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: 1403702
Sex: F
Age: 44
State:

Vax Date: 06/05/2021
Onset Date: 06/07/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Dysphagia, Epiglottitis

Symptoms: PT HAD A VERY PAINFUL PERIOD SHE USUALLY BLEEDS FOR 7 DAYS THIS TIME IT WAS 4 DAYS WITH LOST OF PAIN SHE ALSO HAD AN EARLIER PERIOD

Other Meds:

Current Illness:

ID: 1403703
Sex: M
Age: 41
State: CA

Vax Date: 05/14/2021
Onset Date: 05/16/2021
Rec V Date: 06/16/2021
Hospital: Y

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

Lab Data:

Allergies: Penicillin

Symptom List: Anxiety, Dyspnoea

Symptoms: Elevated heart rate, led to arrhythmias on Sunday 5/16 - 48 hours after my 2nd dose. Apple Watch indicated AFib several times that day. Went to sleep and heart arrhythmia woke me out of my sleep at 4am on Monday 5/17/21, so I went to the ER to get checked out. In the hospital, I was diagnosed with myocarditis, was held there for 4 nights for monitoring and am still taking medication to keep it under control.

Other Meds: None

Current Illness: None

ID: 1403704
Sex: F
Age: 29
State: AZ

Vax Date: 06/12/2021
Onset Date: 06/13/2021
Rec V Date: 06/16/2021
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: penicillin, sulfa, shellfish

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

Symptoms: cellulitis or infection of skin: 4-5 inches in diameter, antibiotic treatment

Other Meds: bupropion xl

Current Illness:

ID: 1403705
Sex: M
Age: 64
State: CA

Vax Date: 02/09/2021
Onset Date: 03/25/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies: NKA, NKDA

Symptom List: Dizziness, Fatigue, Mobility decreased

Symptoms: 3/25/21: woke up in the middle of the night to ringing in the right ear which was persistent. went to see ENT MD 3 weeks after event and diagnosed with partial hearing loss. 2 weeks after with follow up appointment with ENT and was diagnosed with complete hearing loss. will follow up again with ENT MD 7/1/21 for follow up diagnostic testing.

Other Meds: 1) Valsartan 80mg Qday 2) Lexapro 10mg Qday 3) Glucosamine 1 tab qday 4) fish oil 1 tab 1day 5) super b complex 1 tab qday 6) tadalfil 5mg qday 7) magnesium qday 8) zinc q day 9) vita c qday 10) simvastatin qday 11) seqoeul 50mg qpm 12)

Current Illness: None

ID: 1403706
Sex: F
Age: 61
State: TN

Vax Date: 05/18/2021
Onset Date: 05/01/2021
Rec V Date: 06/16/2021
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: Patient stated she has tingling down arm, sores on back, breaking out in a rash for the 2nd time, numbness up and down spine, extreme fatigue, been in bed and out of work for 6 weeks.

Other Meds:

Current Illness:

ID: 1403707
Sex: F
Age: 21
State: OR

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 06/16/2021
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: NKDA

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

Symptoms: RN administered a 4th dose in the 3 dose series. Patient observed in office for a short period after (5 - 10 minutes) and had no reaction to the vaccine, patient stated 'felt fine'. Left clinic ambulating.

Other Meds: Apri OBCP

Current Illness: Patient does not report any illnesses

ID: 1403708
Sex: M
Age: 42
State: NY

Vax Date: 04/19/2021
Onset Date: 04/20/2021
Rec V Date: 06/16/2021
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

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: headache, bodyaches

Other Meds: losartin, escritalopram, avostatin

Current Illness: none

ID: 1403709
Sex: F
Age: 53
State: CA

Vax Date: 06/15/2021
Onset Date: 06/15/2021
Rec V Date: 06/16/2021
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: Pharyngeal swelling

Symptoms: Per LPN on site pt c/o facial swelling and tongue "feeling strange" 7 minutes after vaccine given, Assessed by LPN, vitals taken, all within normal limits. LPV suggested calling 911, pt refused. Patient called her husband who also instructed her to refuse EMS treatment. Pt monitored for 20 minutes, insisted on going home to her husband who is an EMT. Offered Benadryl on site by LVN. Pt refused. LVN requested to follow pt home to ensure she was safe, pt followed home by LVN, husband was waiting in front yard.

Other Meds: none

Current Illness: none

ID: 1403710
Sex: F
Age: 32
State: CA

Vax Date: 01/30/2021
Onset Date: 02/02/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies: sulfa base drugs long term reaction to fermented drinks

Symptom List: Abdominal pain, Chills, Sleep disorder

Symptoms: Immediately after the shot, I started having irregular heart beat and it lasted about 2 or 3 weeks, and that went away. I felt tired on 2nd of feb in the evening, the next day i could barely move, I had itchy throat and nose . I had a COVID -19 test, on feb. 3rd, the results were negative After the 4th I felt better. After a couple of weeks I felt very fatigue, my muscles felt weak and they have been twitching since then, they are still twitching they are just less fatigue.It lasted about a month to two and a half months. It has been gradually getting better, but it started since February after the vaccine.

Other Meds: escitalopral 7.5 mg 1 x day Claritin over the counter 10 mg Adderall 5 mg 1 x day melatonin 1.5 mg

Current Illness: no

ID: 1403711
Sex: F
Age: 66
State: CA

Vax Date: 05/07/2021
Onset Date: 05/08/2021
Rec V Date: 06/16/2021
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: Gluten sensitivity - extreme

Symptom List: Diarrhoea, Nasal congestion

Symptoms: That next day, the injection site pain was with me for over a month. I couldn't move my arm; felt like someone was jabbing me. I can finally touch my arm now without feeling pain. The brain fog - it feels like - in the front of my forehead right above my eyebrows - like there's something the size of orange that is just sitting there. It stops my thoughts and word processing. I was fine the day before the vaccine. That has not gone away. The doctor does not know what to do about the brain fog. I was having horrific full body muscle pain - especially in my legs. Like someone had put 20 lbs weight on each of my ankles. That is sort of resolved. But the fatigue - hasn't resolved. I always have a little bit of low level fatigue but this is worse - I have to have two naps a day now. Brain fog is the most troubling to me - hard to function - it's like instant Alzheimer's - my words are stuck in my mouth and I feel like I'm trying to think through a veil or fog.

Other Meds: Hydrocortisone tablets; hormone replacement - estradiol; Progesterone; Estrogen meds; Liothyronine (P3 Thyroid Medication); T4 Thyroid Medication; Zinc; fish oil; multi-Vitamin; every once in a while magnesium

Current Illness: no

ID: 1403712
Sex: M
Age: 16
State: MO

Vax Date: 06/15/2021
Onset Date: 06/16/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: complete loss of vision, ringing in ears and hearing loss for 30-60seconds; fever > 101, elevated HR

Other Meds: None

Current Illness: none

ID: 1403713
Sex: F
Age: 46
State: CA

Vax Date: 06/14/2021
Onset Date: 06/16/2021
Rec V Date: 06/16/2021
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: Tightness in chest, tightness and mild pain when taking a deep breath

Other Meds: Supplements: zinc, digestive enzyme, b12, ibuprofen

Current Illness: None

ID: 1403714
Sex: M
Age: 40
State: WA

Vax Date: 05/19/2021
Onset Date: 05/21/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies: Penicillin, amoxicillin

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

Symptoms: 2 days post vaccination onset of acute arthritic symptoms symmetrically along body beginning in the hips, and escalating to back, neck, shoulders, wrists, hands, and knees, in that order. Right side is now becoming more severe for pain and stiffness, but still roughly symmetrical. Symptoms are more severe upon waking and some mobility is restored by regular movement within an hour, but it is becoming harder and more painful each day. Was taking ex str. Tylenol at 500mg 8 x3 times a day for pain management, have since switched to aspirin 500mg 4-5 x2 times per day but that too is becoming less effective. Severe mobility impact, cannot get groceries, walk dog, open bags, jars, cans, and am starting to develop anxiety around the worsening symptoms. No health coverage. No primary care physician. Sporadicly I have days that the symptoms are almost completely non-existent, but these ?relief days? are never consecutive and the next day will always have the symptoms worsen again. I have always generally been in pretty good health, and I?ve never taken anything regularly, but this has me terrified.

Other Meds: None

Current Illness: None

ID: 1403715
Sex: F
Age: 42
State: NV

Vax Date: 06/13/2021
Onset Date: 06/14/2021
Rec V Date: 06/16/2021
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: Ragweed, dust, pollen, bees, dogs, cats, grass, perfume, cologne, sented body wash and soap

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

Symptoms: Extreme exhaustion, fatigue, nausea 1pm 6/14 Swelling of extremities, severe itching in arm pits, crotch and under breasts 4pm 6/14 Rash, hives over entire body, severe itching, trouble breathing, swollen throat and tongue 5pm 6/14 Emergency room 5:30pm 6/14

Other Meds: Omeprazole 20mg

Current Illness:

ID: 1403716
Sex: M
Age: 41
State: WA

Vax Date: 03/01/2021
Onset Date: 04/01/2021
Rec V Date: 06/16/2021
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: Dairy sensitivity.

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

Symptoms: Starting about 2-3 weeks after my 2nd dose of the Moderna COVID19 vaccine, I started experiencing daily joint/nerve pain and swelling. It affects different parts of my body each day, but the usual targets are my fingers, wrists, knees, and ankles. Sometimes, it is a pure nerve pain. Other times, it is paired with swelling, especially in the knees and fingers. I've experienced pain like this in the past, but very infrequently (once every few months at the most). But the pain has been on a daily basis ever since late-March/early-April and still persists today.

Other Meds: Triamcinolone Acetonide (nasal spray). System Well (immunity booster) supplement. Calcium/magnesium supplement. Fish oil.

Current Illness:

ID: 1403717
Sex: F
Age: 16
State: AR

Vax Date: 06/15/2021
Onset Date: 06/15/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies: iodine

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

Symptoms: The patient presented to the clinic needing a Tdap vaccination. When the vaccination was taken out of the fridge, Pentacel was taken out and administered instead of regular Tdap. Staff with Department of Health was notified. She got back in contact with our office to let us know that the patient will not need to come back in for a regular tdap, as the pentacel covers as well as regular tdap. Actions to be taken are to report the incident to VAERS and to notify the patient's mother.

Other Meds: Albuterol HFA, loratadine, mupirocin ointment, flonase, montelukast

Current Illness: none

ID: 1403718
Sex: F
Age: 60
State: KY

Vax Date: 11/18/2020
Onset Date: 11/20/2020
Rec V Date: 06/16/2021
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

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

Symptoms: I notified by Dr. that after receiving the Shingles vaccine, I had a severe reaction of weakness in my legs that lasted about 2 months and was afraid to get the 2nd dose. He said the reaction was rare and the CDC recommended to get the 2nd dose. I got the 2nd dose on 2/22/21 and by the next day, the reaction of weakness was SEVERE and has continued to get worse. I have a very difficult time walking and have a bad gait with foot drop. I fall a lot and it is impossible to stand up or climb stairs without assistance. I have to use a wheelchair often. Now after 3 months, I've sought help from a Neurologist and now under his care and testing. (Dr.). Both doctors said they are not aware of any connection to the Shingles vaccine. However, I was a very healthy person and immediately after both doses of the vaccine, the severe leg weakness occurred. I never would have gotten the 2nd dose if I was informed that the side effect could be even worse and long-term. My life has changed dramatically. As of this date, I have undergone four MRI's and have given 12 vials of blood for about 20 blood tests. Dr. is trying to figure out the exact diagnosis and treatment. The Nerve Conduction test showed that a major nerve in both legs in non-functioning. The CK blood test is flagged with an extremely high number. I now understand that Guillain-Barre Syndrome is a possibility. I don't believe either of my doctors are aware of this effect as they didn't think there was any connection to the vaccine. I am writing this VAERS form to inform more doctors and the vaccine maker of this possible long-term side effect if nerve damage and leg weakness.

Other Meds: None

Current Illness: None

ID: 1403720
Sex: F
Age: 63
State: MA

Vax Date: 06/08/2021
Onset Date: 06/08/2021
Rec V Date: 06/16/2021
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 that I am aware of

Symptom List: Ear pain, Hypoaesthesia

Symptoms: Patient states within 30 minutes her cheek felt weird. Then since then off and on, states cheek goes numb, and top of her head gets tingly and feels like wearing a hat and tinnitus.

Other Meds: none that I am aware of

Current Illness: None that I am aware of

ID: 1403721
Sex: F
Age: 62
State: CA

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Abdominal pain upper, Dizziness, Dysgeusia

Symptoms: Moderna COVID-19 vaccine 2nd dose given on day 22

Other Meds:

Current Illness:

ID: 1403722
Sex: M
Age: 48
State: CA

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies: NKDA

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

Symptoms: 48 y/o M presented to receive first dose of Pfizer vaccine. Pt received vaccine at 0915 to LD, pt presented with symptoms shortly after vaccine at 0918. Symptoms included pallor, weakness, nausea, and diaphoresis. RN attended to patient immediately- ice pack applied to back of neck, pt asked to take off mask to allow increased tissue perfusion, ice water offered and pt only able to take a few sips due to nausea. Vital signs were obtained (while patient was sitting up in chair) as the following 76/49 BP, HR 53, SpO2 at 97% at 0923. Vital signs were repeated at 0930 while patient was laying on gurney. Vital signs recorded as the following 101/54 BP, 53 HR, 94% SpO2. RN stat called at 0925, staff arrived to assist patient. Pt taken to treatment room for further observation. Upon arrival to treatment room, vital signs obtained and recorded as the following at 0935 BP 102/70, HR 61, SpO2 96%, RR 20. Pt stated symptoms has improved significantly.

Other Meds: N/A

Current Illness: N/A

ID: 1403723
Sex: F
Age: 56
State: TX

Vax Date: 03/09/2021
Onset Date: 03/30/2021
Rec V Date: 06/16/2021
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: lisinopril, losartan and Irbesartan

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

Symptoms: The day of vaccine I had elbow pain in my right arm by the following week it was in my left arm elbow. Following that week my left knee was in horrible pain then a few days later my right knee. It's been a few months and still have terrible issues with my joints. Never had these issues before.

Other Meds: carvedilol 25 mg 2 x day hydrochlorothiazide 25mg 2x a day

Current Illness: none

ID: 1403724
Sex: F
Age: 50
State: IL

Vax Date: 06/14/2021
Onset Date: 06/14/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies: propylthiouracil augmentin fluorescein

Symptom List: Unevaluable event

Symptoms: After the vaccine was given, my heart began racing and I felt flush. I felt like the room was spinning. The pharmacist took my blood pressure and it was 228/128. My heart rate was 122. My blood pressure is always 120/60. I was trying to call my husband but the room was spinning and I felt like I was going to throw up. I was flushed and my arms and legs felt numb. I was gasping at air because it felt harder to breathe. I tried to stand but had to sit back down. My blood pressure went down after 15 minutes but was still elevated. My heart rate has stayed high. I finally left and when I made it home, I threw up all night. My heart is continuing to be above 100. It has been racing for the past two days. I woke up the past two nights with spitting headaches and my heart rate at 113, 110. I am dripping in sweat both nights which has never happened to me. My glands are now swollen as well and I still feel lousy two days later.

Other Meds:

Current Illness: none

ID: 1403725
Sex: F
Age: 29
State: CO

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 06/16/2021
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: Chills, Dizziness, Injection site pain, Myalgia, Pyrexia

Symptoms: No adverse reactions. After administering and screening, the patient admitted to getting Pfizer on May 29, 2021. Pt. only had one dose of Pfizer.

Other Meds:

Current Illness:

ID: 1403726
Sex: F
Age: 13
State: TX

Vax Date: 06/12/2021
Onset Date: 06/16/2021
Rec V Date: 06/16/2021
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: Allergies to walnuts, pecans, etc.

Symptom List: Injection site pain, Pain

Symptoms: Patient (Female age 13) went to play tennis at 10 AM. Around 10:25 AM she felt very dizzy and had a temporary loss of sight. Her coach gave her some electrolytes and she was fine after that. We are not sure if this is a side effect of the vaccine or not. But she has never had such an episode before. Google says it is due to lower blood pressure.

Other Meds:

Current Illness:

ID: 1403727
Sex: F
Age: 21
State: MN

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 06/16/2021
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: PT RECEIVED AN EXPIRED VACCINE, IT WAS OPENED THE NIGHT PRIOR AND THE PHARMACIST ON DUTY THOUGHT IT WAS OPENED THIS MORNING AND ADMINSTERED A DOSE.

Other Meds:

Current Illness:

ID: 1403728
Sex: M
Age: 61
State: OH

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 06/16/2021
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: n/a

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

Symptoms: The patient first exhibited diaphoresis, then was thirsty. He was then unresponsive and started seizing, and lost control of his bladder. The seizure lasted approximately 1 minute. Emergency services were contacted, and they assessed the patient after the event. He was released from their care back into the community.

Other Meds: n/a

Current Illness: n/a

ID: 1403729
Sex: F
Age: 27
State: GA

Vax Date: 06/02/2021
Onset Date: 06/11/2021
Rec V Date: 06/16/2021
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: Reconstituted vaccine with bacteriostatic Sodium Chloride 0.9%.

Other Meds:

Current Illness:

ID: 1403730
Sex: F
Age: 76
State: MT

Vax Date: 03/11/2021
Onset Date: 03/11/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies: I am allergic to Penicillin, Morphine , and Hydrocortisone. I also stay away from nuts and shell fish.

Symptom List: Chills, Fatigue, Headache, Myalgia

Symptoms: The same night after the vaccine I had shaking violent chills, my teeth were chattering as well. I also was vomiting a lot , I had lots of chills that I could not get warm this went on all night long. The next day I did experience some bad body aches like the flu. The next day after that I slept all day long and tried to hydrate myself back together. Over the next few weeks I noticed how I was running out of breath so fast. I am now suffering from shortness of breath.

Other Meds: I was taking blood pressure medication, and cholesterol medication , Diuretic and potassium and magnesium medication. I also taking medication for low iron and an Advanced Immune Support supplement. I also take Quinol. I take probiotic med

Current Illness: None.

ID: 1403731
Sex: M
Age: 17
State:

Vax Date: 05/04/2021
Onset Date: 05/07/2021
Rec V Date: 06/16/2021
Hospital: Y

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: The patient with a past medical history of Hypertension presented 3 days after receiving the 2nd dose of Pfizer vaccine with chest pain. The patient initially received pain medication for symptom relief. An echocardiogram showed a low normal ejection fraction. Cardiac MRI showed evidence of myocarditis. COVID antibodies were positive. RVP and Lyme panel for myocarditis negative. The patient received a total of 2g/Kg of IVIG over 2 days then was discharged on colchicine, ibuprofen, Aldactone, and lisinopril. In follow up appointment patient endorsed having gotten back to baseline activity and function

Other Meds:

Current Illness:

ID: 1403732
Sex: F
Age: 61
State: TX

Vax Date: 03/31/2021
Onset Date: 03/31/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies: Demerol Chocolate Coco butter Insects Tape

Symptom List: Nausea

Symptoms: Later on the afternoon my left arm felt sore it was hurting. At 3am I woke up with bad chills & a really bad headache. I've never had a fever and I had one of 99.9 I felt very sick & I went to the ER they gave me medicine for my headache. They told me it was the side effects of the vaccine.

Other Meds: Allergy med Topiramate

Current Illness:

ID: 1403733
Sex: M
Age: 55
State: DE

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Injection site pain

Symptoms: WAITED IN THE STORE FOR 15 MINUTES. THEN GOT READY TO LEAVE. WHILE LEAVING HE FELL DOWN

Other Meds:

Current Illness:

ID: 1403734
Sex: F
Age: 88
State: MT

Vax Date: 03/05/2021
Onset Date: 03/19/2021
Rec V Date: 06/16/2021
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: Amoxicillin, prednisone, ciprofloxacin

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

Symptoms: Pt developed left side back pain two weeks after receiving her second dose. Pain persisted until June 10 when she went to the ER and was diagnosed with bilateral pulmonary blood clots. Pt hospitalized for two days and discharged on apixaban.

Other Meds: levothyroxine, lasix

Current Illness: None

ID: 1403735
Sex: F
Age: 22
State: CA

Vax Date: 05/24/2021
Onset Date: 05/25/2021
Rec V Date: 06/16/2021
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: NKA

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

Symptoms: Patient came to pharmacy on 6/16/21 to report the allergy reaction she developed the next day after receiving her fist Moderna dose. Patient does not have a regular physician and went to ER with allergy rash all over her body. She received a shot (medication name is unknown), prescription for Medrol and Hydroxyzine. She also purchased Zyrtec OTC and has been taking all 3 medications but so far she has no relief. Patient reported that she also had to drop out of school.

Other Meds: N/A

Current Illness: no

ID: 1403736
Sex: F
Age: 43
State: NC

Vax Date: 03/27/2021
Onset Date: 03/27/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies: none

Symptom List: Tremor

Symptoms: 04/01/2021 I went to the Emergency Room and was diagnose with pneumonia, I then went back 2 more weeks in a row with symptoms not getting better. My chest stills hurt, headaches getting worse, body aches getting worse, rash, vision is blurry. My doctor has no clue why I'm still having these symptoms. I a 43 YO female that suffer from hEDS,

Other Meds: lexpro

Current Illness:

ID: 1403737
Sex: F
Age: 32
State: MA

Vax Date: 06/14/2021
Onset Date: 06/14/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies: NKDA

Symptom List: Erythema, Pruritus

Symptoms: Patient given vaccine on 6/14/21. Expiration date listed on vaccine 12/07/20. -Patient administered vaccine 6 months beyond stated expiration date. Patient informed subsequently on 6/16/21. She stated that no arm discomfort which was different from initial vaccine dose. No other ill effects. Plans to come for Dose #3 in September.

Other Meds: Odefsey

Current Illness: Tooth infection s/p Root Canal Infected epidermoid cyst in L axilla

ID: 1403738
Sex: M
Age: 30
State: MO

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 06/16/2021
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: None

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

Symptoms: Patient failed, blood pressure dropped, paramedics were called. Patient also got nauseous.

Other Meds: None

Current Illness: None

ID: 1403739
Sex: M
Age: 40
State:

Vax Date: 05/28/2021
Onset Date: 05/29/2021
Rec V Date: 06/16/2021
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: Amoxicillin

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

Symptoms: Constant tinnitus, ears ringing since the 1st Pfizer dose on 28May2021.

Other Meds: None

Current Illness: None

ID: 1403740
Sex: F
Age: 49
State: CA

Vax Date: 02/01/2021
Onset Date: 06/02/2021
Rec V Date: 06/16/2021
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: NKDA or other allergies

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Post menopausal bleeding. 2+ years post menopausal without bleeding.

Other Meds: General multivitamin QD

Current Illness: None

ID: 1403741
Sex: F
Age: 39
State: NJ

Vax Date: 06/15/2021
Onset Date: 06/16/2021
Rec V Date: 06/16/2021
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: Swollen lymph node armpit on left arm, fever , runny nose , body ache and pain on arm

Other Meds: Atorvistatan and bitter melon pills

Current Illness:

ID: 1403742
Sex: F
Age: 38
State:

Vax Date: 04/01/2021
Onset Date: 04/05/2021
Rec V Date: 06/16/2021
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: Patient with an acute hepatitis with Tb 6.5, ALT 2165, AST 1288. Serologies for all chronic liver disease negative. Autoimmune serologies negative. LFTs normalized by June 2021. Jaundice resolved.

Other Meds: None

Current Illness: None

ID: 1403743
Sex: F
Age: 57
State: TX

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 06/16/2021
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: Patient experienced a headache, dizziness and mild shortness of breath roughly 20-30 minutes after receiving the vaccine, the headache and shortness of breath dissipated after about 5-10 minutes of resting in a chair. The dizziness lasted roughly 10-15 minutes and went away with additional rest and some cold water.

Other Meds: Patient did not provide any

Current Illness: Patient did not provide any

ID: 1403744
Sex: M
Age: 15
State: OR

Vax Date: 06/13/2021
Onset Date: 06/13/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies: Penicillins

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

Symptoms: 15 yo old boy c/o difficultly sore throat approximately twenty minutes after receiving the second dose of the Pfizer vaccine. He appears well and has a normal voice. Auscultation of his larynx did not reveal stridor. No rash, wheezing, or other associated signs or symptoms. He was treated with 25 mg of oral diphenhydramine with a resolution of symptoms after an extended monitoring period. Per MD Clinical Lead

Other Meds:

Current Illness:

ID: 1403745
Sex: M
Age: 51
State: GA

Vax Date: 02/10/2021
Onset Date: 04/30/2021
Rec V Date: 06/16/2021
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: Salicylates- anything that has high amounts of salicylic acids , Cinnamon, Mint, aerosol thinerson,, nickel sulfate (not all sulfates), Isothiazolinone

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

Symptoms: Around 04/30/2021 I ended up getting some facial paralysis, a pretty quick onset on the left side of my face. I started to notice I had some difficulty shutting my eye. I wasn't having any slurred speech. I recognized it as a possible Bells Palsy because I have coworkers that have it. My eye sight started to become more affected. I went to the ER that same day to rule out stroke. They ran blood tests and CT scan to rule out any signs of stroke. Everything came back negative and they found no cause for paralysis and assumed it was bells palsy. . I was put on prednisone and an anti-viral drug Baclamir (something that started with B ) . I was on about a weeks worth of the anti viral and about 10 days of the prednisone, and the first 8 days I was showing signs of improvement . I couldn't shut my left eye, raise my eyebrow, my whole face was numb on L side and I lost taste on L side of tongue. They did test me for Covid when I went to ER. I had a metallic taste in my mouth. I took medicine and recovered quickly but within 3-7 days, I ended up getting a rash on my back but it wasn't a regular rash because it didn't itch. It was the worst back acne possible, around 200 bumps on back that erupted overnight. The ER did r/o shingles but this rash was on several different nerve paths, it looked more like a reaction to the prednisone. I am an Archeologist and they ran a test to see if I had lyme disease because I come across ticks regularly but they came back negative for current and past infection. When I take Amoxicillin I do get heart palpitations and that's why I was on the doxycycline. I do take testosterone 1 shot a month in the hip. On the 8th day around 05/08/2021 it started to improve and every day after that was a 5% improvement.

Other Meds: Antibiotics (doxycycline), Allegra, Trazadone, Medication for ringing in ear, Baclofen for back pain, Cymbalta.

Current Illness: None.

ID: 1403746
Sex: M
Age: 26
State: MA

Vax Date: 06/04/2021
Onset Date: 06/06/2021
Rec V Date: 06/16/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: The patient presented 2 days after receiving the 2nd Moderna Vaccine with worsening acute onset right-sided lower chest pain and right upper quadrant abdominal pain associated with shortness of breath. CT pulmonary embolus protocol showed subsegmental pulmonary embolus with evidence of pulmonary infarcts for which the patient was started on an anticoagulant. An echocardiogram showed a mild to moderate decrease in LV systolic function with global hypokinesis. Cardiac MRI findings were consistent with acute myopericarditis with underlying non-ischemic cardiomyopathy disproportionate to the degree of myocarditis. The patient was discharged on a beta-blocker.

Other Meds:

Current Illness:

ID: 1403747
Sex: M
Age: 23
State: GA

Vax Date: 06/03/2021
Onset Date: 06/11/2021
Rec V Date: 06/16/2021
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: Reconstituted vaccine with bacteriostatic Sodium Chloride 0.9%. Customer is understands error and is not interested in revaccination. VAERS (copy in folder).

Other Meds:

Current Illness:

ID: 1403748
Sex: M
Age: 15
State: CA

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

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

Lab Data:

Allergies: None

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Enlarged left axillary lymph node , no treatment, resolved about 7 days later per patient

Other Meds: None

Current Illness: None

ID: 1403749
Sex: F
Age: 13
State: OR

Vax Date: 06/13/2021
Onset Date: 06/13/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies: No known allergies

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

Symptoms: 13 yo old girl c/o difficultly swallowing and scratchy throat approximately ten minutes after receiving the second dose of the Pfizer vaccine. She appears well but has a nasal tone to her voice. Auscultation of her larynx did not reveal stridor. No rash, wheezing, or other associated signs or symptoms. She was treated with 25 mg of oral diphenhydramine with a resolution of symptoms after an extended monitoring period.

Other Meds:

Current Illness:

Date Died: 03/27/2021

ID: 1403750
Sex: M
Age: 82
State: MN

Vax Date: 02/02/2021
Onset Date: 03/20/2021
Rec V Date: 06/16/2021
Hospital: Y

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

Lab Data:

Allergies: None

Symptom List: Injection site swelling, Limb discomfort

Symptoms: Patient complained of feeling unwell and having headaches after his second dose of Moderna vaccine on 2/2/2021. He became increasingly confused, paranoid and started occasionally refusing medications. On early March 2021, he started refusing all medications. Around 3/17/21, his increasing confusion and paranoia prompted suspicion for UTI which was confirmed with a urinalsis. Unfortunately, he refused antibiotic treatment. On 3/20/2021, nursing staff noted that patients right lower extremity was purple from toes to mid-calf, cold to touch and pedal pulse were not present. He complained of right leg pain. He was evaluated and diagnosed with probable thromboembolic event, since patient refused his oral anticoagulant for weeks prior to these event. Patient was sent to the local Emergency Department (ED) and diagnosed with acute critical right limb ischemia. At the local ED, he had a CTA which showed as per radiology: "Occlusion of the right superficial femoral artery beginning just beyond the origin. Occluded right popliteal, anterior tibial, tibioperoneal, peroneal, and posterior tibial arteries without reconstitution on arterial and delayed phases. Patent right deep femoral artery with minimal luminal stenosis in the proximal segment. Patent mid and distal right external iliac artery with up to mild luminal stenosis." Per discharge summary, "vascular surgery evaluated patient in the ED and did not feel operative revascularization with fasciotomy would provide any benefit; recommended continued anticoagulation with amputation/palliative management." He was admitted to the general medicine service which consulted orthopedic, infectious diseases and palliative care. Medicine Service also contacted patient's daughter who is his next of kin who opted for comfort care. He was discharged to facility on 3/25/2021 and started in the Comfort Care Program. He was pronounced dead on March 27, 2021 at 0807 hours. His autopsy showed that he also had thrombi on: 1. Pulmonary embolism, Left pulmonary artery 2. Left renal infarct

Other Meds: None

Current Illness: None, only longstanding chronic conditions as stated in item 12

ID: 1403751
Sex: M
Age: 18
State: CA

Vax Date: 05/19/2021
Onset Date: 06/16/2021
Rec V Date: 06/16/2021
Hospital:

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

Lab Data:

Allergies: none

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

Symptoms: On Wed May 19 at approx 11:45 am my son was given the Johnson and Johnson vaccine as he was due to go to work on June 1st however patient had a seizure as a reaction to vaccine he was taken to vaccine site ER by ambulance where he had a second seizure around 3:55 pm he was released from ER after several hours and was told to follow up with PC within 2-3 days. As a result of reaction my son was disqualified from going to work on 6/1, due to seizure -this changed his whole life plans. To add his drivers license was medically suspended as well. Which we are now working having to submit medical test results in order clear him of having medical conditions.

Other Meds: none

Current Illness: none

ID: 1403752
Sex: F
Age: 89
State: NJ

Vax Date: 06/16/2021
Onset Date: 06/16/2021
Rec V Date: 06/16/2021
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: NKA

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

Symptoms: No adverse reaction note at this time. Vaccine medication error- Administered different manufacturer COVID vaccine on second dose

Other Meds: Psychotropics; Oral glycemic; Anti HTN; pain meds; Nicotene

Current Illness: HTN, DM, Depression Femural Fx; Pneumonia

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm