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: 1370818
Sex: F
Age:
State: IL

Vax Date: 01/23/2021
Onset Date: 02/23/2021
Rec V Date: 06/03/2021
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: Pericarditis; This spontaneous case was reported by a consumer and describes the occurrence of PERICARDITIS (Pericarditis) in a female patient of an unknown age who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 029K20A) for COVID-19 vaccination. No Medical History information was reported. On 23-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) at an unspecified dose. On 23-Feb-2021, the patient experienced PERICARDITIS (Pericarditis) (seriousness criterion medically significant). The patient was treated with CLONIDINE for Symptomatic treatment, at an unspecified dose and frequency and MORPHINE for Symptomatic treatment, at an unspecified dose and frequency. At the time of the report, PERICARDITIS (Pericarditis) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) and mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown Route) was unknown. Concomitant product use was not provided by the reporter. The patient had a pace maker put in on 23-Feb-2021 and had pericarditis the same day. About two weeks before Easter, the patient had pain every time she took a breath like she was going to have a heart attack. Based on current available information and the temporal association between product use and the start date of the events a causal relationship is unlikely.; Sender's Comments: Based on current available information and the temporal association between product use and the start date of the events a causal relationship is unlikely.

Other Meds:

Current Illness:

ID: 1370819
Sex: F
Age: 64
State: MD

Vax Date: 02/23/2021
Onset Date:
Rec V Date: 06/03/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Anxiety, Dyspnoea

Symptoms: Conductive deafness; Ear discomfort; Paranasal sinus discomfort; Ear congestion; Hypoacusis; sensorineural hearing loss; This spontaneous case was reported by a health care professional and describes the occurrence of CONDUCTIVE DEAFNESS (Conductive deafness) and DEAFNESS NEUROSENSORY (sensorineural hearing loss) in a 64-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 026A21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No medical history was provided by the reporter. Concomitant products included PREDNISONE, FLUTICASONE PROPIONATE (FLONASE [FLUTICASONE PROPIONATE]), LEVOTHYROXINE SODIUM (SYNTHROID), ESTRADIOL (ESTRACE VAGINAL), PROGESTERONE, DEXLANSOPRAZOLE (DEXILANT) and ESTRADIOL (MENOSTAR) for an unknown indication. On 23-Feb-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 23-Mar-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient experienced CONDUCTIVE DEAFNESS (Conductive deafness) (seriousness criterion medically significant), EAR DISCOMFORT (Ear discomfort), PARANASAL SINUS DISCOMFORT (Paranasal sinus discomfort), EAR CONGESTION (Ear congestion), HYPOACUSIS (Hypoacusis) and DEAFNESS NEUROSENSORY (sensorineural hearing loss) (seriousness criterion medically significant). The patient was treated with NEOMYCIN at an unspecified dose and frequency; POLYMYXIN on 25-May-2021 at an unspecified dose and frequency; FLUTICASONE PROPIONATE (FLONASE [FLUTICASONE PROPIONATE]) (nasal) at an unspecified dose and frequency and PREDNISONE on 20-May-2021 at an unspecified dose and frequency. At the time of the report, CONDUCTIVE DEAFNESS (Conductive deafness), EAR DISCOMFORT (Ear discomfort), PARANASAL SINUS DISCOMFORT (Paranasal sinus discomfort), EAR CONGESTION (Ear congestion), HYPOACUSIS (Hypoacusis) and DEAFNESS NEUROSENSORY (sensorineural hearing loss) outcome was unknown. DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Acoustic stimulation tests: mixed sensory neuro/conductive hearing loss (abnormal) mixed sensory neuro/conductive hearing loss. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments. Action taken with the drug in response to events was not applicable. Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded. Symptoms were still ongoing and present at the time of this report; Sender's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.

Other Meds: PREDNISONE; FLONASE [FLUTICASONE PROPIONATE]; SYNTHROID; ESTRACE VAGINAL; PROGESTERONE; DEXILANT; MENOSTAR

Current Illness:

ID: 1370820
Sex: F
Age: 59
State: PA

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 06/03/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Felt seek; Diverticulitis exacerbation; Recommendations to defer the second vaccination from Physician; This case was received via an unknown source (no reference has been entered for a health authority or license partner) on 25-May-2021 and was forwarded to Moderna on 25-May-2021. This spontaneous case was reported by a consumer (subsequently medically confirmed) and describes the occurrence of DIVERTICULITIS (Diverticulitis exacerbation) in a 59-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 018B21A) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Concomitant products included METFORMIN, ROSUVASTATIN, ATENOLOL, LANSOPRAZOLE (PREVACID), ALPRAZOLAM (XANAX), VENLAFAXINE HYDROCHLORIDE (EFFEXOR) and DICYCLOMINE [DICYCLOVERINE] for an unknown indication. On 02-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 02-Apr-2021, the patient experienced OFF LABEL USE (Recommendations to defer the second vaccination from Physician). On 17-Apr-2021, the patient experienced DIVERTICULITIS (Diverticulitis exacerbation) (seriousness criterion medically significant). On 25-May-2021, the patient experienced MALAISE (Felt seek). At the time of the report, DIVERTICULITIS (Diverticulitis exacerbation) and MALAISE (Felt seek) had not resolved and OFF LABEL USE (Recommendations to defer the second vaccination from Physician) outcome was unknown. Not Provided The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. It was reported that the patient was not hospitalized and had no surgery but received recommendations to defer the second vaccination from Physician. For now patient still had exacerbation and "felt seek" so asked to defer second vaccination presumably on 05Jun2021 which is out of recommended time frame. No treatment information was provided. Company Comment : Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.

Other Meds: METFORMIN; ROSUVASTATIN; ATENOLOL; PREVACID; XANAX; EFFEXOR; DICYCLOMINE [DICYCLOVERINE]

Current Illness:

ID: 1370821
Sex: F
Age: 18
State: IL

Vax Date: 05/24/2021
Onset Date: 05/24/2021
Rec V Date: 06/03/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Inappropriate age at vaccine administration; Fever; Chills; bodyache; Seizure; This spontaneous case was reported by a consumer and describes the occurrence of SEIZURE (Seizure) in a 17-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. On 24-May-2021, the patient received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) dosage was changed to 1 dosage form. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 24-May-2021, the patient experienced SEIZURE (Seizure) (seriousness criterion medically significant), PYREXIA (Fever), CHILLS (Chills) and MYALGIA (bodyache). On an unknown date, the patient experienced PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (Inappropriate age at vaccine administration). At the time of the report, SEIZURE (Seizure), PRODUCT ADMINISTERED TO PATIENT OF INAPPROPRIATE AGE (Inappropriate age at vaccine administration), PYREXIA (Fever), CHILLS (Chills) and MYALGIA (bodyache) outcome was unknown. Not Provided No concomitant medications were provided by the reporter. No treatment information was provided. Company comment: Based on the current available information and temporal association between the use of the product and the start date of the events Seizure, Pyrexia, Chills, and Myalgia, a causal relationship cannot be excluded. This report also refers to a case of product administered to patient of inappropriate age for mRNA-1273, lot # unknown, with no associated AEs.; Sender's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events Seizure, Pyrexia, Chills, and Myalgia, a causal relationship cannot be excluded. This report also refers to a case of product administered to patient of inappropriate age for mRNA-1273, lot # unknown, with no associated AEs.

Other Meds:

Current Illness:

ID: 1370822
Sex: M
Age: 49
State: IL

Vax Date: 04/01/2021
Onset Date:
Rec V Date: 06/03/2021
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: Cataract; Dialysis; Feeling cold; Feeling hot; Feeling abnormal; Post procedural complication; Sleepiness; Fatigue/Tiredness; This spontaneous case was reported by a physician and describes the occurrence of CATARACT (Cataract) in an adult male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. UNK) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Co-suspect product included non-company product ADALIMUMAB injection for Crohn's disease. Concurrent medical conditions included Crohn's disease (Moderate to severe Crohn's disease). In April 2021, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient started ADALIMUMAB (Subcutaneous) 1 dosage form. On an unknown date, the patient experienced CATARACT (Cataract) (seriousness criterion medically significant), DIALYSIS (Dialysis), FEELING COLD (Feeling cold), FEELING HOT (Feeling hot), FEELING ABNORMAL (Feeling abnormal), POST PROCEDURAL COMPLICATION (Post procedural complication), SOMNOLENCE (Sleepiness) and FATIGUE (Fatigue/Tiredness). At the time of the report, CATARACT (Cataract), DIALYSIS (Dialysis), FEELING COLD (Feeling cold), SOMNOLENCE (Sleepiness) and FATIGUE (Fatigue/Tiredness) had not resolved, FEELING HOT (Feeling hot) had resolved, FEELING ABNORMAL (Feeling abnormal) was resolving and POST PROCEDURAL COMPLICATION (Post procedural complication) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. Concomitant product use was not reported. Treatment information was not reported. Company Comment: Very limited information regarding the events, Cataract, Dialysis, feeling cold, feeling hot, Feeling abnormal, Post procedural complication, Sleepiness, Fatigue has been provided at this time for an adult male patient who received mRNA-1273 on an unknown date. There is no patient information to further request for an additional information.; Sender's Comments: Very limited information regarding the events, Cataract, Dialysis, feeling cold, feeling hot, Feeling abnormal, Post procedural complication, Sleepiness, Fatigue has been provided at this time for an adult male patient who received mRNA-1273 on an unknown date. There is no patient information to further request for an additional information.

Other Meds:

Current Illness: Crohn's disease (Moderate to severe Crohn's disease)

ID: 1370823
Sex: F
Age: 38
State:

Vax Date: 09/10/2020
Onset Date:
Rec V Date: 06/03/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Internal Bleeding; Anaphylactic reaction; bad allergies; sinus migraine; acne on face/ back; nausea; vomiting; This spontaneous case was reported by an other health care professional (subsequently medically confirmed) and describes the occurrence of INTERNAL HAEMORRHAGE (Internal Bleeding) and ANAPHYLACTIC REACTION (Anaphylactic reaction) in a 39-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. The occurrence of additional non-serious events is detailed below. Co-suspect product included non-company product TOFACITINIB CITRATE (XELJANZ XR) for Rheumatoid arthritis. Concurrent medical conditions included Latex allergy (latex allergy), Gluten intolerance (Gluten allergy) and Drug allergy (Tylenol). Concomitant products included MAGNESIUM CITRATE, MOMETASONE FUROATE (NASONEX), CETIRIZINE HYDROCHLORIDE (ZYRTEC ALLERGY), ASCORBIC ACID (VITAMIN C ACID), VITAMIN D3, MULTIVITAMIN AND MINERAL and FISH OIL for an unknown indication. On 10-Sep-2020, the patient started TOFACITINIB CITRATE (XELJANZ XR) (unknown route) 11 mg once a day. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced INTERNAL HAEMORRHAGE (Internal Bleeding) (seriousness criterion medically significant), ANAPHYLACTIC REACTION (Anaphylactic reaction) (seriousness criterion medically significant), HYPERSENSITIVITY (bad allergies), MIGRAINE (sinus migraine), ACNE (acne on face/ back), NAUSEA (nausea) and VOMITING (vomiting). At the time of the report, INTERNAL HAEMORRHAGE (Internal Bleeding), ANAPHYLACTIC REACTION (Anaphylactic reaction), HYPERSENSITIVITY (bad allergies), MIGRAINE (sinus migraine), ACNE (acne on face/ back), NAUSEA (nausea) and VOMITING (vomiting) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular), the reporter did not provide any causality assessments. No concomitant medications and treatment medications were reported. Company comment: Based on the current available information which shows a temporal association between the use of mRNA-1273 and the onset of the reported events, a causal relationship cannot be excluded. Nausea and vomiting are consistent with the product known safety profile.; Sender's Comments: Based on the current available information which shows a temporal association between the use of mRNA-1273 and the onset of the reported events, a causal relationship cannot be excluded. Nausea and vomiting are consistent with the product known safety profile.

Other Meds: MAGNESIUM CITRATE; NASONEX; ZYRTEC ALLERGY; VITAMIN C ACID; VITAMIN D3; MULTIVITAMIN AND MINERAL; FISH OIL;XELJANZ XR

Current Illness: Drug allergy (Tylenol); Gluten intolerance (Gluten allergy); Latex allergy (latex allergy)

ID: 1370824
Sex: M
Age: 80
State: NJ

Vax Date: 04/30/2021
Onset Date: 05/18/2021
Rec V Date: 06/03/2021
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: Pyrexia, White blood cell count decreased

Symptoms: TIA; This spontaneous case was reported by a patient (subsequently medically confirmed) and describes the occurrence of TRANSIENT ISCHAEMIC ATTACK (TIA) in an 80-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch no. 078B20A) for COVID-19 vaccination. No medical history was reported. Concomitant products included DICLOFENAC and FINASTERIDE for an unknown indication. On 30-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 18-May-2021, the patient experienced TRANSIENT ISCHAEMIC ATTACK (TIA) (seriousness criterion medically significant). The patient was treated with ASPIRIN [ACETYLSALICYLIC ACID] at a dose of Low dose and CLOPIDOGREL BISULFATE (PLAVIX) at an unspecified dose and frequency. At the time of the report, TRANSIENT ISCHAEMIC ATTACK (TIA) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. Treatment provided were unknown blood thinner medication. Company comment: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.; Sender's Comments: Based on the current available information and temporal association between the use of the product and the start date of the events, a causal relationship cannot be excluded.

Other Meds: DICLOFENAC; FINASTERIDE

Current Illness:

ID: 1370825
Sex: M
Age:
State:

Vax Date: 04/28/2021
Onset Date: 05/20/2021
Rec V Date: 06/03/2021
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: diagnosed with pneumonia; This spontaneous case was reported by a consumer and describes the occurrence of PNEUMONIA (diagnosed with pneumonia) in a 69-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On 28-Apr-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On 20-May-2021, the patient experienced PNEUMONIA (diagnosed with pneumonia) (seriousness criterion medically significant). At the time of the report, PNEUMONIA (diagnosed with pneumonia) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. The patient's concomitant medication was not reported. No treatment information was provided. Company Comment: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. No further information is expected at this time.; Sender's Comments: Based on the current available information and temporal association between the use of the product and the start date of the event, a causal relationship cannot be excluded. No further information is expected at this time.

Other Meds:

Current Illness:

ID: 1370826
Sex: U
Age:
State:

Vax Date:
Onset Date:
Rec V Date: 06/03/2021
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: broken blood vessels in my eye; Based on the current case data, this case has been classified as invalid. This spontaneous case was reported by a consumer and describes the occurrence of EYE HAEMORRHAGE (broken blood vessels in my eye) in a patient of an unknown age and gender who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. No Medical History information was reported. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) 1 dosage form. On an unknown date, the patient experienced EYE HAEMORRHAGE (broken blood vessels in my eye) (seriousness criterion medically significant). At the time of the report, EYE HAEMORRHAGE (broken blood vessels in my eye) outcome was unknown. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular) was unknown. The patient's concomitant medication was not reported. No treatment information was provided.; Sender's Comments: Very limited information regarding the event, Eye haemorrhage, has been provided at this time. There is no patient information, no onset date and outcome of the event. No patient information to further follow-up. This case was submitted via adverse event chatbot Text.

Other Meds:

Current Illness:

ID: 1370827
Sex: F
Age: 50
State: OH

Vax Date: 04/09/2021
Onset Date: 04/10/2021
Rec V Date: 06/03/2021
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: Sulfa

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Extreme pain numbness tingling

Other Meds: None

Current Illness: None

ID: 1370828
Sex: M
Age: 74
State: NY

Vax Date: 05/28/2021
Onset Date: 05/29/2021
Rec V Date: 06/03/2021
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 reported

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

Symptoms: Urticaria in axilla

Other Meds:

Current Illness:

ID: 1370829
Sex: F
Age: 50
State: FL

Vax Date: 06/02/2021
Onset Date: 06/02/2021
Rec V Date: 06/03/2021
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: n/a

Symptom List: Rash, Urticaria

Symptoms: Pt. experiencing anxiety, light headedness and dizziness. B/P 89/54, B/P 101/65

Other Meds:

Current Illness: n/a

ID: 1370830
Sex: M
Age: 0
State: OH

Vax Date: 02/28/2020
Onset Date: 03/02/2020
Rec V Date: 06/03/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Patient received all the vaccines due at the four month visit. As soon as we got home he slept a lot, when he woke up he cried a lot, kept banging his head and we noticed that from a very chatty baby he was completely silent. I inquired about the type of vaccines he received and all I received was the name but not the manufacturer or other information. His doctor knows about the side effects and we stopped vaccinating since we don?t know what or which vaccine affected him.

Other Meds: None

Current Illness: No

ID: 1370831
Sex: F
Age: 55
State: FL

Vax Date: 06/02/2021
Onset Date: 06/02/2021
Rec V Date: 06/03/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Pt. complains of dizziness and weakness. She has a hx of hypertension and diabetes and advised she had not really eaten before vaccine. Pt. went home w/ son. Vitals spO2 99%, BP 167/85, HR 65.

Other Meds:

Current Illness:

ID: 1370832
Sex: F
Age: 28
State: CA

Vax Date: 04/02/2021
Onset Date: 04/02/2021
Rec V Date: 06/03/2021
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: Systemic: Dizziness / Lightheadness-Mild, Systemic: Flushed / Sweating-Mild

Other Meds:

Current Illness:

ID: 1370833
Sex: F
Age: 56
State: PA

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 06/03/2021
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: sulfa drugs, bee stings

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

Symptoms: 4/14/21 - 1st CoVid shot 11:30 a.m.- arm pain over the next 2 days, few days later noticed a ringing in my ears that didn't go away. Not certain exactly when it started as it wasn't very loud and other sounds would mask it. 5/12/21 - 2nd CoVid shot 11:00 a.m.- arm pain, felt like my equilibrium was off that afternoon (a little dizzy, etc), constant ringing in the ears became louder. Next day after the shot had arm pain, fairly bad headache, light nausea, low fever 100.2 in the morning but was gone later in the day. (Felt like a really bad hangover) Took a few days to feel normal, however the constant ringing in the ears has not subsided as of this writing (6/3/21) and can be quite annoying.

Other Meds: vitamin D, over-the-counter seasonal allergy med. as needed.

Current Illness: n/a

ID: 1370834
Sex: M
Age: 42
State: MA

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

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

Lab Data:

Allergies:

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

Symptoms: Site: Itching at Injection Site-Mild, Site: Redness at Injection Site-Mild, Systemic: Allergic: Itch (specify: facial area, extremeties)-Mild, Systemic: Allergic: Itch Generalized-Mild, Systemic: Allergic: Rash Generalized-Mild, Additional Details: Patient had itchiness at the injection site within 5 min of administration. Patient had redness and slight swelling. He was given 25mg of benadryl and checked up on 15 min after. Patient said the itching went down and the redness decreased. He went home with his partner and confirmed no further issues.

Other Meds:

Current Illness:

ID: 1370835
Sex: M
Age: 68
State: NJ

Vax Date: 02/22/2021
Onset Date: 04/21/2021
Rec V Date: 06/03/2021
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: Diagnosed with AFib on 04/21/2021

Other Meds: aspirin 81mg 2X omeprazole 40mg cialis 5mg atorvastatin 10mg

Current Illness: none

ID: 1370836
Sex: F
Age: 41
State: WV

Vax Date: 05/25/2021
Onset Date: 06/02/2021
Rec V Date: 06/03/2021
Hospital:

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

Lab Data:

Allergies: Nka

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Starting around 2:00pm June 2, 2021 approximately 9 days after first dose I had terrible stomach cramps and my arm had a small itchy raised spot I took for a bug bite because I actually forgot about the vaccine at the time. It itched badly. After going to bed, all night it got worse and upon waking today there?s a large red itchy rash right below the injection site and a red spot AT the site. I also have had a headache nearly nonstop for 36 hours.

Other Meds: Methadone 130 mg once/day

Current Illness: None

ID: 1370837
Sex: F
Age: 27
State: FL

Vax Date: 06/02/2021
Onset Date: 06/02/2021
Rec V Date: 06/03/2021
Hospital:

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

Lab Data:

Allergies: no

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

Symptoms: At 6:25pm after patient received vaccine EMT observed patient appeared pale with her eyes closed. Medic walked over to patient in which patient informed that, "I don't feel good, I feel nervous and dizzy." Medic took patient to medic area where vital signs were done and water was given. After 15 mins. patient recovered.

Other Meds: no

Current Illness: no

ID: 1370838
Sex: M
Age: 25
State: MO

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/03/2021
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: Systemic: Chills-Mild, Systemic: Dizziness / Lightheadness-Medium, Systemic: Hypotension-Mild, Additional Details: 1st Dose given at 6:05 PM, lightheaded within 5 minutes. also developed chills. BP read 115/60, 5 mins later 108/67 and sat for 30 minutes. patient had improved since then and was able to leave.

Other Meds:

Current Illness:

ID: 1370840
Sex: M
Age:
State: AS

Vax Date: 02/05/2021
Onset Date: 03/05/2021
Rec V Date: 06/03/2021
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: Dizziness; loss of balance resulting in falling; Chills; fatigue; sleepiness; diarrhea; Loss of strength; loss of appetite; This is a spontaneous report from a contactable consumer, the patient. A 78-years-old male patient received a first dose of BNT162B2 (PFIZER BIONTECH COVID-19 mRNA VACCINE) (Lot number = unknown) via an unspecified route of administration in the left arm on 05Feb2021 at 01:00pm (at the age of 78-years-old) as a single dose for COVID-19 immunisation. Medical history included glaucoma, shingles (15 years ago) and anemia. The patient was allergic to codeine. Concomitant medications included vitamin b12, c, d3, iron and Tylenol (MANUFACTURER UNKNOWN). The patient was not diagnosed with COVID-19 prior to vaccination. The patient did not receive any other vaccine within 4 weeks prior to covid vaccination. On 05Mar2021 at 1:00 PM, the patient experienced dizziness, loss of balance resulting in falling, chills, fatigue, sleepiness, diarrhoea, loss of strength and loss of appetite. On 06Mar2021, the patient underwent COVID-19 virus test (nasal swab type) and the result reported as negative. Adverse events resulted in emergency room/department or urgent care. Clinical outcome of the events dizziness, loss of balance resulting in falling, chills, fatigue, sleepiness, diarrhoea, loss of strength and loss of appetite was reported as not recovered. Information about lot number cannot be obtained and no further information is expected.

Other Meds: Vitamin B12; Vitamin C; TYLENOL; IRON

Current Illness:

ID: 1370974
Sex: M
Age: 33
State: IN

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/03/2021
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: Ibuprofen

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

Symptoms: Flu like symptoms. Extreme fatigue, body aches, back pain, joint pain, chills and fever.

Other Meds:

Current Illness:

ID: 1370975
Sex: F
Age: 39
State: MA

Vax Date: 05/04/2021
Onset Date: 05/04/2021
Rec V Date: 06/03/2021
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: PCN, Celor

Symptom List: Injection site pain, Pain

Symptoms: After 2nd dose body felt like it was on fire/itchy/hot for about 24 hrs after. Was relieved by Benadryl. Continue to have breast tenderness that was never a symptom before as well as odd menstral cramping

Other Meds: None

Current Illness: None

ID: 1370976
Sex: M
Age: 35
State: TX

Vax Date: 05/21/2021
Onset Date: 05/21/2021
Rec V Date: 06/03/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain, Menorrhagia

Symptoms: Error: Shoulder Joint Injury (prolonged pain, tingling, etc.)

Other Meds:

Current Illness:

ID: 1370977
Sex: F
Age: 38
State: FL

Vax Date: 05/13/2021
Onset Date: 05/13/2021
Rec V Date: 06/03/2021
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: Selective serotonin reuptake inhibitors (SSRIs) Seasonal allergies

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

Symptoms: - Dizziness / feeling of dis-ease within 15-30 mins following shot - Some face swelling and redness, hot to touch within first hour with itchiness - swelling and redness similar to a bad sunburn - itchiness spread down neck and eventually to whole body and lasted for around 5-6 days - Nausea / general discomfort within first hour - swelling feeling in my calves and feet like I was retaining water the first night after the shot, lasted a few days - what felt like swelling / tightness in throat - felt like the back of my tongue was swelling a bit / harder to swallow - extremely swollen lymph node at left collar bone - noticeably swollen lymph node under left arm area

Other Meds: Loratadine tablets 10 mg antihistamine (taken daily)

Current Illness: N/A

ID: 1370978
Sex: M
Age: 20
State: FL

Vax Date: 06/02/2021
Onset Date: 06/02/2021
Rec V Date: 06/03/2021
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:

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Error: Improper Storage (temperature).

Other Meds:

Current Illness:

ID: 1370979
Sex: M
Age: 42
State: IN

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/03/2021
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: Skin began to ache and became sensitive about 11 hours after vaccine was received. Began having chills, lethargy, body aches (it felt like both inside of body and outside of skin), nausea, and high fever. Took Tylenol and Advil to attempt to alleviate symptoms. Could not get to sleep until about 12:30 a.m. and woke up at 2:30 a.m. with headache, extreme chilling, and intense body aches. I didn't know if I could walk. I put a sweatshirt and a coat on, and my teeth were chattering uncontrollably. I can't remember the last time that I was that sick. I contemplated going to the ER but didn't think I could drive. The entire day was a headache, nausea and lethargy. When at the clinic, I stated that I had heard that there could be some minor side effects with the 2nd shot and was told, "Nah, people make things up." I'm so glad that I'm vaccinated, but people need to be forewarned of those kinds of side effects. They have to be aware because that was dangerously sick and was totally unprepared to combat it. 103+ degree fever and this kinds of symptoms aren't things that a person should have to try to make it through alone.

Other Meds: n/a

Current Illness: None

ID: 1370980
Sex: M
Age: 24
State: FL

Vax Date: 06/02/2021
Onset Date: 06/02/2021
Rec V Date: 06/03/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1370981
Sex: F
Age: 59
State: NY

Vax Date: 03/19/2021
Onset Date: 03/19/2021
Rec V Date: 06/03/2021
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: Nausea

Symptoms: My left should and upper arm, started becoming sore and stiff the same evening I received the injection which was on a Friday and by Sunday my arm was very painful and I could not move my arm in any direction. Dr. diagnosed it as being a frozen shoulder due to the injection being improperly administered. Currently going through 8 weeks of physical therapy and if my arm and shoulder haven't had significant improvement by the end of June, I may have to have surgery. Constant pain every day now for 3 months, can't sleep well as pain keeps me up at night, difficulty getting dressed and undressed, driving a car and doing my hair, can't lift anything and every time after therapy I suffer from severe pain for two to three days after.

Other Meds: atentolol, levothyroxine, omeprazole, smvastatin, chewable C, vitamin D3, probotics, and super B complex

Current Illness: none

ID: 1370982
Sex: F
Age: 21
State: RI

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

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: Systemic: Dizziness / Lightheadness-Medium, Additional Details: During the 15 minute monitoring period patient complained of dizziness and lightheadedness. Sat on floor, gave pt bottle of water and instructed her to lower her head. She never lost consciousness. She called her father to pick her up as she refused any suggestion of 911. By the time her family member arrived she was feeling much better. I walked her out to the parking lot and spoke to her ride. I called her at 7:10pm and she had slept/napped and felt back to normal.

Other Meds:

Current Illness:

ID: 1370983
Sex: F
Age: 16
State: FL

Vax Date: 06/02/2021
Onset Date: 06/02/2021
Rec V Date: 06/03/2021
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: Error: Improper Storage (temperature)

Other Meds:

Current Illness:

ID: 1370984
Sex: M
Age: 21
State: MD

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

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

Lab Data:

Allergies:

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

Symptoms: Error: Booster Given Too Early.

Other Meds:

Current Illness:

ID: 1370985
Sex: F
Age: 39
State: NJ

Vax Date: 05/19/2021
Onset Date: 06/01/2021
Rec V Date: 06/03/2021
Hospital: Y

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: Within a week went to hospital with severe chest pains. Diagnosed with inflammation around and in my heart

Other Meds: None

Current Illness: None

ID: 1370986
Sex: F
Age: 41
State: IN

Vax Date: 06/01/2021
Onset Date: 06/02/2021
Rec V Date: 06/03/2021
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: Iodine

Symptom List: Erythema, Pruritus

Symptoms: Pain at injection site, body pain, fatigue, malaise

Other Meds:

Current Illness:

ID: 1370987
Sex: M
Age: 81
State: MD

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/03/2021
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:

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

Symptoms: Systemic: slight numbness left leg,patient was able to walk-Mild, Systemic: Numbness (specify: facial area, extremities)-Mild, Additional Details: patient complained of slight numbness in his left leg after the shot. according to daughter he sometimes gets numbness in his leg. it has happened before, just not with a vaccine.

Other Meds:

Current Illness:

ID: 1370988
Sex: F
Age: 49
State: TX

Vax Date: 04/18/2021
Onset Date: 04/18/2021
Rec V Date: 06/03/2021
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: Systemic: Chest Tightness / Heaviness / Pain-Mild, Additional Details: heavy menstrual flow for 2 periods after her 2nd vaccine, ears feel blocked, lump in chest, chest pain

Other Meds:

Current Illness:

ID: 1370989
Sex: F
Age: 21
State: IL

Vax Date: 06/02/2021
Onset Date: 06/02/2021
Rec V Date: 06/03/2021
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: Asthenia, Chills, Headache, Myalgia

Symptoms: Systemic: Body Aches Generalized-Severe, Systemic: Fever-Medium, Systemic: Nausea-Medium, Additional Details: Patient describes also skin painful to touch along with pain all over her body. Describes pain as the worst she has ever had.

Other Meds:

Current Illness:

ID: 1370990
Sex: M
Age: 34
State: NV

Vax Date: 04/21/2021
Onset Date: 04/21/2021
Rec V Date: 06/03/2021
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: Site: Pain at Injection Site-Severe, Additional Details: Pt claims he has constant pain radiating from his left deltoid all the way to his biceps and triceps.

Other Meds:

Current Illness:

ID: 1370991
Sex: F
Age: 51
State: MS

Vax Date: 05/10/2021
Onset Date: 05/14/2021
Rec V Date: 06/03/2021
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: Site: Itching at Injection Site-Mild, Site: Redness at Injection Site-Mild, Site: Swelling at Injection Site-Mild

Other Meds:

Current Illness:

ID: 1370992
Sex: F
Age: 18
State: VA

Vax Date: 06/02/2021
Onset Date: 06/03/2021
Rec V Date: 06/03/2021
Hospital:

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

Lab Data:

Allergies: -Shellfish -Peanuts -Tree nuts -Apples

Symptom List: Pain in extremity

Symptoms: Vomiting every 20 minutes for a period of 3 times.

Other Meds: -Multivitamin pill -Iron supplements -Biotin gummies -Allegra

Current Illness:

ID: 1370993
Sex: M
Age: 36
State: CA

Vax Date: 05/30/2021
Onset Date: 05/30/2021
Rec V Date: 06/03/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Systemic: Allergic: Difficulty Breathing-Medium, Systemic: Diarrhea-Medium, Systemic: Nausea-Medium, Systemic: Vomiting-Medium, Additional Details: Received 2 nd dose of Moderna shot on Sunday. Sunday night and Monday, patient states he had vomting and diarrhea. Vomiting and diarrhea stop on Monday. Monday night and Tuesday, bodyache. Tuesday night and Wednesday, patient has asthmatic symptoms.

Other Meds:

Current Illness:

ID: 1370995
Sex: F
Age: 36
State: NC

Vax Date: 01/12/2021
Onset Date: 04/01/2021
Rec V Date: 06/03/2021
Hospital: Y

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

Lab Data:

Allergies: Nkda

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

Symptoms: Intrauterine growth restriction. Treated with Csection at 37 weeks on 5/10/21 ( original estimated due date was 5/28/21). Birthweight only 4lbs 2oz.

Other Meds: Prenatal, aspirin, vitamin d

Current Illness:

ID: 1370996
Sex: F
Age: 25
State: IN

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

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

Lab Data:

Allergies:

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

Symptoms: Fatigue, aches, fever, chills

Other Meds: Birth control - Blisovi, Claritin

Current Illness:

ID: 1370997
Sex: F
Age: 75
State: MI

Vax Date: 05/10/2021
Onset Date: 05/24/2021
Rec V Date: 06/03/2021
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: Systemic: Blood Disorder (diagnosed by MD)-Severe, Additional Details: Patient was diagonised with blood clot few days after J&J covid vaccine. Patient was treated in the hospital and doing better.

Other Meds:

Current Illness:

ID: 1370998
Sex: F
Age: 55
State: MI

Vax Date: 04/10/2021
Onset Date: 04/22/2021
Rec V Date: 06/03/2021
Hospital: Y

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

Lab Data:

Allergies: Adhesive tape (rash)

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Patient presented to emergency department on 4/22/2021 with symptoms of shortness of breath, fatigue, body aches, and fever. Patient was diagnosed with COVID-19 infection on 4/17/2021 with symptoms starting on 4/14/2021. Patient was treated with dexamethasone, remdesivir, and supplemental oxygen. Patient has clinically improved and was discharged from hospital on 4/28/2021.

Other Meds: amLODIPine (NORVASC) 5 MG tablet furosemide (LASIX) 20 MG tablet gabapentin (NEURONTIN) 600 MG tablet ibuprofen (MOTRIN) 800 MG tablet lisinopril (PRINIVIL) 10 MG tablet

Current Illness: None known

ID: 1370999
Sex: F
Age: 46
State: NJ

Vax Date: 06/02/2021
Onset Date: 06/02/2021
Rec V Date: 06/03/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Error: Diluent Administered Instead of Vaccine

Other Meds:

Current Illness:

ID: 1371000
Sex: F
Age: 48
State: IN

Vax Date: 01/29/2021
Onset Date: 03/19/2021
Rec V Date: 06/03/2021
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: Sulfa and codeine

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Soreness an arm immediately after. Three weeks later began having severe joint pain, chronic fatigue and hives with extreme itching

Other Meds: Zoloft, trazadone, pantoprozol, acyclovir, synthroid, lisinopril, estradiol, stool softener, vit d3, fish oil, biotin, multivitamin

Current Illness: None

ID: 1371003
Sex: F
Age: 78
State: MI

Vax Date: 06/02/2021
Onset Date: 06/02/2021
Rec V Date: 06/03/2021
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: Systemic: Headache-Medium, Systemic: Hypertension-Mild, Additional Details: said her head started hurting her from behind. her bp was 140/77 heart rade 77. told her to take tylenol and her regular meds. if her headache persists or gets worse to go to the er. her son has a bp cuff and will check her bp

Other Meds:

Current Illness:

ID: 1371004
Sex: M
Age: 15
State: ME

Vax Date: 06/02/2021
Onset Date: 06/02/2021
Rec V Date: 06/03/2021
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 known

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

Symptoms: Patient felt like a lump in his throat. No difficulty breathing or swallowing. VS 110/70 P. 56 Patient drank water and felt a little better. He went outside and felt better after removing mask. He felt it was starting to go away but was still there on one side. Both parents were with him and he went to the ER with them in their vehicle. This was dose 2 of Pfizer and he had no difficulty with the first dose.

Other Meds: None known

Current Illness: None known

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm