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: 1394309
Sex: F
Age: 59
State: WI

Vax Date: 04/19/2021
Onset Date: 04/22/2021
Rec V Date: 06/12/2021
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: None

Symptom List: Dysphagia, Epiglottitis

Symptoms: 3 days after 2nd Pfizer COVID vaccine- developed tinnitus in left ear. Peaked 2 weeks after shot. Still present 7 weeks post vaccine. Joined a tinnitus group on social media that has been very informative and helpful. Time seems to be the most common advice.

Other Meds: Glucosamine chondroitin Turmeric w/pipeline D3 Magnesium Fish oil Multivitamin Cranberry UC-ll Collagen

Current Illness: Moderate osteoarthritis

ID: 1394310
Sex: M
Age: 21
State: SC

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 06/12/2021
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: none

Symptom List: Anxiety, Dyspnoea

Symptoms: PT DID FINE IMMEDIATELY, ATER VACCINE WITHIN A FEW MINUTES HE PASSED OUT, FELL OUT OF HIS CHAIR AND STARTED SEIZING. I RUSHED OUT OF THE PHARMACY PUT A SOFT PAD UNDER HIS HEAD AND PREVENTED HIM FROM HITTING IT ON THE FLOOR. I TOLD A CUSTOMER TO CALL 911, SHOTRLY AFTER PATIENT WOKE UP AND ASKED US TO CALL HIS PARENTS. ANOTHER CUSTOMER DID THAT AND THEN THE EMS ARRIVED. THEY CHECKED ALL HIS VITALS WHICH WERE WITHIN NORMAL LIMITS AND HE CHOSE TO NOT GO WITH THEM. HIS SISTER PICKED HIM UP TO GO HOME. PT STATED HE HAD NOT EATEN THAT DAY AND HAD TAKEN IBUPROFEN BEFORE ARRIVING.

Other Meds: Ibuprofen OTC

Current Illness: none

ID: 1394311
Sex: F
Age: 21
State: MD

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

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

Lab Data:

Allergies: no

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

Symptoms: fever, nausea, difficulty breathing, chest pain, fast heart beat 125

Other Meds: nuva ring birth control, 20 mg of Methylphenidate

Current Illness: no

ID: 1394312
Sex: M
Age: 61
State: AZ

Vax Date: 04/19/2021
Onset Date: 05/14/2021
Rec V Date: 06/12/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: Racing heart, blood pressure drops feel clammy. 2 severe events many smaller events. Heart rate gets to near 100. My idle heart rate is in the mid 50's.

Other Meds: None

Current Illness: None

ID: 1394313
Sex: M
Age: 30
State: CT

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 06/12/2021
Hospital:

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

Lab Data:

Allergies: N/A

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

Symptoms: Pale, light headed, low blood pressure

Other Meds: N/A

Current Illness: N/A

Date Died: 06/12/2021

ID: 1394314
Sex: F
Age: 73
State: IN

Vax Date: 05/28/2021
Onset Date: 05/31/2021
Rec V Date: 06/12/2021
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: Latex Codeine

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

Symptoms: 73 y.o. female with a past medical history of non-insulin-requiring diabetes type 2 and recent admission at Hospital (5/31-6/6/2021) who was transferred on 6/9 for chest pain with worsening EF with concerns for ischemic cardiomyopathy. Hospital course by dates 5/31?6/6/2021: Admitted for abdominal pain, nausea and vomiting thought to be secondary to ischemic colitis and severe constipation. Patient was found to be anemic during that hospitalization, but did not require blood transfusion. Patient's hospital course was complicated by aspiration pneumonia requiring PICC placement and norepinephrine. She is no longer requiring supplemental oxygen was discharged home. 6/9: Return to hospital with increasing shortness of breath, confusion and generalized malaise. Repeat TTE with anterior wall motion abnormalities and decreased EF. Patient was transferred to bed for cardiology evaluation 6/10: Cardiac catheterization with moderate three-vessel coronary disease, wall motion abnormality does not correspond to coronary disease. Cardiology thinks findings are related to stress-induced cardiomyopathy. 6/11: Patient continues have downtrending hemoglobin, started to prep for colonoscopy on 6/12. 6/12: Rapid response was called at at approximately 4:40 AM, patient ultimately expired at 7:35 AM Patient was transferred from Hospital given new wall motion abnormalities and severe hypokinesis seen on repeat TTE. Fortunately, cardiac catheterization on 6/10 without coronary artery disease that corresponded to these wall motion abnormalities. Ultimately, it was thought to be stress induced cardiomyopathy. Patient was improving, but still complained of epigastric discomfort. Given her recent diagnosis of ischemic colitis and ongoing abdominal pain, GI was consulted for EGD/colonoscopy on 6/12 Rapid response was called at at approximately 4:40 AM. They were mottled appearing, hypotensive and cool to touch. Patient was found to be severely hypoglycemic and had wide-complex tachycardia. Multiple amps of D50 were given but remained hypoglycemic. Patient was also found to be hypoxemic and did not tolerate BiPAP. Eventually patient was transition to comfort measures only. After discussion with patient's daughter, patient's last 10 minutes of life consisted of "fluid pouring out of her mouth". Work-up also was positive for elevated lactic acid and elevated D-dimer. Given the abrupt change in patient's clinical status, concern for embolic thrombosis is the most likely cause. Unclear if had pulmonary embolism or ischemia to gut. Interestingly, patient was visiting her from Indiana for her brother's funeral. After discussion with family, patient's brother had a similar unexplained death just a few weeks prior. The Family going back to the fact that she had her second Maderna vaccine 3 days prior to presenting to select hospital. Patient's brother also had a Maderna vaccine before his recent demise. Given the unknown cause of death, an autopsy was discussed with family. They were agreeable to this. Highly concern for thrombotic event, but unable to confirm at this time without autopsy. Unknown if recent vaccine was related to her death, but could explain thrombosis leading to ischemic colitis prompting her last admission. Patient was noted to have a "severe" reaction to her first vaccine.

Other Meds: glycopyrrolate (Robinul) 2 mg tablet Take 4 mg by mouth daily. hydrOXYzine (Vistaril) 25 mg capsule Take 25 mg by mouth 3 (three) times a day as needed for itching. lisinopriL (Zestril) 10 mg tablet Take 10 mg by mouth daily. metFORMIN (

Current Illness:

ID: 1394315
Sex: F
Age: 52
State: NY

Vax Date: 05/20/2021
Onset Date: 05/21/2021
Rec V Date: 06/12/2021
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: Codeine, Penicillin, Iodine. All Seafood. (Primary)

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: Initially, all I felt was extreme pain in my left arm. I was advised by the medical staff that my reaction was normal. During the middle of the night, my left arm felt as if it was burning. It woke me up out of my sleep. From the injection site down mid-elbow, my arm was filled with hives & welts and it was extremely itchy. The arm also felt as if it was on fire. I applied some Benadryl ointment on my arm and tried to go back to sleep. When I got up, both of my legs felt extremely numb. I felt as if I was walking on air. I attempted to walk around and fell in the street because I was not able to feel my legs. The numbness remained for the balance of the day. I stayed in bed because I injured myself quite a bit. Every time I tried to move around, I felt as if I was walking on air and was not in a position to stabilize myself. This numbness feeling did not subside until Sunday evening, as well as the issue with my arm.

Other Meds: No vitamins and or herbal supplements were taken two weeks prior to the vaccine.

Current Illness: None

ID: 1394316
Sex: F
Age: 20
State: CA

Vax Date: 02/28/2021
Onset Date: 03/01/2021
Rec V Date: 06/12/2021
Hospital:

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

Lab Data:

Allergies: promethazine

Symptom List: Pharyngeal swelling

Symptoms: heart fluttering and tachycardia

Other Meds: blosovi fe

Current Illness: no

ID: 1394317
Sex: F
Age: 76
State: AZ

Vax Date: 01/29/2021
Onset Date: 01/31/2021
Rec V Date: 06/12/2021
Hospital:

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

Lab Data:

Allergies: Aldendronate, Cyclobenzaprine, Fludrocortisone, Lorazepam, Valium, Codeine, Macrolides/Ketolides, NSAIDS, Penicillins, Salicylates, Sulfa Antibiotics, Sulfonamide Derivatives.

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: The patient presented to our pharmacy on 6/12/21 to pick up a prescription for Ketoconazole 2% topical cream. At the consultation window the patient mentioned that this was to treat a rash on her neck that she believes was caused by the Moderna vaccine. She received her first dose on 1/29/21 and reported that two days later she had a rash on her neck. She stated that the rash burned and was itchy, and that it gradually spread to her inner left forearm and face. At the pharmacy on 6/12/21, her neck was visibly red, along with her face and left forearm. The patient saw her primary care doctor in Februrary, but she states that she was not given any thing for the rash and was told by her doctor to monitor the rash. The patient saw Doctor again in May and was prescribed a cream for the rash, but the patient does not recall the name of the cream and there is no history of that prescription at our pharmacy. The patient reports that the cream did not help, so she saw her allergist in June. She saw Provider and was prescribed ketoconazole 2%.

Other Meds: Azelastine 0.05% ophthalmic drops, rosuvastatin 20 mg tablet

Current Illness:

ID: 1394318
Sex: F
Age: 12
State:

Vax Date: 05/17/2021
Onset Date: 05/19/2021
Rec V Date: 06/12/2021
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: Penicillin allergy. Adverse reaction to some antibiotics, especially sulfur?s.

Symptom List: Diarrhoea, Nasal congestion

Symptoms: Arm soreness, really painful heart burn and acidity that lasted 24 hours

Other Meds:

Current Illness:

ID: 1394319
Sex: M
Age: 70
State: OR

Vax Date: 02/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/12/2021
Hospital: Y

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

Lab Data:

Allergies: NKDA

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

Symptoms: pt with very bad headache two weeks ago. now in hospital with very large cerebral sinus thrombosis

Other Meds: benazepriL (Lotensin) 20 mg tablet Take 20 mg by mouth daily. fluticasone propionate (Flonase) 50 mcg/actuation nasal spray levothyroxine (Synthroid) 100 mcg tablet pravastatin (Pravachol) 40 mg tablet tamsulosin (Flomax) 0.4 mg 24 hr c

Current Illness: no acute illness

ID: 1394320
Sex: M
Age: 51
State: NC

Vax Date: 06/02/2021
Onset Date: 06/02/2021
Rec V Date: 06/12/2021
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: 2nd dose was administered on 6-2-21. It was supposed to be given 6-12-21

Other Meds: N/A

Current Illness: None

ID: 1394321
Sex: M
Age: 20
State: CA

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 06/12/2021
Hospital:

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

Lab Data:

Allergies: N/A per patient

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

Symptoms: The patient became very weak, unable to follow commands and was alert and oriented x1. Within 1 minute of the event the patient became very stiff, his eyes started to roll in the back of his head and he was unresponsive. Pt was placed in a wheelchair, full set of vitals obtained,sternum rub performed, cold compress applied to the forehead, and the nurse begin to ask a series of questions to try and keep the patient conscious. Patient begin to respond, no food or drinks given, EMS arrived and took control of the scene.

Other Meds: N/A per patient

Current Illness: N/A per patient

ID: 1394322
Sex: F
Age: 32
State: CA

Vax Date: 05/26/2021
Onset Date: 05/26/2021
Rec V Date: 06/12/2021
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: No.

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

Symptoms: The night of my vaccine dose (5/26/2021), I experienced chills, aches, and a low grade fever. The next day, the symptoms continued but lessened. However, beginning on 5/28/2021, I was experiencing shortness of breath. I would feel like I would need to catch my breath even when I was just sitting down. For the following two days (5/29 and 5/30), I experienced shortness of breath but it slowly lessened with each passing day. I'm feeling fine now but it was scary especially since shortness of breath isn?t listed as a common symptom. I also wanted to mention that I did have momentary bouts of shortness of breath with my first covid-19 moderna dose (4/28/2021) but it was much less severe and went away quickly.

Other Meds: No.

Current Illness: No.

ID: 1394323
Sex: F
Age: 47
State: MI

Vax Date: 05/28/2021
Onset Date: 05/29/2021
Rec V Date: 06/12/2021
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: Invasive latex

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

Symptoms: Fever, chills, muscle aches, fatigue, headache, chest congestion, cough. All symptoms lasted 4 days, chest congestion and cough still present today

Other Meds: Celebrex, Aciphex, Multivitamin, Vitamin D3, PeriColace, Wellbutrin, Trintellix, Intuniv, Adderall, Namenda

Current Illness: None

ID: 1394324
Sex: F
Age: 72
State: CA

Vax Date: 02/04/2021
Onset Date: 02/09/2021
Rec V Date: 06/12/2021
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: PT REPORTS BEING PREVIOUSLY ACTIVE AND HEALTHY, 4 DAYS AFTER RECEIVING VACCINE SHE PRESENTED TO ER WITH A. FIB AND HEART FAILURE. PT UNDERWENT CARDIOVERSION ON 3/15 AND REPORTS 4 NORMAL EKG'S SINCE. PT DOES NOT REPORT A RE-EVALUATION OF INJECTION FRACTION SINCE. PT RECEIVED 2ND DOSE ON 3/4 BUT THOUGHT THEY MIGHT BE RELATED SINCE SEEING REPORTS OF HEART ISSUES FOLLOWING VACCINATION

Other Meds:

Current Illness:

ID: 1394325
Sex: F
Age: 15
State: TN

Vax Date: 06/01/2021
Onset Date: 06/01/2021
Rec V Date: 06/12/2021
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: Patient received second dose on 06/01/2021 of the vaccine 14 days after receiving the first dose on 05/18/2021. Patient did not report any adverse events.

Other Meds:

Current Illness:

ID: 1394326
Sex: F
Age: 71
State: MN

Vax Date: 03/22/2021
Onset Date: 04/22/2021
Rec V Date: 06/12/2021
Hospital:

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

Lab Data:

Allergies: Ampicillin

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Extreme pressure on chest, worse on lying down. Angiogram and EKG slightly abnormal. Troponin elevated. MRI suggest no evidence of heart attack, but possible pericarditis

Other Meds: Losartan (50mg)

Current Illness: None

ID: 1394327
Sex: F
Age: 28
State: MA

Vax Date: 01/27/2021
Onset Date: 02/01/2021
Rec V Date: 06/12/2021
Hospital:

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

Lab Data:

Allergies: N/A

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: I have had about 6 episodes of heart palpitations, shortness of breath, dizziness/ lightheadedness, and at times accompanying tingling in leg limbs starting a few days after first dose of the COVID19 Moderna vaccine on 1/27/21 until about April 2021. I got my second dose 2/23/21. I am a healthy and active 29 year old female, and have not had heart palpitations or dizziness in the past. I was not on any medications or supplements. I made an appointment to see my primary care physician regarding this issue, but can't get an appointment until July 20, 2021.

Other Meds: N/A

Current Illness: N/A

ID: 1394328
Sex: M
Age: 53
State: VA

Vax Date: 05/08/2021
Onset Date: 05/27/2021
Rec V Date: 06/12/2021
Hospital: Y

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: Started experiencing shortness of breath and coughing on May 27, 2021. Noticed shortness of breath as walking up hill. Breathing issues continues to get worse over time. Went to urgent care doctor on June 4th. They said my oxygen level was low and could hear wheezing in chest. They did a chest x-ray and thought I might have pneumonia. Gave me antibiotics. Recommended to see primary care doctor. Went to HCF on 6/7/2021. Saw FNP. She did blood work. Scheduled me for a cat scan on 6/8. Blood tests indicated d-dimer level was high. Cat scan showed pulmonary embolisms in both lungs. Went to hospital.

Other Meds: None

Current Illness: None

ID: 1394329
Sex: F
Age: 48
State: PA

Vax Date: 06/04/2021
Onset Date: 06/04/2021
Rec V Date: 06/12/2021
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: None

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

Symptoms: Within 6 hours, I developed a fever, all over body aches (from neck to toes), headache, inability to think clearly, difficulty speaking. This lasted for approximately 48 hours until the fever broke. Fogginess and headache lasted for another 48 hours.

Other Meds: Mobic & 5 mg melatonin (at night)

Current Illness: None

ID: 1394330
Sex: M
Age: 12
State: FL

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

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

Lab Data:

Allergies: None

Symptom List: Unevaluable event

Symptoms: Large raised rectangular red rash around injectjon site. NA

Other Meds: None

Current Illness: None

ID: 1394331
Sex: F
Age: 33
State: NY

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 06/12/2021
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: NKDA

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

Symptoms: a registered nurse at the vaccination site was stuck with a used needle to her left hand as she was trying to pull back the plunger to activate the safety component. She washed her hands wit soap and water and as soon as she notified the clinical lead she was sent to Hospital for evaluation

Other Meds: Iron

Current Illness: Anemia

ID: 1394332
Sex: F
Age: 51
State: NM

Vax Date: 06/02/2021
Onset Date: 06/04/2021
Rec V Date: 06/12/2021
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: NKDA

Symptom List: Injection site pain, Pain

Symptoms: reports 2 days following her 1st Covid 19 vaccine she had left leg ache and small nodule/lump on her left leg, reports she "massaged it out", denies redness or swelling but states leg feels sore. Also reports palpitations beginning on 6/4, full body pain, fever, nausea. She presented to the pharmacy today and appeared in no acute distress and arrived with her husband to report the event.

Other Meds: unknown, nothing listed at pharmacy

Current Illness: unknown

ID: 1394333
Sex: F
Age: 35
State: CO

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

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

Lab Data:

Allergies: Contrast dye

Symptom List: Injection site pain, Menorrhagia

Symptoms: Excess stomach acid within 5-10 minutes. At 1 hour, upper lip swelling. I took 50mg Benadryl and the swelling went down after an hour. At 3 hours I became overly sleepy, and elbow and knees began to ache.

Other Meds: Zoloft

Current Illness:

ID: 1394334
Sex: F
Age: 62
State: CA

Vax Date: 06/09/2021
Onset Date: 06/09/2021
Rec V Date: 06/12/2021
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: no known allergies

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

Symptoms: Patient to receive Shingrix shot but was given COVID19 shot by mistake. No harm was caused to patient and the patient was given the shingrix vaccine the same day on 6/9/21.

Other Meds: Carvedilol, chlorthalidone, diclofenac, edarbi, ezetimibe, rosuvastatin, vascepa

Current Illness:

ID: 1394335
Sex: M
Age: 37
State: OK

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 06/12/2021
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: Pt felt dizzy after administration. Had him lie down with feet elevated for five minutes. Pt was able to sit up again and rest for 30 minutes. Was able to leave normally

Other Meds:

Current Illness:

ID: 1394336
Sex: F
Age: 69
State: CA

Vax Date: 05/14/2021
Onset Date: 06/11/2021
Rec V Date: 06/12/2021
Hospital:

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

Lab Data:

Allergies: nkda

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: Patient reported that she has nerve issue in her neck after the Moderna vaccine; She also reported that she can't raise her arm much after the vaccine, and her left arm feels numb

Other Meds: N/A

Current Illness: none reported to us

ID: 1394337
Sex: F
Age: 17
State: IL

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 06/12/2021
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: Patient had gotten dose 1 of the Pfizer COVID vaccine on 5/27/21 and was accidentally scheduled by pharmacy staff for 2nd dose on 6/10/21. This was overlooked upon administration of second dose and patient received 2nd dose at 2 week interval instead of 3 week interval. Spoke with patient on 6/11/21 and she has not experienced any adverse effects other than "muscle spasms" in the vaccinated arm.

Other Meds:

Current Illness:

ID: 1394338
Sex: M
Age: 51
State: CA

Vax Date: 04/01/2021
Onset Date: 04/15/2021
Rec V Date: 06/12/2021
Hospital:

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

Lab Data:

Allergies: Cucumber,

Symptom List: Nausea

Symptoms: Pain in Heart area, followed by immediate shortness of breath intermittent throughout the day.

Other Meds: Lisinopril

Current Illness:

ID: 1394339
Sex: M
Age: 31
State: CA

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 06/12/2021
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: within a minute patient felt nervous ..faint, two minutes later he started to sweat, but talkative and I took blood pressure at 1:32 it read 69/41 67 a few minutes later he looked less pale and his demeanor improved I re took the blood pressure at 1:38 and it read 112/85 91 he continued to improve and at 1:45 he stood up said he felt normal, stayed for a few more minutes then went home

Other Meds: unknown

Current Illness: none

ID: 1394340
Sex: F
Age: 31
State: AL

Vax Date: 03/17/2021
Onset Date: 05/11/2021
Rec V Date: 06/12/2021
Hospital: Y

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

Lab Data:

Allergies: None

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

Symptoms: On 5/11/21 at a routine growth ultrasound, my baby was diagnosed with hydrops with pericardial effusion, swelling and fluid around the scalp and an abdominal mass that measured estimately 6cmx6cm. EDD: 8/1/21. 2nd pregnancy, no complications with first except spontaneous rupture of membranes at 35w4d. Amniocentesis shows no genetic or chromosomal defects or infections present. No true diagnosis for the occurrence of hydrops fetalis. Diagnosed with polyhydramnios and preeclampsia related secondary to hydrops.

Other Meds: Labetolol, Omeprazole, Reglan, Celexa

Current Illness: None

ID: 1394341
Sex: F
Age: 20
State: FL

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 06/12/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Patient developed light headedness and almost fainted within minutes of receiving the vaccine.

Other Meds:

Current Illness:

ID: 1394342
Sex: F
Age: 36
State:

Vax Date: 06/10/2021
Onset Date: 06/10/2021
Rec V Date: 06/12/2021
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: lidocaine, soy

Symptom List: Tremor

Symptoms: Moderna arm (injection site red rash), chills, fatigue, fever, body aches, migraine, nausea, shortness of breath, injection site pain, and swollen lymph nodes. Fever, shortness of breath, swollen lymph nodes, and moderna arm still persists. All other side effects started to go away after 24 hours.

Other Meds: none

Current Illness:

ID: 1394343
Sex: M
Age: 22
State: OR

Vax Date: 05/17/2021
Onset Date: 05/20/2021
Rec V Date: 06/12/2021
Hospital:

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

Lab Data:

Allergies: None known

Symptom List: Erythema, Pruritus

Symptoms: Patient experienced Myocarditis-like symptoms beginning 05/20/2021, 3 days after Dose 2 vaccination. See Continuation Page for Item 18 information details. Additional information for Item 18: Day 1 (5/18) Patient had typical dose 2 reactions of low fever (100-101 degF), headache, soreness at injection site, mild dizziness. Day 2 (5/19) he felt much better. On Day 3 (20 May 2021 9:00AM) Patient experienced notable chest pain (level 5-6 on scale of 10) lasting about 30 minutes. Pain then decreased to level 1-2 for the next several hours. Patient said this felt exactly like the pain he experienced when he had Myocarditis in Nov 2017, only less severe. (The 2017 event required 4 days of hospitalization and temporarily left patient with heart failure in one ventricle (Ejection Fraction <40%) although EJ returned to normal after a few months). patient was seeing his Primary Care Physician on another matter later this same morning (5/20) and mentioned the pain. PCP listened to his heart and did not note any irregularities. Patient had no additional pain episodes for the next 3 days so we did not worry. But daily chest pain episodes resumed 5/24, 1 to 3 times a day, mostly level 1-2, sometimes level 3, typically lasting 30 min to 2 hrs, through 6/3. From 6/4 and on episodes have been less frequent. On 5/25 patient contacted his 2017 Cardiologist who ordered a Troponin-I lab. Labs were done 5/26 and were normal so we were advised to monitor but go to the ER if severe chest pain occurred. Patient has an office visit scheduled with his Cardiologist July 2. As of 6/12 (date of report) episodes tend to occur after moderate physical activity but clear after rest. This pattern is similar to what patient experienced during the first 3 months following his 2017 illness. Accordingly patient has reduced his physical activity, using chest pain episodes as an indicator of too much activity. The 2017 illness appeared to be completely resolved after April 2018 with normal ECG, Echo, EJ and no further reports of chest pain even with normal activity levels. May 20, 2021 was the first time this type of chest pain reoccurred.

Other Meds: None

Current Illness: None

ID: 1394344
Sex: M
Age: 32
State: MA

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 06/12/2021
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: NKA

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

Symptoms: Patient was feeling light headache and sweaty after 15 minutes of the Pfizer shot. He fainted and felt on the floor. His legs were elevated after 10 seconds he was fine and refused to have any kind of medical treatments. After 30 minutes of observation he was alert, happy and left.

Other Meds: No

Current Illness: No

ID: 1394345
Sex: M
Age: 50
State: WA

Vax Date: 04/19/2021
Onset Date: 04/23/2021
Rec V Date: 06/12/2021
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: Seafood/shellfish

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

Symptoms: Low Limb Edema. Legs, ankles, Feet. Went to Urgent Care, admitted to ER, they did blood work and head CT test. Was given Lasix, (diuretic) to reduce water weight in legs. Have had to take 2 rounds of Lasix as swelling continues. Currently not taking Lasix, and swelling seems to be increasing again. Going in for heart echo (resting) Tuesday June 15 to see if myocardial or pericardial inflammation exists, since leg, ankle, foot swelling is a symptom of those.

Other Meds: Telemesartin, Testosterone,,

Current Illness: None

ID: 1394346
Sex: F
Age: 19
State: MI

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 06/12/2021
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: unknown

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Patient experienced vasovagal syncope about 4 to 5 minutes after vaccine. Patient was unresponsive for about 50 seconds and then came back for a minute then was unresponsive for 10 seconds and then came back for good. the paramedics we called and patient was checked out. they gave her the ok to leave.

Other Meds: unknown

Current Illness:

ID: 1394347
Sex: F
Age: 45
State: AZ

Vax Date: 05/09/2021
Onset Date: 05/09/2021
Rec V Date: 06/12/2021
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: None

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

Symptoms: Pain in arm, fatigue, headache, joint pain, muscle pain, diarrhea, stomach ache, nausea, chills.

Other Meds: None

Current Illness: None

ID: 1394348
Sex: M
Age: 24
State: VA

Vax Date: 05/17/2021
Onset Date: 06/03/2021
Rec V Date: 06/12/2021
Hospital: Y

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

Lab Data:

Allergies: Sulfa, Amoxicillin

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

Symptoms: Woke up with chest pains when breathing, overall tightness with sharp pain in the right pectoral as well as neck pain. Waited a week and then went to an urgent care for symptoms and they sent me to ED. After evaluation I was admitted for more testing and started on treatment. Discharged on 6/10 taking ibuprofen and colchicine with outpatient follow-up on 6/17/2021.

Other Meds:

Current Illness:

ID: 1394349
Sex: M
Age: 38
State: UT

Vax Date: 02/01/2021
Onset Date: 02/01/2021
Rec V Date: 06/12/2021
Hospital:

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

Lab Data:

Allergies: None

Symptom List: Pain in extremity

Symptoms: Extreme shortness of breath at rest and with exertion and mild chest discomfort that started within a week or two after vaccination and has lasted for 4 months with no prior history of difficulty breathing. I received a chest X-ray and CT scan that were negative for clotting. Oral and inhaled steroids that were newly prescribed to me helped a little bit to be able to breathe. I have no history or family history of asthma. I still have difficulty breathing but it has slowly improved over time. It is now June and my difficulty breathing has slowly improved but is not back to normal yet. The symptoms have slowly improved and I haven't used the prednisone or inhaler for a few weeks. I still have difficulty breathing but it is slowly getting better. I will follow up with my doctor in 2 weeks (it is now 6/12/21)

Other Meds: Adderall

Current Illness: None

ID: 1394350
Sex: F
Age: 30
State: OR

Vax Date: 06/09/2021
Onset Date: 06/10/2021
Rec V Date: 06/12/2021
Hospital:

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

Lab Data:

Allergies: No

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

Symptoms: I woke up at 2am freezing. I had severe chills and could not get warm for a few hrs. I was able to get back to sleep and woke up sweating. I proceeded to have ?chills? and ?hot flashes? until around 3pm the day after vaccine. My temperature reached 101 at its highest. I noticed yesterday, 2 days after the vaccine, that I was getting a large red mark on my left arm. It?s in a circular shape and about 3-4 inches in diameter. It is slightly tender and itchy. Today, 3 days after the vaccine, my left arm still has the large red circle and it does still itch. Luckily the fever and chills have gone away. I have been sweating in my sleep the past 2 nights, which I never do. Not sure if that?s related, but it seems like it is more than coincidence.

Other Meds: Paxil- 20 mg

Current Illness: No

ID: 1394351
Sex: F
Age: 35
State: MD

Vax Date: 01/08/2021
Onset Date: 01/08/2021
Rec V Date: 06/12/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Numbness on left side of face for 45min, began within 5min after injection.

Other Meds: Lamictal, Vilasadone, Lorazepam

Current Illness:

ID: 1394352
Sex: F
Age: 22
State: MD

Vax Date: 06/04/2021
Onset Date: 06/05/2021
Rec V Date: 06/12/2021
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: N/A

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

Symptoms: Severe body aches, chills, fever, flu like symptoms

Other Meds: Phentermine, Lexapro

Current Illness: N/A

ID: 1394353
Sex: F
Age: 27
State: AZ

Vax Date: 06/11/2021
Onset Date: 06/11/2021
Rec V Date: 06/12/2021
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: Patient has a short episode of fainting, about 5 minutes after receiving vaccine. Patient fell to the floor and was able to regain consciousness in about a minute. EMS was contacted and they took over care for the patient. Patient was taken to the hospital for further evaluation. Patients doctor was contacted to notify them of the incident..

Other Meds:

Current Illness:

ID: 1394354
Sex: M
Age: 15
State: CA

Vax Date: 05/18/2021
Onset Date: 06/10/2021
Rec V Date: 06/12/2021
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: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Chest pain and shortness of breath 2 days after 2nd vaccine. Presented to ED and found to have elevated troponin.

Other Meds: None

Current Illness: None

ID: 1394355
Sex: M
Age: 15
State: VA

Vax Date: 06/08/2021
Onset Date: 06/08/2021
Rec V Date: 06/12/2021
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: Unconfirmed environmental allergies

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

Symptoms: Developed fever, chills, nausea by about 9pm that night (6/12/21). Administered alternating tylenol/advil. Symptoms lasted approx 36 hours. Too weak and fevered to attend school the day following 2nd vax (6/13/21). Still fevered on the morning of the 14th, but given last dose of Tylenol and was then fine for school.

Other Meds: Concerta, generic Claratin D

Current Illness: N/A

ID: 1394356
Sex: F
Age: 33
State:

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 06/12/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site swelling, Limb discomfort

Symptoms: 0850am pt. states she felt dizzy, and had numbness and tingling. A plastic blanket was placed on the floor for her to lay down. Pt. Legs elevated. The pt. was drinking water before the incident occurred. A few minutes prior to the incident occurring the patient was asked if she was feeling OK and she said that she was. While the pt. was laying down EMTs, several RNs, and the NP were by the patient, they were by her side within a minute of her reporting dizziness. Initial vital signs: AOX4, 98 SpO2, 96 HR, the BP was not taken while the Pt. was laying down. Pt. denies allergies, medical history, and states that she did not eat this morning, but drank coffee. Pt. negative for LOC and diaphoresis. This was the second dose of Pfizer that this pt. received. For her first dose the pt. stated that she felt sick for the first few days. 858am: Pt. states symptoms of dizziness are subsiding. At this time she was also provided a Gatorade and a snack. 901am: The pt. sat up on the blanket and her BP was taken, she began drinking the Gatorade at this time. 902am: 136/94 BP 905am: Pt. sat down in a folding chair. She was talkative, alert, and appear dizzy. 909am: Pt. states she is feeling good and denies nausea. 910am: 120/82 BP 912am: 99 SpO2, 75 HR 914am: Pt. was advised to drink liquids and eat 916am: Pt. left site, approved by NP who advised the Pt. she was able to leave.

Other Meds:

Current Illness:

ID: 1394357
Sex: M
Age: 12
State: NE

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

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

Symptoms: Fevers and fatigue first 24 hours then nausea, vomiting and right lower quadrant abdominal pain. He was found to have an acute appendicitis approx 48 hours after his second covid vaccine. He received preop antibiotics and underwent a laparoscopic appendectomy.

Other Meds: Lexapro, methylphenidate, Zyrtec. Melatonin.

Current Illness: None

ID: 1394358
Sex: F
Age: 45
State: AZ

Vax Date: 06/12/2021
Onset Date: 06/12/2021
Rec V Date: 06/12/2021
Hospital:

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

Lab Data:

Allergies: None

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

Symptoms: Pain Arm, muscle pain, joint pain, headache, nausea, diarrhea, dizziness, muscle spasms, stomach aches, weakness, fatigue.

Other Meds: None

Current Illness: None None

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm