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: 1432894
Sex: F
Age:
State: NJ

Vax Date: 02/13/2021
Onset Date: 02/21/2021
Rec V Date: 06/29/2021
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: A week after my first vaccine I started developing hives all over of my body. I would get them about 2-3 times a week.; This is a spontaneous report from a contactable consumer or other non hcp. A 27-years-old non pregnant female patient received first dose of BNT162b2 (PFIZER-BIONTECH COVID-19 mRNA VACCINE, formulation: Solution for injection, lot Number: EL9266 expiry date was not reported) as dose 1 via an unspecified route of administration, administered at Arm Left on 13Feb2021 as a single dose (age at avccination was 27-years-old) for COVID-19 immunisation. Patient's medical history reported as none. The patient's concomitant medications were not reported. Prior to the vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient had not been tested for COVID-19. The patient did not have known allergies. The patient no other vaccine in four weeks. The patient had not received other medications in two weeks. The patient experienced a week after first vaccine she started developing hives all over of patient body and she would get them about 2-3 times a week. She went to an allergist and she cannot diagnose (urticaria) (disability). Therapeutic measures were taken because of a week after my first vaccine she started developing hives all over of my body. Patient received treatment of Allegra twice a day and Zyrtec. She would get them about 2-3 times a week. The outcome event was not recovered. Information is needed. Further inform is requested.

Other Meds:

Current Illness:

ID: 1432895
Sex: F
Age:
State: CO

Vax Date: 02/14/2021
Onset Date: 02/28/2021
Rec V Date: 06/29/2021
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:

Symptom List: Anxiety, Dyspnoea

Symptoms: Approximately two weeks after vaccination rapid development of Dementia, literally from Saturday evening to Sunday morning.; This is a spontaneous report from a contactable consumer (patient herself). A 96-year-old female patient received BNT162b2 (PFIZER BIONTECH COVID-19 mRNA VACCINE, Solution for injection, Lot number- UNKNOWN) via an unspecified route of administration in right arm on 14Feb2021 13:15 as dose 1, single (at the age of 96-years-old) for COVID-19 immunization. The patient was not pregnant at the time of vaccination. Facility where the most recent COVID-19 vaccine was administered was reported as Other. Patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The patient was not diagnosed with COVID-19, prior to vaccination. Patient had been tested for COVID-19, since the vaccination using the nasal swab test with results as unknown on an unspecified date in 2021. Patient medical history included moderate dementia. Patient did had no known allergies. The concomitant medications were not reported. On 28Feb2021, approximately two weeks after vaccination patient developed rapidly Dementia, from Saturday (27Feb2021) evening to Sunday (28Feb2021) morning. The adverse events resulted in emergency room/department or urgent care, hospitalization (for a period of 2 days) and disability or permanent damage (as reported). The treatment received for the adverse events included supportive care. The outcome of the event was not recovered. Information on Lot/Batch number has been requested.

Other Meds:

Current Illness:

ID: 1432896
Sex: F
Age:
State: NJ

Vax Date: 03/13/2021
Onset Date: 03/13/2021
Rec V Date: 06/29/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Hives all over my body every single day.; This is a spontaneous report from a contactable consumer or other non hcp. A 28-years-old female patient received second dose of bnt162b2 (BNT162B2), dose 2 via an unspecified route of administration, administered in Arm Left on 13Mar2021 (Batch/Lot Number: EN9266), single for covid-19 immunization. The patient did not had any medical history. Concomitant medications were not reported. The patient did not receive any other vaccine within four weeks prior to the COVID or any other medications within two weeks of vaccination. Prior to vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient had not been tested for COVID-19.The patient previously received first dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection; Batch/Lot Number: EL6208) via an unspecified route of administration on 13Feb2021 as dose 1, single dose for covid-19 immunization and experienced hives all over her body a week after first dose of vaccine and she would get them about 2-3 times a week. In Mar2021, after receiving the second dose of vaccine the patient experienced hives all over her body every single day. The adverse event resulted in doctor or other healthcare professional office/clinic visit. She visited an allergist, but she cannot diagnose her. The patient knew that the event was from the vaccine. The patient was advised to take Allegra twice a day and Zyrtec as therapeutic measure for event. The outcome of the event was unknown.; Sender's Comments: As per the information provided in the narrative, the causal association between the suspect drug and the event cannot be excluded.

Other Meds:

Current Illness:

ID: 1432897
Sex: F
Age:
State: UT

Vax Date: 04/13/2021
Onset Date:
Rec V Date: 06/29/2021
Hospital: Y

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: she was hospitalized for 4 days and treated for ITP.; nose bleed; Caller states she gave birth to her son 28DEC2020, and she had been exclusively breastfeeding; Caller states she gave birth to her son 28DEC2020, and she had been exclusively breastfeeding; they did a blood count and sent her to the ER because her platelets were 5 or 7, they were low; This is a spontaneous report from a contactable consumer or other non hcp. A 40-years-old female patient received second dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: solution for injection, Batch/Lot number was not reported) via an unspecified route of administration, administered in Left arm on 13Apr2021 10:30 (At the age 40-years-old) as single dose for covid-19 immunisation. Medical history included covid-19 from Mar2020 to an unknown date. Family Medical History Relevant to AE(s): None, all have had the Moderna vaccine and no adverse reactions besides fever and pain in the arm but nothing like this. The patient's concomitant medications were not reported. On 10Apr2021 the patient experienced she was hospitalized for 4 days and treated for itp, nosebleed from 13 Apr 2021 to 16 Apr 2021, on 05Apr2021 states she gave birth to her son 28dec2020, and she had been exclusively breastfeeding, on 05Apr2021 they did a blood count and sent her to the er because her platelets were 5 or 7, they were low. The patient was hospitalized for nosebleed from 13Apr2021 to 16Apr2021. Caller states on 13APR2021, she had her second Pfizer Shot. Caller states that night she had a nose bleed so she went to the Urgent Care and they did a blood count and sent her to the ER because her platelets were 5 or 7, they were low. Caller states she was hospitalized for 4 days and treated for ITP. Caller states then she did one treatment for ITP and then she did a second treatment for ITP. Caller states she was hospitalized a couple of weeks later and given treatment. Caller states she is taking a 3rd treatment currently. Caller states her Platelets keep crashing down. Caller states she has blood work drawn every few days and she is being monitored closely to make sure her platelets don't drop too low. Caller states one treatment was given for over a month. Caller states she had 2 dexamethasone treatments, 2 IVIG treatments and now she is on Prednisone and doing a slow taper. Caller states if this doesn't work, they are going to explore other longer-term options. Caller states she has no history of autoimmune disorders or ITP. Caller states when she says ITP, it stands for Immune Thrombocytopenia, or it is also called something else, Idiopathic Thrombocytopenia. Caller states she went to the Urgent Care first for the nosebleed and petechiae and she didn't think anything was probably going on, but they did bloodwork and her platelets were really low so they sent her to the ER and she was admitted to the hospital from 13Apr2021-16Apr2021 for 4 Days. Caller states she was admitted to the hospital a second time 23Apr-26Apr2021 for 4 days. The patient underwent lab tests and procedures which included antibody test: positive, platelet count: 5-7 low on 13Apr2021. Other Conditions tested Positive Antibody IVG Spike Protein and Nucleocapsid; states result from antibody test indicate that she has probably had Covid sometime in the past, only time would have been March 2020 when the pandemic started, she had symptoms that weren't reported as symptoms yet and she was traveling in India at the time. States she doesn't know what strain it may have been. States she tested for antibodies because she was interested to see how the steroid was affecting her response to vaccine. Patient was healthy before vaccination with no allergies. Outcome for the event immune thrombocytopenia, maternal exposure during breast feeding, off label use was unknown, event nosebleed was recovered, event blood count abnormal not recovered. Information on Lot/Batch has been requested.

Other Meds:

Current Illness:

ID: 1432898
Sex: F
Age:
State: NC

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

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

Symptoms: an uncontrollable head movement/functional movement disorder; stuttering really bad; complain of a twitch in her neck; a headache in the back of her head; This is a spontaneous report from a contactable consumer. A 16-year-old non-pregnant female patient received second dose of BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: solution for injection, Lot number: EW0176) via an unspecified route of administration on 04May2021 (age at vaccination 16-year-old) at single dose for covid-19 immunization. The patient's medical history and concomitant medications were not reported. Prior to the vaccination, the patient was not diagnosed with COVID-19. Since the vaccination, the patient had not been tested for COVID-19. The patient received first dose of BNT62B2 (PFIZER-BIONTECH COVID-19 VACCINE, formulation: solution for injection, Lot number: ER8731) via an unspecified route of administration on 13Apr2021 at single dose for covid-19 immunization. On 04May2021, patient stated that she had a headache in the back of her head after receiving their second dose of the vaccine. On 23May2021, patient complained of a twitch in her neck. On 24May2021, patient experienced stuttering really bad and developed an uncontrollable head movement. One physician indicated that it was a nervous tic while a neurologist indicated it was a functional movement disorder. However, she did not have these symptoms prior to the second dose. Adverse event resulted into Doctor or other healthcare professional office/clinic visit, Emergency room/department or urgent care and hospitalization. Patient was hospitalized for 2 days. The outcome of event was unknown. No follow-up attempts are needed. No further information is expected.

Other Meds:

Current Illness:

ID: 1432899
Sex: F
Age:
State: VA

Vax Date: 02/27/2021
Onset Date: 03/04/2021
Rec V Date: 06/29/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Shortness of breath/breathing problems; This is a spontaneous report from a contactable consumer or other healthcare professional (patient). A 81-years-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Formulation: Solution for injection, Lot Number: EN6198), via an unspecified route of administration on 27Feb2021 (at the age of 81-years-old) as DOSE 2, SINGLE for covid-19 immunisation. Medical history included heart and blood pressure, depression and asthma. Concomitant medication included metoprolol taken for heart and blood pressure from Jan2021 and ongoing, escitalopram taken for depression, start and stop date were not reported and medication for asthma.(allergy drug for asthma). Historical vaccine included bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, Formulation: Solution for injection, Lot Number: EM9810), via an unspecified route of administration on 06Feb2021 as DOSE 1, SINGLE for covid-19 immunisation. On 04Mar2021 the patient began to experience shortness of breath/breathing problems. On 06Mar2021 she was seen in the emergency department and evaluated for her shortness of breath. On an unknown date in Mar2021 she underwent computerised tomogram (CT) of her lungs which resulted normal (found nothing wrong). She received montelukast 10mg as treatment for the event. Stated that she began experiencing shortness of breath on 04Mar2021, she thought it was just normal so she did not do anything, states it continued and on Saturday morning, 06Mar2021 she went to the emergency room. On an unknown date in Mar2021 they did all the tests, CT of her lungs and everything and they found nothing wrong. She followed up with her family doctor who told her it was not an allergic reaction to the vaccine because if she was going to have one it would have been closer to when she got the vaccine. States she was then started on an antidepressant and an allergy drug for asthma. Clarifies she began escitalopram 5mg, and a medication for asthma, Montelukast, 10mg at night time for breathing to take at night, clarified this was all back in Mar2021. Caller stated she had been on medication since then, and it helped some. She wanted to know have other people had this problem from taking the vaccine, have they reported shortness of breath after the vaccine. She stated tomorrow she was going to the cardiologist. At the time of report, outcome of the event was not resolved.

Other Meds: METOPROLOL; ESCITALOPRAM

Current Illness:

Date Died:

ID: 1432900
Sex: U
Age:
State: MI

Vax Date:
Onset Date:
Rec V Date: 06/29/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Pyrexia, White blood cell count decreased

Symptoms: and have a question about a death being reported as possible link to COVID-19 vaccine; This is a spontaneous report from a contactable consumer. An unspecified age and gender patient received an unspecified dose of BNT162B2 via an unspecified route of administration on an unspecified date for COVID-19 immunization. Medical history and concomitant medication were not reported. On an unknown date, the patient experienced death and it was been reported as possible link to COVID-19 vaccine. The reporter stated that was reported a teen dead several days after gotten a vaccine. Since only Pfizer vaccine is available to teens and reporter wanted to know whether have a statement about this. The CDC was investigated any potential link. The outcome of event was fatal. Information on the lot/batch number has been requested.; Reported Cause(s) of Death: and have a question about a death being reported as possible link to COVID-19 vaccine

Other Meds:

Current Illness:

ID: 1432902
Sex: F
Age: 51
State: MO

Vax Date: 06/28/2021
Onset Date: 06/28/2021
Rec V Date: 06/29/2021
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: Systemic: pt indicated that has numbness in fingers/hand/arm-Medium

Other Meds:

Current Illness:

ID: 1432903
Sex: M
Age: 31
State: MD

Vax Date: 05/07/2021
Onset Date: 05/17/2021
Rec V Date: 06/29/2021
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: Abdominal pain, Chills, Sleep disorder

Symptoms: The patient is a 31 year old kidney transplant recipient who had been in his usual state of health and feeling well over the past months. On May 7, he received the first dose of COVID vaccine and experienced intense myalgias at that time. He recovered, but then around May 17 noted the onset of pain in the R thigh and lower R back and subsequently developed a vesicular rash in this area. He saw his primary care physician who prescribed gabapentin. However his pain worsened and the rash extended and he presented for admission. He was diagnosed with disseminated zoster, was hospitalized from 5/24/21 - 5/29/21 and was treated with IV acyclovir followed by oral valacyclovir.

Other Meds: Prednisone, tacrolimus, mycophenolate, amlodipine, atenolol, lisinopril, pantoprazole

Current Illness: History of kidney transplant in 2016, on stable immunosuppression

ID: 1432904
Sex: M
Age: 33
State: NM

Vax Date: 06/20/2021
Onset Date: 06/20/2021
Rec V Date: 06/29/2021
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:

Symptom List: Diarrhoea, Nasal congestion

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

Other Meds:

Current Illness:

ID: 1432905
Sex: M
Age: 62
State: NY

Vax Date: 04/15/2021
Onset Date: 06/11/2021
Rec V Date: 06/29/2021
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: 2 months later I had two insect bites and the second day I had a severe case of hives (I have never had hives before). This lead to anaphylactic shock resulting in low blood pressure and passing out. EMTs administered saline/epinephrine/steroid. Currently Doing follow up for allergies. Stopped taking lisinopril.

Other Meds: Lisinopril - hydrochlorothiazide 10mg-12.5 mg Rosuvastatin 5mg Aspirin 81mg

Current Illness: None

ID: 1432906
Sex: F
Age: 57
State:

Vax Date: 06/03/2021
Onset Date: 06/14/2021
Rec V Date: 06/29/2021
Hospital: Y

Vax Type: COVID19
Manufacturer: MODERNA
Vax Name: COVID19 (COVID19 (MODERNA))
Lot: 039k20a
Dose Series: 1
Vax Route: SYR
Vax Site: RA

Lab Data:

Allergies:

Symptom List: Rash, Urticaria

Symptoms: I21.4 - NSTEMI (non-ST elevated myocardial infarction)

Other Meds:

Current Illness:

ID: 1432907
Sex: F
Age: 26
State: NY

Vax Date: 06/18/2021
Onset Date: 06/18/2021
Rec V Date: 06/29/2021
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: Blood pressure decreased, Chest pain, Chills, Confusional state, Decreased appetite

Symptoms: Error: Wrong Dose of Vaccine - Too Low-

Other Meds:

Current Illness:

ID: 1432908
Sex: F
Age: 34
State: CT

Vax Date: 06/28/2021
Onset Date: 06/28/2021
Rec V Date: 06/29/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Site: Redness at Injection Site-Mild, Systemic: Fainting / Unresponsive-Mild, Systemic: Fever-Mild, Systemic: Flushed / Sweating-Mild

Other Meds:

Current Illness:

ID: 1432909
Sex: M
Age: 60
State:

Vax Date: 02/11/2021
Onset Date: 05/23/2021
Rec V Date: 06/29/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: I21.4 - Non-ST elevation (NSTEMI) myocardial infarction

Other Meds:

Current Illness:

ID: 1432910
Sex: F
Age: 60
State: NC

Vax Date: 06/24/2021
Onset Date: 06/25/2021
Rec V Date: 06/29/2021
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: Site: Pain at Injection Site-Medium, Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Severe, Systemic: Headache-Severe, Systemic: Nausea-Severe, Additional Details: Patient reports that the symptoms started the morning after she received the vaccine. She slept part of the day but felt very lightheaded and was throwing up a lot, so she called an ambulance and was treated with IV fluids in the ED. She reports a full recovery as of today, 6/28/2021.

Other Meds:

Current Illness:

ID: 1432911
Sex: M
Age: 71
State:

Vax Date: 04/10/2021
Onset Date: 05/12/2021
Rec V Date: 06/29/2021
Hospital: Y

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: I21.4 - NSTEMI (non-ST elevated myocardial infarction) (CMS/HCC)

Other Meds:

Current Illness:

ID: 1432912
Sex: F
Age: 51
State: IN

Vax Date: 06/17/2021
Onset Date: 06/18/2021
Rec V Date: 06/29/2021
Hospital:

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

Lab Data:

Allergies: Iodine

Symptom List: Ear pain, Hypoaesthesia

Symptoms: I woke up at 6am the morning after receiving the vaccination. I was awake for about 2 and a half hours when I began feeling exhausted, nauseated, had an intense headache and cold chills. I went back to bed at 8:30am. I covered myself with 2 quilts and my bathrobe due to chills. I had cold sweats, a fever, nausea, diarrhea, body pain, a migraine, lucid dreams, and hallucinations for the next 36 hours. At around 36 hours I still had a migraine, muscle and body pain, the other symptoms had waned. My last three symptoms lasted for about 4 days and slowly lessened over time.

Other Meds: none

Current Illness: none

ID: 1432913
Sex: M
Age: 22
State: IL

Vax Date: 06/25/2021
Onset Date: 06/28/2021
Rec V Date: 06/29/2021
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: Systemic: Dizziness / Lightheadness-Mild, Systemic: Vomiting-Mild

Other Meds:

Current Illness:

ID: 1432914
Sex: F
Age: 66
State:

Vax Date: 04/21/2021
Onset Date: 05/11/2021
Rec V Date: 06/29/2021
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:

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

Symptoms: N17.9 - Acute kidney failure, unspecified E87.1 - Hypo-osmolality and hyponatremia NASAL CONGESTION COUGH VOMITING WEAKNESS - GENERALIZED

Other Meds:

Current Illness:

ID: 1432916
Sex: M
Age: 20
State: NY

Vax Date: 06/28/2021
Onset Date: 06/28/2021
Rec V Date: 06/29/2021
Hospital:

Vax Type: COVID19
Manufacturer: PFIZER\BIONTECH
Vax Name: COVID19 (COVID19 (PFIZER-BIONTECH))
Lot: Eh9899
Dose Series: 1
Vax Route: IM
Vax Site: LA

Lab Data:

Allergies:

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

Symptoms: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

Other Meds:

Current Illness:

ID: 1432917
Sex: F
Age: 74
State:

Vax Date: 03/12/2021
Onset Date: 05/17/2021
Rec V Date: 06/29/2021
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:

Symptom List: Unevaluable event

Symptoms: NSTEMI (non-ST elevated myocardial infarction)

Other Meds:

Current Illness:

ID: 1432918
Sex: F
Age: 12
State: TX

Vax Date: 06/28/2021
Onset Date: 06/28/2021
Rec V Date: 06/29/2021
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: Systemic: Allergic: Anaphylaxis-Severe, Systemic: Allergic: Difficulty Breathing-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Medium, Systemic: Fainting / Unresponsive-Medium

Other Meds:

Current Illness:

ID: 1432919
Sex: F
Age: 66
State:

Vax Date: 03/19/2021
Onset Date: 05/21/2021
Rec V Date: 06/29/2021
Hospital: Y

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: I21.4 - NSTEMI (non-ST elevated myocardial infarction)

Other Meds:

Current Illness:

ID: 1432920
Sex: F
Age: 49
State: CT

Vax Date: 04/15/2021
Onset Date: 04/15/2021
Rec V Date: 06/29/2021
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: Site: Bruising at Injection Site-Severe, Site: Pain at Injection Site-Severe, Systemic: Joint Pain-Medium, Additional Details: patient has came to pharmacy multiple times to report inability to move arm, which she thinks is due to the vaccine. All three times she spoke with a pharmacist and wanted to let the nurse who gave the shot that she injected too low on her arm. However, she now complains of bursitis and injection too high on the arm. She says she cant move her arm and her reporting changes/inconsisten with each conversation. She spoke to providers, who she claims say its due to vaccine. Story changes every time.

Other Meds:

Current Illness:

ID: 1432921
Sex: M
Age: 52
State:

Vax Date: 05/19/2021
Onset Date: 06/15/2021
Rec V Date: 06/29/2021
Hospital: Y

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

Lab Data:

Allergies:

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

Symptoms: NSTEMI (non-ST elevated myocardial infarction).

Other Meds:

Current Illness:

ID: 1432922
Sex: F
Age: 12
State: TX

Vax Date: 06/28/2021
Onset Date: 06/28/2021
Rec V Date: 06/29/2021
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: Systemic: Allergic: Anaphylaxis-Severe, Systemic: Allergic: Difficulty Breathing-Severe, Systemic: Dizziness / Lightheadness-Severe, Systemic: Fainting / Unresponsive-Medium

Other Meds:

Current Illness:

ID: 1432923
Sex: F
Age: 60
State: MO

Vax Date: 06/28/2021
Onset Date: 06/28/2021
Rec V Date: 06/29/2021
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: Error: Incorrect Reconstitution-

Other Meds:

Current Illness:

ID: 1432924
Sex: M
Age: 34
State: FL

Vax Date: 06/28/2021
Onset Date: 06/28/2021
Rec V Date: 06/29/2021
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: Systemic: Chills-Medium, Systemic: Dizziness / Lightheadness-Severe, Systemic: Exhaustion / Lethargy-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Shakiness-Medium, Systemic: Weakness-Medium, Additional Details: Pt fainted about 4 minutes after receiving the first covid vaccine, pt was warm, sweating. He was light headed and dizzy for about 10 minutes, his girl friend came to pick him up.

Other Meds:

Current Illness:

ID: 1432925
Sex: M
Age: 72
State: PA

Vax Date: 03/26/2021
Onset Date: 05/15/2021
Rec V Date: 06/29/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Nausea

Symptoms: Red blotches on both arms at bicep and minor blotches at groin (itchy) lasted approximately 1 day. This occurred twice in a period of 3 weeks. Severe swelling of the right hand lasted approximately 3 days. Severe swelling of left-side of face. Lasted approximately 3 days. Severe swelling of entire face including lips. Lasted approximately 3 days. The doctor prescribed a Medrol Dose Pak 3 times to correct the 3 events of swelling.

Other Meds: Ranexa, Xanax, Neurontin, Norvasc, Lipitor, Vascepa, Cozaar, Coreg, Pepcid, Plavix, Flonase, Trelegy Ellipta, Tylenol PM

Current Illness:

ID: 1432926
Sex: F
Age: 14
State: FL

Vax Date: 06/28/2021
Onset Date: 06/28/2021
Rec V Date: 06/29/2021
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: Site: Pain at Injection Site-Mild, Systemic: Dizziness / Lightheadness-Mild, Additional Details: NO EMS needed, pt felt on her head

Other Meds:

Current Illness:

ID: 1432927
Sex: F
Age: 14
State: CA

Vax Date: 06/28/2021
Onset Date: 06/28/2021
Rec V Date: 06/29/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Site: Bruising at Injection Site-Mild, Site: Itching at Injection Site-Mild, Site: Pain at Injection Site-Mild, Site: Redness at Injection Site-Mild, Site: Swelling at Injection Site-Mild, Systemic: Allergic: Anaphylaxis-Medium, Systemic: Allergic: Difficulty Breathing-Severe, Systemic: Allergic: Difficulty Swallowing, Throat Tightness-Medium, Systemic: Allergic: Swelling of Face / Eyes / Mouth / Tongue-Mild, Systemic: Chest Tightness / Heaviness / Pain-Medium, Systemic: Confusion-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Hyperventilation-Medium, Systemic: Shakiness-Medium, Systemic: Tachycardia-Medium, Systemic: Visual Changes/Disturbances-Medium, Systemic: Weakness-Medium

Other Meds:

Current Illness:

ID: 1432928
Sex: F
Age: 49
State: NY

Vax Date: 06/22/2021
Onset Date: 06/23/2021
Rec V Date: 06/29/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Systemic: Delayed/Unusual menstrual cycle-Medium, Additional Details: Patient discribes no mentrual activity except for one large dispersion of blood then nothing after that

Other Meds:

Current Illness:

ID: 1432929
Sex: M
Age: 30
State: FL

Vax Date: 06/28/2021
Onset Date: 06/28/2021
Rec V Date: 06/29/2021
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: Tremor

Symptoms: Systemic: Fainting / Unresponsive-Mild, Additional Details: Patient fainted on the floor gave him crackers and gatorade fell better called 911 but he refused to go to the hospital. patinet was ok and responsive when he left. He fainted for a few seconds and care was given immediately. patient had no pain or swelling

Other Meds:

Current Illness:

ID: 1432930
Sex: F
Age: 21
State: FL

Vax Date: 06/26/2021
Onset Date: 06/26/2021
Rec V Date: 06/29/2021
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: Erythema, Pruritus

Symptoms: Systemic: Fainting / Unresponsive-Mild, Additional Details: Patient stated that she always faints when she gets the vaccine however she did not mention that before she was given the vaccine. She was with her mom. she was given gatorate/ crackers and felt better. she was reponsive however it is a common side effect that she gets when she gets blood drawn or vaccines. the mom stated that she will always have to be with her when she gets vaccinated. Patinet did not want us to call 911. she was ok before she left.

Other Meds:

Current Illness:

ID: 1432931
Sex: F
Age: 31
State: FL

Vax Date: 06/28/2021
Onset Date: 06/28/2021
Rec V Date: 06/29/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Systemic: Fainting / Unresponsive-Mild, Systemic: Shakiness-Mild

Other Meds:

Current Illness:

ID: 1432932
Sex: F
Age: 39
State: NY

Vax Date: 04/14/2021
Onset Date: 04/15/2021
Rec V Date: 06/29/2021
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: Seasonal and household allergies, penicillin and sulfa allergies.

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

Symptoms: Initial onset w 1st dosage- fever headache body ache and dizziness. Second dosage on 4/15 past standard side effects led to massive hair loss, bleeding and clotting issues, lasting and persistent headache, extreme fatigue still two months out, bouts of dizziness, menstrual pain and excessive bleeding.

Other Meds:

Current Illness: None

ID: 1432933
Sex: F
Age: 45
State: IN

Vax Date: 06/09/2021
Onset Date: 06/09/2021
Rec V Date: 06/29/2021
Hospital:

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

Lab Data:

Allergies:

Symptom List: Asthenia, Chills, Headache, Myalgia

Symptoms: Systemic: Flushed / Sweating-Mild, Additional Details: She said probably triggered are anxiety

Other Meds:

Current Illness:

ID: 1432934
Sex: F
Age: 27
State: NY

Vax Date: 06/28/2021
Onset Date: 06/28/2021
Rec V Date: 06/29/2021
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: Systemic: Dizziness Lightheadness-Medium, Additional Details: Patient received vaccine. After a minute or 2 , patient got dizzy and fell foward, cut his forehead on his sunglasses that were on his forehead when he fell. Called 911, police came and so did EMT. pateint talked to police and EMT. Patient walked out of store without assistance. Patient refused EMT ride to emergency room. His girlfriend and mother were taking him to urgent care with his car.

Other Meds:

Current Illness:

ID: 1432935
Sex: F
Age: 19
State: CT

Vax Date: 06/27/2021
Onset Date: 06/28/2021
Rec V Date: 06/29/2021
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: soy, shellfish, raw fruits, raw vegetables, peanuts, tree nuts, gold

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

Symptoms: after receiving the shot, that night I started to have vaginal bleeding. My period ended well over a week ago and it?s strictly black blood. Also, The morning of Monday, June 28, 2021, one day after the vaccine from 6 AM until 10 AM I threw up 10 times. And today Tuesday, June 29 I am still bleeding black blood vaginally and now have cramps in my lower abdomen

Other Meds: birth control (vienva) at 8:30 pm following the vaccine

Current Illness: none

ID: 1432936
Sex: M
Age: 14
State: CA

Vax Date: 06/26/2021
Onset Date: 06/27/2021
Rec V Date: 06/29/2021
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: Pain in extremity

Symptoms: Systemic: "color of red" was observed after using the restoom-Mild

Other Meds:

Current Illness:

ID: 1432937
Sex: F
Age: 21
State: TX

Vax Date: 06/07/2021
Onset Date: 06/07/2021
Rec V Date: 06/29/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Systemic: Chest Tightness / Heaviness / Pain-Mild, Additional Details: Night after 1st shot, patient had some chest pain/pressure on/off that lasted for 3 days. Very mild & no difficulty breathing. Patient had COVID in February & had chest tightness/pressure during that infection. Patient didn't require any treatment & recovered on her own.

Other Meds:

Current Illness:

ID: 1432938
Sex: M
Age: 67
State: MA

Vax Date: 03/30/2021
Onset Date: 04/08/2021
Rec V Date: 06/29/2021
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: Peanuts, Shellfish, Eggs, Soy, fish

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

Symptoms: Have had a significant change to the way my long standing allergies manifest themselves. Since early childhood they would manifest with congestion and wheezing - typical asthmatic reaction to allergies. Now I am getting rashes and most importantly watery eyes. I have never had watery eyes except in the most severe allergenic reactions like from peanuts or shellfish (anaphylactic shock) - and only for very short periods. Now I am getting watery eyes. from even minor food and pollen allergenic reactions. While not with the frequency of the watery eyes I am also getting rashes. The watery eyes are to the point when I wake up in the morning my eyes are glued shut. I never have had these reactions before. Note: I waited several months to report this because I was hoping it was random events - the events are not random and nothing I have experienced in my 67 years before the vaccination. With the long term health problems I have I am keenly aware of my allergenic reactions. I have always had them but never before with watery eyes and occasional rashes.

Other Meds: Oxymetazoline HCL .05% (Afrin) Aspirin (Bayer Low Dose) 81 MG Atorvastatin Calcium (Atorvastatin Calcium) 20 MG Bupropion Ext-Release (Budeprion XL) 300 MG Diltiazem ER 180 MG Diphenhydramine* (Benadryl*) 25 MG Dofetilide 500 MG Fluticasone

Current Illness: Asthma, AFID, ADHD

ID: 1432939
Sex: F
Age: 20
State: GA

Vax Date: 06/28/2021
Onset Date: 06/28/2021
Rec V Date: 06/29/2021
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: Systemic: Allergic: Difficulty Breathing-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Tachycardia-Medium

Other Meds:

Current Illness:

ID: 1432941
Sex: F
Age: 59
State: SC

Vax Date: 03/31/2021
Onset Date: 06/19/2021
Rec V Date: 06/29/2021
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: None known

Symptom List: Vomiting

Symptoms: Quickly after receiving the second dose I experienced numbness in my right big toe. That went on for at least a couple weeks. Then this month I experienced pain around my upper right leg and hip area and thought initially that it was bursitis or arthritis in my hip. However, a rash then broke out and I was diagnosed Sunday with shingles.I have read extensively that incidence of shingles have increased following the COVID-19 vaccine especially those with autoimmune issues like me where I have Raynauds.

Other Meds: Low dose estrogen

Current Illness: None

ID: 1432942
Sex: F
Age: 40
State: RI

Vax Date: 06/28/2021
Onset Date: 06/28/2021
Rec V Date: 06/29/2021
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:

Symptom List: Headache, Limb discomfort, Nasal congestion

Symptoms: Site: Itching at Injection Site-Mild, Site: Pain at Injection Site-Mild, Systemic: Allergic: Itch (specify: facial area, extremeties)-Medium, Systemic: Chills-Mild, Systemic: runny nose and eyes-Medium, Systemic: Numbness (specify: facial area, extremities)-Medium, Systemic: Tingling (specify: facial area, extemities)-Medium, Additional Details: onset of adverse effects started about 30 minutes after vaccination

Other Meds:

Current Illness:

ID: 1432943
Sex: F
Age: 67
State: MA

Vax Date: 06/28/2021
Onset Date: 06/28/2021
Rec V Date: 06/29/2021
Hospital:

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

Lab Data:

Allergies:

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

Symptoms: Error: Wrong Vaccine Formulation (ex. different manufact. initial and booster)-

Other Meds:

Current Illness:

ID: 1432944
Sex: F
Age: 44
State: GA

Vax Date: 06/26/2021
Onset Date: 06/28/2021
Rec V Date: 06/29/2021
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: Feelings of having a fast-beating or fluttering heart, hives, and swelling

Other Meds: Amlodipine/Valsartan 5-160mg

Current Illness:

ID: 1432946
Sex: F
Age: 38
State: PA

Vax Date: 05/27/2021
Onset Date: 05/28/2021
Rec V Date: 06/29/2021
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: Upon waking up the next morning, the patient felt feverish. After taking several steps, a sudden bout of nauseousness came over them followed by lightheadedness, vision going black, and the patient fainting. This lightheadedness and fainting occurred again a few minutes later.

Other Meds: Vitamin D + K3, magnesium, vitamin B complex, zinc

Current Illness: Lower back/hip pain

ID: 1432947
Sex: M
Age: 15
State: GA

Vax Date: 06/28/2021
Onset Date: 06/28/2021
Rec V Date: 06/29/2021
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: Systemic: Dizziness / Lightheadness-Medium, Systemic: Exhaustion / Lethargy-Medium, Systemic: Fainting / Unresponsive-Medium, Systemic: Flushed / Sweating-Medium, Systemic: Hypotension-Medium, Additional Details: Patient fainted after first dose of Pfizer. Called ambulance and they came to check him out. His blood pressure was very low do they took him to the ER.

Other Meds:

Current Illness:

Total 2021 VAERS Injuries: 636,615

Page last modified: 03 October 2021 5:28pm