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: 1390176
Sex: F
Age: 41
State: OH

Vax Date: 04/27/2021
Onset Date: 04/27/2021
Rec V Date: 06/10/2021
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: N/a

Symptom List: Dysphagia, Epiglottitis

Symptoms: My left arm hurt and it was hard to lift above my head. It has remained painful and I am having difficulty using it.

Other Meds: Multivitamin

Current Illness: N/a

ID: 1390177
Sex: F
Age: 35
State: IN

Vax Date: 06/08/2021
Onset Date: 06/09/2021
Rec V Date: 06/10/2021
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: Codeine MSG

Symptom List: Anxiety, Dyspnoea

Symptoms: Nausea morning after, extending through second day after Dizziness Ears felt congested Hot flashes Treatment: rest, fluids, took time off work

Other Meds: Vitamin D Vitamin C Probiotic Multivitamin Spironolactone

Current Illness: None

ID: 1390178
Sex: M
Age: 11
State: PA

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 06/10/2021
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: none

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

Symptoms: Patient came with his father who put his date of birth as date. I verified his birthday and I also talked for several minutes about this birthday being on the same day as his vaccine. When I went to data enter information on the patient we had rxs and documentation from his doctor that his birthday was date. We tried to call the father to ask about the discrepancy but did not hear back from them. The child will be 12 in 6 more days.

Other Meds: unknown

Current Illness: none

ID: 1390179
Sex: F
Age: 53
State: PA

Vax Date: 05/28/2021
Onset Date: 06/09/2021
Rec V Date: 06/10/2021
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: Very heavy and painful menstrual cycle.

Other Meds:

Current Illness:

ID: 1390180
Sex: F
Age: 24
State: TN

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 06/10/2021
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: The pharmacy administered a vaccine that had been out of the refrigerator for 7.5 hours. Then administered a 2nd dose within 10 to 15 minutes after the first dose

Other Meds:

Current Illness:

ID: 1390181
Sex: F
Age: 23
State: CA

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 06/10/2021
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: NA

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

Symptoms: Patient received 2nd dose of Moderna vaccine, and as she stood up, she reported feeling dizzy and some tingling in BUE and BLE. Patient had a witnessed-assisted fall to the floor, did not hit her head, regains consciousness quickly with no injury from fall. Initial VS: BP 135/86 HR 97 RR 18 O2 sat 98%. Assisted to WC. Brought to medical bay. Monitored vital signs. Provided H2O. At 5:20 PM Checked final V/S: BP: 127/83 HR 99 RR 19 SaO2 99%. At discharge, patient A&O x4 with no complaint. Patient able to ambulate without assist. Patient discharged home with bf.

Other Meds: NA

Current Illness: NA

ID: 1390182
Sex: F
Age: 33
State: TN

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

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

Lab Data:

Allergies: none known

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Dizziness, fainting, possible seizure, numbness/tingling in right arm, slight numbness/tingling in right side of face

Other Meds: Norethindrone (birth control), prenatal vitamins, probiotic supplement

Current Illness: N/A

ID: 1390183
Sex: F
Age: 20
State: CO

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/10/2021
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: pfizer vaccine kept frozen more than the approved 14 day interval before thawing to administer.

Other Meds:

Current Illness:

ID: 1390184
Sex: F
Age: 40
State:

Vax Date: 04/14/2021
Onset Date: 04/14/2021
Rec V Date: 06/10/2021
Hospital:

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

Lab Data:

Allergies: Amoxycillin, Pollen, dust, citrus acid, foods in the nightshade family (tomatoes, eggplant, etc),

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Day 1, Swollen lips within 1hour, which disappeared when I took allergy medicine Day 3-14, Elongated red rash on arm below the injection site. Arm was very sore - could not turn in sleep . I went to another urgent care around day 11 and they said it was the vaccine. The rash cleared up but arm is discolored.

Other Meds: Fish oil, multi-vitamins, Vitamin-B Complex, Lutein

Current Illness: None

ID: 1390185
Sex: F
Age: 29
State: OR

Vax Date: 06/04/2021
Onset Date: 06/09/2021
Rec V Date: 06/10/2021
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: mild allergy to soy (rash, itchy eyes)

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Delayed rash at injection site. Arm is red, warm, painful, sore and itching. Skin appears red, shiny and indurated (hard). Rash started approx 6 days after vaccine. No fevers or other symptoms.

Other Meds: duloxetine 60mg vitamin D

Current Illness: none

ID: 1390186
Sex: F
Age: 34
State:

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 06/10/2021
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: At 1430 client reported to RN feeling "sensation of fluid running down arm". Vitals: blood pressure 148/98, pulse 86. Client reported feeling tingling sensation again within 5 minutes. Full sensation and motor present. 1445 client reported to PHN feeling tingling, but less than last time. No other complaints. Client stayed with RN for 30 mins. Last vitals at 1455: blood pressure 144/96, pulse 80. Per client only tingling sensation at fingers. RN educated client to follow up with provider and gave ER precautions. Client left facility with steady gait at 1500.

Other Meds: none

Current Illness:

ID: 1390187
Sex: F
Age: 0
State:

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 06/10/2021
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: None

Symptom List: Rash, Urticaria

Symptoms: Shortness of breath, cyanotic, irritability, fever over 39.5 ? C, on the verge of convulsions, paleness.

Other Meds: None

Current Illness: None

ID: 1390188
Sex: F
Age: 12
State: IA

Vax Date: 06/05/2021
Onset Date: 06/06/2021
Rec V Date: 06/10/2021
Hospital:

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

Lab Data:

Allergies: Blue dye (including blue food dye), pineapple, mango, kiwi

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

Symptoms: Chest pain and pressure; fever of 101 degrees F; shallow rapid breathing; rapid heart rate (120); fatigue and tiredness; feeling of being hot and unable to catch breath.

Other Meds: Flonase, Allegra, Singulair, multivitamin, vitamin C

Current Illness:

ID: 1390190
Sex: F
Age: 40
State:

Vax Date: 05/12/2021
Onset Date: 05/12/2021
Rec V Date: 06/10/2021
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: Amoxycillin, pollen, dust, citric acid, foods in nightshade family (e.g. tomatoes, eggplant)

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

Symptoms: Day 1 - 10, Elongated red rash on arm below injection site . It went away but arm is slightly discolored. Day 1-4, Fever, achy all over, felt weak - went away on day 4 Day 2-10, heavy feeling on chest - like someone was sitting on me

Other Meds: Fish oil, multi-vitamin, Vitamin-B complex, Lutein

Current Illness: Reaction from first shot - rash

ID: 1390191
Sex: F
Age: 30
State:

Vax Date: 05/14/2021
Onset Date: 06/01/2021
Rec V Date: 06/10/2021
Hospital:

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

Lab Data:

Allergies: No

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

Symptoms: Small indentation in the arm The area also itches

Other Meds: Bith Control ibuprofen

Current Illness: No

ID: 1390192
Sex: F
Age: 19
State:

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

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

Lab Data:

Allergies:

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

Symptoms: dizziness after 15 minutes sitting down post vaccination. Recommended pt to sit another 10 minutes to sip on water, snack and relax. after which pt stated she felt better. no more dizzines

Other Meds:

Current Illness:

ID: 1390193
Sex: F
Age: 23
State: OR

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 06/10/2021
Hospital:

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

Lab Data:

Allergies: None listed

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

Symptoms: Pt had small rash on wrist.

Other Meds: Unknown

Current Illness: None listed

ID: 1390194
Sex: F
Age: 22
State: PA

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 06/10/2021
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 known

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Soreness radiating from injection site from shoulder blade to fingers, like getting punched. Not unusual for me. 12ish hours later, lethargy, feeling like I'm on the verge of crying, body aches, chest tightness, tightness of jaw, nausea, headache, chills, dizziness, emotional sensitivity, palpitations, still numb in the left arm.

Other Meds: Bupropion HCL SR 100mg

Current Illness: none known

ID: 1390195
Sex: F
Age: 0
State: MN

Vax Date: 11/17/2020
Onset Date: 11/17/2020
Rec V Date: 06/10/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Patient received a fourth dose of HepB at her six month appointment. She received doses at birth, 2 months, 4 months, and 6 months. I don't have a specific onset of symptoms but she was noted to have unexplained increased irritability. In the weeks after she was sent home from daycare with a fever of unknown origin.

Other Meds: none

Current Illness: none

ID: 1390197
Sex: M
Age: 13
State: WA

Vax Date: 06/08/2021
Onset Date: 06/10/2021
Rec V Date: 06/10/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: Pt texted mom at work, stating he was having difficulty breathing. Advised mom to arrange to have him examined as soon as possible.

Other Meds: not known

Current Illness: none known

ID: 1390198
Sex: F
Age: 76
State: NY

Vax Date: 03/26/2021
Onset Date: 05/09/2021
Rec V Date: 06/10/2021
Hospital: Y

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: None

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

Symptoms: Acute idiopathic Pericarditis with recent hx of new onset rapid atrial fib admitted from 5/18-5/21 thought to be a possible immune mediated side effect from her covid 19 vaccine .. since 5/9 she has been experiencing daily severe headaches, malaise, intermittent palpitations. Ct brain at that time neg for bleed but showed small/old b/l lacunar infarcts. cta was neg for pe/acute pathology. She was discharged out on amiodarone, metoprolol and eliquiss to follow up with cardiology.on follow up with him her amiodarone was dc'd and the plan was to see EP for possible cardioversion but She then was readmitted from 6/5 -6/8 with new pericardititis with new b/l pleural effusions, new chf and new cardiomyopathy. She c/o 2 days of sob, b/l shoulder pain, chest heaviness and pain, worsened while lying flat along with continued intermittent racing heart. cxr showed new Basilar predominant opacities in both lungs suggesting pulmonary edema and was admitted with new chf with bnp of 993. She was then noted to have an elevated wbc with left shift and a fever and her CRP was markedly elevated at 67. CT chest showing Nonspecific abnormalities including 1cm thick pericardial effusion, bilateral pleural effusions and mild right-sided ground-glass lung opacification. . She has had no recent infections, travel, cont meds, does not drink alcohol, smoke or use drugs or supplements covid 19 neg. She was started on colchicine 0.6mg bid and ibuprofen 600mg q8h on 6/6 and was discharged home to follow up again with cardiology. she has improvement in herwbc to normal, resolution of L shift, resolution of fever and only slight increased crp. She has also converted to sinus rhythm although still tachycardic around 110bpm. Her headache is gone and she is no longer vomiting. State echo done this am showing ef 55% and new hypokinesis of the basal inferior wall and a Small amount of pericardial effusion with out any doppler evidence of Tamponade She had an echo last month which was normal She was also started on antibiotics due to b/l effusions which were eventually stopped before discharge

Other Meds: citalopram 10 MG Oral tablet gabapentin 300 MG Oral capsule levothyroxine 175 MCG Oral tablet lisinopriL 10 MG Oral tablet traMADoL 50 mg Oral tablet

Current Illness: None

ID: 1390199
Sex: M
Age: 13
State: TX

Vax Date: 06/08/2021
Onset Date: 06/09/2021
Rec V Date: 06/10/2021
Hospital:

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

Lab Data:

Allergies: Omnicef

Symptom List: Unevaluable event

Symptoms: Fever and fatigue the day of injection, itching and rash all over his body 12 hrs after injection

Other Meds: Claritin, Zyrtec

Current Illness: None

ID: 1390200
Sex: M
Age: 13
State: NC

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 06/10/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Brief 1-2 second episodes of vertigo once or twice daily since day of vaccination, reported on 6/10/2021. Of note, patient had one such episode of vertigo one week prior to first vaccination on or about 5/13/2021, so not entirely clear that this was new symptom after vaccine, but frequency did increase. No other associated cardiac or neurologic symptoms.

Other Meds: None

Current Illness: Patient did describe one episode of brief vertigo about one week prior to vaccination, about 5/13/2021, so not entirely clear that these were new symptoms after vaccination.

ID: 1390201
Sex: M
Age: 32
State: MA

Vax Date: 05/05/2021
Onset Date: 05/05/2021
Rec V Date: 06/10/2021
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:

Symptom List: Injection site pain, Pain

Symptoms: Within 30 minutes I felt confused and light headed and it reminded me of feeling like I had a concussion. I had dark spots in my vision and intense pressure in my head. As I had been told to expect random side effects I went home and went to sleep early. The next day I had a lack of motor function with continued intracranial pressure and confusion. I called my doctor and went to the Emergency Room where my Blood Pressure was recorded to be Hypertensive and then retaken. I was given a CT scan and sent home. I was unable to work the rest of the week and was out of work after being sent home sick the following week. I continued to experience intense intracranial pressure and an inability to form short term memories for three weeks after vaccination. I still continue to experience intracranial pressure and episodes of hypertension but have more ease in forming short term memories. Intracranial pressure has nonetheless decreased significantly compared to the immediate onset following inoculation. My medical testing is ongoing.

Other Meds: Omeprazole

Current Illness:

ID: 1390202
Sex: M
Age: 57
State:

Vax Date: 06/09/2021
Onset Date: 06/10/2021
Rec V Date: 06/10/2021
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: dizziness 15 min after vaccine, called patient, only sore arm now, will follow up with PCP if any other symptoms

Other Meds:

Current Illness:

ID: 1390203
Sex: M
Age: 39
State: NY

Vax Date: 05/12/2021
Onset Date: 05/16/2021
Rec V Date: 06/10/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Bilateral swollen lymph nodes in armpits. Painful. Large swollen left supraclavical lymph node.

Other Meds: None

Current Illness: None

ID: 1390204
Sex: M
Age: 28
State: CA

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 06/10/2021
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: onions

Symptom List: Nausea, Pain in extremity, Pyrexia

Symptoms: Client reports immediately after getting does that his left arm from the injection site down feels "heavy". At 4:04PM Vitals are taken by PHNs pulse 77, blood pressure: 130/80 and oxygen: 97%, . Client reports sensory and motor are intact. No other symptoms reported. At 4:06pm client reports arm is feeling better. At 4:09PM oxygen is 98%, pulse: 72 and blood pressure 122/86 and still feeling heaviness in arm. At 4:14pm, client reports that arm sensation of "heaviness" has resolved. Oxygen: 99%, pulse:76 and blood pressure: 122/82. At 4:19pm vitals oxygen:98%, pulse:77 and blood pressure 110/88 no symptoms at this time. At 4:24pm no symptoms reported and vitals: oxygen:98%, pulse:76 and blood pressure:120/82. At 4:30pm PHN gave ER precautions. oxygen 98%, pulse: 79 and blood pressure: 128/90. Client reports he has no primary care provider and will be returning to his country tonight. No symptoms reported. At 4:33pm last set of vitals: blood pressure:120/86, pulse:79 and oxygen 99%. Client left the facility unassisted at 4:35pm.

Other Meds: none

Current Illness:

ID: 1390205
Sex: M
Age: 24
State: OR

Vax Date: 05/16/2021
Onset Date: 05/18/2021
Rec V Date: 06/10/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Chest pain. Felt like pressure in the upper chest. Hurts less when leaning backwards or laying down. Hurt worse when breathing in.

Other Meds:

Current Illness:

ID: 1390206
Sex: F
Age: 55
State: TN

Vax Date: 05/11/2021
Onset Date: 05/12/2021
Rec V Date: 06/10/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Very large hand size bruise, very dark about 2 inches below injection site. Lasted a complete 3 weeks.

Other Meds: None

Current Illness: None

ID: 1390315
Sex: F
Age: 81
State: NY

Vax Date: 05/14/2021
Onset Date: 05/31/2021
Rec V Date: 06/10/2021
Hospital: Y

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: Recent J and J vaccine on may 14th and then hospitalized on 5/31/21 till 6/7/21 with new onset rapid afib/new non ischemic cardiomyopathy ef 35%/ elevated inflammatory markers, new pleural effusions/sob-CTA chest neg for pulmonary embolism. , Pt did not have her vaccine card for her lot number. Reports her friend stole her card because she wasn't vaccinated and wanted it so she stole it but reports she has had the J and J on May 14th in her right arm. Pt was transferred to a larger teritary care hospital on 6/3 where she had cardiac cath and was evaluated by the heart failure team and discharged home with home health care services on 6/7/21. Her cardiac catheterization revealed patent 2 vessel bypass grafts/non ischemic cardiomyopathy. Cause for sudden cardiomyopathy and new atrial fibrillation unknown. discharged on amiodarone, entresto, demedex and eliquis.

Other Meds: estridiol vaginal cream lisinopril baby aspirin metformin

Current Illness: None

ID: 1390316
Sex: M
Age: 62
State: AZ

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

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

Lab Data:

Allergies: None

Symptom List: Injection site pain

Symptoms: Chest pain , nausea, sweating, back pain, light headed , high blood presser. 159/108 .

Other Meds: Omeprazol 40 mg. E.R. Propranolol 60 mg Magnesium 400 mg Red Yeast Rice plus 1200 mg Mens multivitamin Vitamin D3 5000 mg

Current Illness: None

ID: 1390317
Sex: F
Age: 47
State: NM

Vax Date: 04/07/2021
Onset Date: 04/08/2021
Rec V Date: 06/10/2021
Hospital:

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

Lab Data:

Allergies: no

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

Symptoms: Pain at injection site beginning day of vaccine and lasting 5 days. Occurred with both vaccine doses. Fatigue for 48 hours beginning day after vaccination. Occurred with both doses. Fever for 24 hours beginning day after vaccination. Occurred with second dose only. Nausea for 24 hours beginning day after vaccination. Occurred with second dose only. Two menstrual cycles occurred 14 days apart between first and second doses of vaccine. (Never experienced rapid cycle before.) Menstrual cycle has since returned to normal. Intense muscle and joint pain interfering with mobility and activities began day after first dose of vaccine, and has continued intermittently for two months until present. (June 10, 2021) Pain affects hips, back, knees, ankles, knuckles, wrists, and elbows. Previous to vaccine, pain only experienced in hips and back if over-exercised.

Other Meds: Advil, Tylenol

Current Illness: no

ID: 1390318
Sex: M
Age: 59
State: MO

Vax Date: 04/28/2021
Onset Date: 05/12/2021
Rec V Date: 06/10/2021
Hospital: Y

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

Lab Data:

Allergies: none

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

Symptoms: about 2 weeks after 2nd injection, have had 3 episodes of left arm and hand (stroke affected), tingling, then hand seemed to shake progressing to arm violently shaking for a few minutes, conscious each time, but seemed like a dream, wet the bed unknowingly until waking up and feeling nauseous. The third time 05/30/2021, went by ambulance to emergency room and told they were seizures. was prescribed Levetiracetam 500mg. No seizures so far. Followed up today 06/10/2021 with primary care physician. Have July 21,2021 follow up appointment with neurologist *The reason I am reporting is because of my primary care physicians response to a comment I made to him about my sister thinking it could be the covid vaccine, while I thought perhaps it might be mini strokes, and he said it wasn't known that it might not be the vaccine. They told me in the hospital that the mri didn't show any more stroke damage than what had occurred from the initial stroke I had earlier.

Other Meds: Amlodopine 5mg, aspirin325mg,glipizide 5mg, Levothyroxine 100mcg,sertraline 100mg

Current Illness: none

ID: 1390319
Sex: F
Age: 52
State: VA

Vax Date: 02/04/2021
Onset Date: 02/26/2021
Rec V Date: 06/10/2021
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: Penicillin, cefalexin, Cipro, chicken, seaweed, bergamot

Symptom List: Tremor

Symptoms: Intestinal pain, antibiotics (Flagyl and Cipro for 10 days), continued intestinal pain, ER visit on 4/10/2021, CT scan showed appendicitis, appendectomy on same day

Other Meds: Doxycycline , Vitamin D, Mirena

Current Illness: Rosacea

ID: 1390321
Sex: F
Age: 61
State: CA

Vax Date: 04/26/2021
Onset Date: 04/26/2021
Rec V Date: 06/10/2021
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, Cipro

Symptom List: Erythema, Pruritus

Symptoms: Pins and Needles neuropathy, still hasn't gone away as of today at 6 ? weeks.

Other Meds: vitamins

Current Illness: None

ID: 1390322
Sex: M
Age: 32
State: IL

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

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

Symptoms: slept first day after vaccine began losing appetite slightly no change in bowel by day 3 breathing was a bit labored chalked it up to regular auto immune response and chest inflammation day 5 night sweats and woke up to wet pillow day 6 fought consciousness after coming home from non strenuous day and was taken to hospital at my resquest. sweaty palms mild headache chest pain and slight tenderness in ribs

Other Meds: none

Current Illness: none

ID: 1390323
Sex: F
Age: 55
State: FL

Vax Date: 04/06/2021
Onset Date: 04/06/2021
Rec V Date: 06/10/2021
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: n/a

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

Symptoms: Headache Chest pain Difficulty walking Shortness of breath Abnormal heart rhythm

Other Meds: Aspirin 81 mg Dapagliflozin 10 mg Gabapentin 100 mg Glyburide-metFORMIN 5 mg 500 mg Insulin glargine (Toujeo Solostar) 15 units Lisinopril 20 mg Metoprolol 50 mg Multivitamin (Super B complex) 1 tab Prescription: Pantoprazole (Protonix 40

Current Illness: n/a

ID: 1390324
Sex: F
Age: 0
State: CA

Vax Date: 12/20/2009
Onset Date: 05/20/2021
Rec V Date: 06/10/2021
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: n/a

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Parent was not honest about patient age. Patient is actually 11 year old

Other Meds: n/a

Current Illness: n/a

ID: 1390325
Sex: F
Age: 10
State: CA

Vax Date: 05/20/2021
Onset Date: 05/20/2021
Rec V Date: 06/10/2021
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: client received 1st dose pfizer covid vaccine at age 10. Client did not report any adverse reactions.

Other Meds:

Current Illness:

ID: 1390326
Sex: F
Age: 23
State: MO

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 06/10/2021
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: None

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

Symptoms: Within minutes of receiving the covid vaccine, the patient stated that she felt hot and dizzy. She kept seated on her chair for 10 more mins, after which she felt like she was about to faint. She walked up to me (pharmacist) for assistance, at which point she lost consciousness for a brief second. My colleague and I held her and we laid her down on the floor. As soon as she was laid down she vomited. Her vomit was bright red color with granular particles. To avoid her from chocking, I immediately rolled her over to the left side at which point she said she is okay and needed to get up. She said that she just had some flaming hot chips before coming to get the vaccine. She was given water to drink and a granola bar to eat and she was monitored for another 30 minutes without any further issues.

Other Meds: None

Current Illness: None

ID: 1390327
Sex: F
Age: 34
State: NJ

Vax Date: 04/15/2021
Onset Date: 04/18/2021
Rec V Date: 06/10/2021
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: dust, cats, seasonal, sunlight

Symptom List: Pain in extremity

Symptoms: The Moderna covid vaccine was the first vaccine I ever had. On the evening of the 18th, I was sitting alone after work, scrolling my phone when my heart started beating very fast, hard, and irregularly. I felt pressure in my chest and a wave of tingling wash over my head. My vision went funny and grey around the edges as if I was about to pass out. It felt lie something was squeezing my heart. I sat on the floor, put my head between my knees and took deep breaths. The heart rate spikes seemed to come in waves with a feeling of pressure every few minutes. I called someone to take me to the ER and they arrived about 45 minutes after initial symptom onset. My heart rate had slowed slightly and the spikes were coming farther apart by then. It was cold in the car and it gave me chills, but I felt that it made me feel a little better. At the ER, they kept me from about 9:30 pm to after 3:00 am. My symptoms slowly abated, with heart rate spikes coming about every 15 to 30 minutes, but shorter, and not going as high. I sat there and watched the pulse monitor for abot 5 hours, varying between the 60s and 108. I was discharged after several tests without a diagnosis and told to follow up with a cardiologist in 2 days. The attending physician verbally told me the tests were normal and I was fine, but when I viewed my test results online, it said I had an abnormal ECG, left atrial inflammation, and a possible heart attack. I was uninsured at the time, so they declined to run expensive tests. I also did not have a primary care provider. Around midnight on the evening of the 20th/morning of the 21st, a similar thing occurred while I had a late night snack and watched a TV show. I did not feel as if I was going to pass out, but had regular heart rate spikes, and a rapid, irregular heartbeat with pressure in my chest. This time I also had nausea and burning in my stomach. I did deep breathing all night. Managed to doze for about an hour. This episode lasted until 6 am. I felt better then and tried to find a cardiologist, but was referred to the ER. By the time a friend took me there (around 7-7:30 am, I think), my symptoms had largely abated, but I was very fatigued and short of breath just standing. I was again discharged after testing with no diagnosis, but told to follow-up with a cardiologist. Again, I was verbally told again that the tests were normal and I was fine, but the notes said possible biatrial inflammation. By this point, my chest ached constantly. A close friend came to help take care of me on the evening of the 22nd, and I got so excited to see her that my heart rate spiked again. I lay down and did deep breathing and couldn?t talk to her or look at her until the next day without intense heart rate spikes, nausea, chest pain, and chest pressure. I saw Dr. on the 23rd. He diagnosed me with orthostatic hypotension and tachycardia. He took my pulse while sitting (about 80, which is high for me, because my average resting pulse is usually in the high 40s/low 50s), and when standing. When I stood up, my pulse went to 120 and I became short of breath. He told me to drink pedialyte, ingest a lot of salt (he declined to recommend a specific amount), wear compression stockings, exercise while lying down, and ease myself back into activity. I should also keep my feet up as much as possible. I immediately started drinking a lot of pedialyte (a gallon to a gallon and a half a day), eating salty foods, and keeping my feet elevated. I continued to be very fatigued with episodes of rapid heartbeat (though not as bad as I went to the ER for). I frequently got a squeezing feeling in my chest as if my heartbeat was irregular. I took my blood pressure regularly and it was usually low (90s/?). Anything that was remotely exciting spiked my heart rate. I could not watch TV, listen to music, game, talk on the phone, or even sit upright.All I could do was lie flat and play boring, unexciting games on my phone. This continued for weeks. I could only sleep on my back because sleeping on my side gave me a feeling that my heart was compressed and increased my heart rate. When I got out of bed, after a few seconds I would get black spots in my vision and a wave of tingling over my scalp and feel as if I were abot to pass out. Bending over and leaning on the counter for about 5-10 seconds makes this abate. My friend had made me an appointment on April 28th, so I went to this appointment because I was not feeling better and wanted a second opinion. Dr. did not communicate as well, but seemed to agree with Dr. assessment. He prescribed fludrocortisone, metaprolol, and sertraline. He told me to take the fludrocortisone for two days before starting the metaprolol. The metaprolol seemed to help. It started keeping my heart beat irregularity/spike episodes from getting as high or lasting as long. Those have slowly diminished, though I still have a lesser version of them. The metaprolol also seemed to mostly end the squeezing feeling to my heart and irregular beat. On the evening of the May 6th, my heart started beating very hard and fast. My blood pressure was 140/?. I stopped taking the fludrocortisone and ingesting salt. I also had a squeezing feeling at the bottom of my sternum. On the 7th, I was unable to take a full breath. Whenever I tried to inflate my lungs, the squeezing feeling at the bottom of my sternum would worsen and keep my lungs from expanding. If I lay flat and only took shallow breaths, I didn?t notice anything, but as soon as I sat up or tried to stand, I could barely breathe. Dr. office referred me to the ER . At the ER, my blood pressure was 160/?. I was admitted to the hospital on the evening of the 7th and discharged on the 10th. During my stay, I was able to get temporary Medicaid to cover my hospital bills. Insurance through get covered would start on the first of June. During my hospital stay, I lay flat constantly so I could breathe, and that symptom slowly lessened, though did not go away completely. I also started experiencing tension in my throat and jaw while lying flat on my back and could not find a comfortable sleeping position. I was seen by a cardiologist who ordered tests for me on the 8th and the tests were administered on the 10th. I was briefly seen by a cardiologist, that morning and he said it was possible I had a hiatal hernia that was physically irritating my heart. At that time, my admitting doctor, told me nothing matched my symptoms and maybe it was anxiety. The discharge paper listed anxiety, depression, increased risk of falls, decreased cardiac output, high risk of bleeding, and orthostatic hypotension. Verbally, I was told I was a clot risk, but it was not on my discharge papers. I was not referred to psych or prescribed medication, or referred for an endoscopy, but discharged with the exact same symptoms I had been admitted for and told to follow up with a cardiologist in a couple weeks. Over the course of the next couple weeks, without treatment, the tension in my chest slowly eased until I could breathe almost normally. Taking a deep breath still gives me a weird feeling of uncomfortableness and pressure in my chest, but only a deep one. I still get winded easily, but not fromstanding up or walking around my apartment. Bending over is hard. I started being able to carry things as long as they weren't heavy. On May 18th and June 8th, I saw a primary care provider, who ordered more tests and referred me to a pulmonologist, endocrinologist (next week and the week after), psychiatrist and psychologist (but I am having trouble finding ones who will work with my insurance). I also saw a gastroenterologist, on the 21st, was prescribed Prilosec, and scheduled an endoscopy in early July. I still have a lot of the same symptoms, some of them have lessened a little, and some are mostly gone. Fatigue is constant, shortness of breath, tightness in my throat, tightness at the bottom of my esophagus, and increased heartbeat are common. Nausea and stomach burning only occur occasionally, but I still have nearly constant discomfort at the bottom of my esophagus/top of my stomach. I constantly feel as if som

Other Meds: melatonin, cbd, multivitamin

Current Illness: none

ID: 1390329
Sex: F
Age: 73
State: WA

Vax Date: 03/12/2021
Onset Date: 03/13/2021
Rec V Date: 06/10/2021
Hospital:

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

Lab Data:

Allergies: cephalexin monohydrate, co-trimoxazole, etodolac, gentamicin sulfate, latex, penicillin, sulfa, sulfacetamide sodium.

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

Symptoms: Reaction was either in my lymph nodes or bursa's that became inflamed in left elbow and left knee. To date (6-10-21) the elbow has gotten better, but, the knee has still remained swollen and painful. 4-20-21 Dr., Rheumatologist, removed fluid off left knee and gave me a cortisone shot. First shot was given at fairgrounds. Second shot was scheduled for 4-2-21 but, deferred due to allergic reaction to first shot. this has been indicated on my vaccine card. Please let me know if I need to provide any additional information. Thank you

Other Meds: none

Current Illness: none

ID: 1390330
Sex: F
Age: 63
State: NC

Vax Date: 05/19/2021
Onset Date: 05/19/2021
Rec V Date: 06/10/2021
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: flagyl

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

Symptoms: serious Flu symptoms: fever, chills, muscle aches/weakness, fatigue, bedridden, lasted 2 days

Other Meds:

Current Illness: cholesterol; arthritis; hand neuropathy; obese; general anxiety; low blood sugar

ID: 1391423
Sex: F
Age:
State: OR

Vax Date: 01/01/1970
Onset Date:
Rec V Date: 06/10/2021
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: None stated.

Other Meds:

Current Illness:

ID: 1395622
Sex: M
Age: 67
State: WI

Vax Date: 02/10/2021
Onset Date: 02/24/2021
Rec V Date: 06/10/2021
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: Paxil

Symptom List: Vomiting

Symptoms: Blurred vision due to central RetiNal VeiN occlusion uccured 1 week after 1st Pfizer COVID 19 vacc on 2/10/21

Other Meds: Vit D3, Vit B12 , Atenolol, CloNazepam, Buproprion

Current Illness: N/A

ID: 1395902
Sex: F
Age:
State: WI

Vax Date:
Onset Date:
Rec V Date: 06/10/2021
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: NSAID's (gi upset)

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Fatigue, weakness, shaky, short of breath, tired. nauseated, palpitations, headaches, feels like she is 'hung-over' all of The time (headaches). muscle aches . all over The body. chest pressure all symptoms starting within 2 weeks of the 1st vaccine. and worsening with the 2nd vaccine

Other Meds: oral Budesonide

Current Illness: -

ID: 1403036
Sex: F
Age: 76
State: FL

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 06/10/2021
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: Patient received second dose of Covid 19 vaccine at 10:15am. Patient was asked to wait 15 minutes and report any adverse events. She stated she was experiencing blurry vision. Patient was asked to wait another 15 minutes and then she stated she was ok to return home. Called to check on patient at home. Patient stated she still had blurry vision

Other Meds:

Current Illness: N/A

ID: 1390331
Sex: F
Age: 56
State: WA

Vax Date: 04/22/2021
Onset Date: 05/12/2021
Rec V Date: 06/11/2021
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: adverse reaction to Codeine

Symptom List: Injection site swelling, Limb discomfort

Symptoms: 20 days following 1st Moderna dose, I experienced significant vertigo (have never had previously), onset included complete loss of balance, dizziness, nausea, vomiting, which improved to dizziness and feeling of motion sickness throughout the first 24 hours. Nausea and motion sickness persisted, at varying levels, for the following 5 days. Dramamine provided some relief.

Other Meds: Alive Women's 50+ multi-vitamin, Spring Valley Calcium, Magnesium & Zinc supplement

Current Illness: none

ID: 1390332
Sex: M
Age: 76
State: OR

Vax Date: 04/30/2021
Onset Date: 05/24/2021
Rec V Date: 06/11/2021
Hospital: Y

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

Lab Data:

Allergies: methylprednisone, grasses

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

Symptoms: Initially - chest pain 10 on 1-10 scale, heart rate 145 BPM, headaches, paramedics said A-fib abnormal heart rhythm, converted as they were checking; went to ER, admitted patient, stayed 5/24-5/27, gave tests including cardiac catheterization, echocardiograms, C-T scans of chest & head - all negative. In ER also found elevated cardiac protein-enzyme. Also in ER, chest pain reduced to 3 on 1-10 scale. Repeated some of the tests next day.

Other Meds: carvedilol, lisinopril, nifedipine, atorvastatin, paxil, vitamins D & E, fish oil, melatonin, caffeine, ibuprofen, omeprazole

Current Illness: high blood pressure

ID: 1390333
Sex: F
Age: 58
State: CA

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 06/11/2021
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:

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

Symptoms: Patient reports headache, dizziness, feeling a hot sensation and a dry throat within 5 minutes after vaccine. Patient had similar reaction for first dose. Patient received a medical consult and was approved for 2nd dose of Moderna. Patient reports no shortness of breath, no chest pain, no blurred vision. Vitals taken at 2:04pm: blood pressure:110/76, pulse: 64 and oxygen: 96%. At 2:09pm patients vitals are taken again blood pressure: 110/71, oxygen: 98% and pulse 60. Patient reports feeling no improvement. PHN offers to call 911 but patient declines request. At 2:15pm vitals are pulse: 67, blood pressure: 111/69 and oxygen:98%. Patient alert and oriented x 4. no new symptoms reported. At 2:20pm patient reports dry throat is improving and heat sensation is improving . Vitals are pulse:62, oxygen:96% blood pressure:110/80. Patients' dizziness slowly improves . Headache resolves completely at 2:47pm. Patient attempts to stand up but still feels slight dizziness. Patient wait 15 more minutes and is walked out accompanied by 2 PHNs to vehicle. Patient is told it is not safe to drive while dizzy and provided with ER precautions.

Other Meds: lisinopril, atorvistatin, aspirin, metformin, xanax

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm