F
Age: 31
State: ID

Vax Date: 05/25/2021
Onset Date: 05/26/2021
Rec V Date: 06/01/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Tremor

Symptoms: Rash around neckline, first appeared like a bad sunburn. Not irritated or raised surface, almost hive like. Gave Benadryl and increased fluid intake. Rash improved and is now peeling over the course of 5 days. No pain or itching.

Other Meds: sertraline, guanfacine, latuda, clonidine

Current Illness: difficulty with skin

ID: 1365545
Sex: F
Age: 36
State: FL

Vax Date: 04/24/2021
Onset Date: 04/26/2021
Rec V Date: 06/01/2021
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: Mushrooms

Symptom List: Erythema, Pruritus

Symptoms: I don't know if related, but talking to a group of other women, figured I should note because we all had similar side effects. It could have been a bad period, or even a chemical pregnancy, but my period immediately after my Pfizer vaccine was late by a few days. It was also incredibly heavy and I was very lightheaded and nauseous from the pain. The following month, it was back to normal.

Other Meds: FLO Vitamins, multivitamin prenatal, Zyrtec, Flonase

Current Illness: None

ID: 1365546
Sex: M
Age: 15
State: TX

Vax Date: 05/21/2021
Onset Date: 05/30/2021
Rec V Date: 06/01/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: My son was evaluated by ER after experiencing 2 fainting episodes within an hour. ER report stated reason for visit as Loss of Consciousness with diagnoses of Syncope (Vasovagal) and Concussion.

Other Meds: None

Current Illness: None

ID: 1365547
Sex: F
Age: 22
State: CA

Vax Date: 04/22/2021
Onset Date: 05/17/2021
Rec V Date: 06/01/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: I am 3 weeks late on my menstrual cycle. No cramps or period related side effects. I was suppose to start on May 17. Not pregnant.

Other Meds:

Current Illness:

ID: 1365548
Sex: M
Age: 65
State: SC

Vax Date: 01/25/2021
Onset Date: 01/25/2021
Rec V Date: 06/01/2021
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: Shrimp, shellfish

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: I got the vaccine at 4:00 PM on 1/25. On the same day, I was rapid tested for COVID at 5:30. That night, they called me to let me know I had tested positive. I had been tested previously on 1/23, and the results were negative. On 1/27, I was retested, and the results were negative. On 1/28, I had a PCR test, and the results were negative.

Other Meds: I was taking Losartan, pravastatin, tamsulosin, 81mg of aspirin, and finasteride.S

Current Illness: None.

ID: 1365549
Sex: F
Age: 62
State: TX

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

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

Lab Data:

Allergies:

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

Symptoms: Less than 5 minutes after getting the vaccine, I had hot head coming from my head to me feet. The nurses giving the vaccinations, told me to sit in a secluded area. About 15 minutes later, my heart started racing, a nurse took my BP it was around 180ish. They gave me a bottle of water and one bar of granola. After 30 minutes they checked my BP again and then they called the paramedics and I went to the ER. When I got to the ER they took blood work, an EKG, a urine sample, and they gave me IV fluids. They ruled out a heart attack. I was there for about 8 hours and left around 8:30pm. I didn't work the next day, but 7-8 days after I had a persistent headache. My PCP just told me to stay hydrated and take ibuprofen. It went away after a week.

Other Meds: Carvedilol - 25mg - 2xday Valsartan - 160mg - 2xday Flecainide - 100mg - 2xday Aspirin - 81mg - 1xday Folic Acid - 1mg - 1xday Buspar - 45mg - 2xday Calcium - 1500mg - 1xday Vitamin D - 1000 units - 1xday Humira - 40sq- every other w

Current Illness:

ID: 1365551
Sex: M
Age: 30
State: MN

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/01/2021
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: NKDA

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

Symptoms: Patient lost consciousness ten minutes after receiving shot with a reduced pulse and losing all color in face. Patient denies any history of adverse reaction to previous injections or immunizations.

Other Meds: N/A

Current Illness: No known illness

ID: 1365552
Sex: M
Age: 17
State: CO

Vax Date: 05/27/2021
Onset Date: 05/29/2021
Rec V Date: 06/01/2021
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: Pain in extremity

Symptoms: myo-pericarditis . TTE showed normal LV function, no pericardial effusion, Troponins elevated to as high as 15.8 (still rising) with cMRI confirming myocardial inflammation.

Other Meds: Ibuprofen

Current Illness: none

ID: 1365553
Sex: F
Age: 62
State: NC

Vax Date: 03/20/2021
Onset Date: 03/25/2021
Rec V Date: 06/01/2021
Hospital:

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

Lab Data:

Allergies: Narcardic Pain meds - Ultram, Hydrocodone, morphine, demoral, and etc.

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

Symptoms: Extreme Fatigue/Lethargic - Wake up tired and not refreshed. Constant fatigue and sleepiness. Inflammation beyond belief. Pain in places that I have never felt. Left shoulder, Right shoulder, Right leg and left leg tendons. I am struggling to to normal activities. Increase in the intensity and severity of the pain, and tenderness and soreness associated with fibroymalgia. Example: Woke up at 7 am, had breakfast, Mani/Pedi Appt at 11 am, Could hardly stay woke for Mani, but slept through the Pedicure. This is getting to extremely overwhelming for me to deal with.

Other Meds: Celebrax, Buprion, Avapro, Tenenol, Symbalta, Restasis, Refresh,

Current Illness:

ID: 1365554
Sex: M
Age: 12
State: CA

Vax Date: 05/15/2021
Onset Date: 05/16/2021
Rec V Date: 06/01/2021
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: Consciousness fluctuating, Crying, Dry skin, Epistaxis, Headache

Symptoms: PT mother states that the next day her son started with fever 24 hours after the vaccine. He had a fever for the next 8 days. At times his fever got up to 103F. His other symptoms were that his lymph nodes in his neck got very swollen and painful to touch and was very tired. He also threw up 3 times on various days. He also had a very mild sore throat before his vaccine. His pediatrician thinks it was the vaccine with in combination with his virus, was tested for strep, mono and covid, and all was negative, also lab work was performed and all was negative. He slowly started to feel better after his fever went down.

Other Meds:

Current Illness: Asthma

ID: 1365555
Sex: F
Age: 16
State: PA

Vax Date: 04/26/2021
Onset Date: 04/28/2021
Rec V Date: 06/01/2021
Hospital: Y

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

Lab Data:

Allergies: amoxicillin

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

Symptoms: chest pain ER visit BNP was elevated

Other Meds: she was on day 2 of Macrobid but doctor took her off on 4/28 because UTI culture came back negative

Current Illness: uti symptoms a few days before but specimen was found negative

ID: 1365556
Sex: F
Age: 31
State: WA

Vax Date: 05/25/2021
Onset Date: 05/27/2021
Rec V Date: 06/01/2021
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: Pt received her vaccine on 5/25/21, she started to have a HA right after being vaccinated. She then noticed small red and white itchy bumps on her arms, chest, and back that progressed over the next several days. She called the clinic today as they have not improved yet. She says she has never had anything like them before.

Other Meds:

Current Illness:

ID: 1365557
Sex: F
Age: 18
State: PA

Vax Date: 05/30/2021
Onset Date: 05/31/2021
Rec V Date: 06/01/2021
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 reported

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Bright red rash (size of dollar bill) on injection arm. Hot to the touch but not painful or itchy

Other Meds: None reported

Current Illness: None reported

ID: 1365558
Sex: F
Age: 34
State: MA

Vax Date: 04/25/2021
Onset Date: 05/28/2021
Rec V Date: 06/01/2021
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: NA

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

Symptoms: Shingles - torso

Other Meds: Flo vitamins

Current Illness: NA

ID: 1365559
Sex: M
Age: 38
State: FL

Vax Date: 05/25/2021
Onset Date: 05/27/2021
Rec V Date: 06/01/2021
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: Nickel and Cobalt

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Felt sick 12 hours after the shot. I woke up 5/26 with a slight headache but otherwise felt fine, arm was sore. Thursday morning i woke up with a tingling sensation in my left hand and it progressively spread throughout the left side of my body and into my right foot. Hand, chest, stomach, left leg and left foot and right foot all have have pins and needles sensation.

Other Meds: NONE

Current Illness: NONE

ID: 1365560
Sex: F
Age: 38
State: CA

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/01/2021
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: dizziness vitals taken stable 109/76, pulse 81, 98.3 , spo2 98% alert, water given. monitored for 30 min. pt has a family member , took client home

Other Meds:

Current Illness: denied

ID: 1365561
Sex: F
Age: 35
State: CA

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/01/2021
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: Pt experienced nausea within 4 minutes of vaccination. Pt denied itchiness or hives. Symptoms quickly progressed to difficulty swallowing, redness, and notable upper airway swelling. Pt given Epi 0.3 mg IM and taken to ER via wheelchair.

Other Meds: Ibuprofen (MOTRIN) 800 mg Oral Tab Gabapentin (NEURONTIN) 100 mg Oral Cap Fluticasone (FLONASE ALLERGY RELIEF) 50 mcg/actuation Nasl SpSn Ibuprofen (MOTRIN) 800 mg Oral Tab Levothyroxine (LEVOTHROID/SYNTHROID) 25 mcg Oral Tab Norethindrone

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm